Public Health
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what we as a society do collectively to ensure the conditions in which people healthy
def by Institute of Medicine
public health focuses on community based promotion and prevention
Core functions
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Assessment - systematically collect data on the population monitoring the populations health status, making info
avails ab the health of the community ; assessing the needs of the community
Policy development - need to provide leadership in developing policies that support health of populations; seeks to
build constituencies
Assurance - insuring that essential community oriented health services are available where and when needed –
making sure that essential community oriented health services are available
Community Health improvement Process (CHIP): method for improving health of the population on a community basis
Social determinants of health- factors that influence the health of a community, population and or individual
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Housing: secure/ appropriate
Environment: home/ work/ pollution/ air quality/ air at work
Access to healthy foods
Economics: local job availability/ bsuinesses
Social support: family/ neighbors/ local neighbor reosurces
Access to health care services
Public Health Nursing:
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community oriented
population focused
strategies that are community based, combination of pplt ocused sommunity oriented
direct care clinilca staregies
e,phasizes on freeliving pplts
Community health nursing- population level strategies aimed at promoting, preserving and maintaining the health of
populations through the delivery of personal health care services to individuals, families and groups in an effort to improve the
health of community as a whole
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applies to all nurses practicing in the community
provides direct personal services
could be in pts home or clinical environment
Community based nursing- focuses on illness care of induvial and families across the life span; aim is to manage acute and
chronic health conditions in community and the practice is family centered illness care
England’s Elizabeth Poor Law: guanteed poor, blind, and lame indivuals, even those witghot families
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strongly influced clonolian ides of social welfare and care of the sick
Early Colonial PH efforts
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collection of vital statics
impivemnt to sanitation systems
control any commercial dieases introduced throughout sea ports
colonist aclked a mechanic, to ensure public health efforts would be suppored and enforced
After American Rvolution
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threat ot dieasea, especially yellow fever, brought public support for establishing gov spread or official boards of
health
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PHS: still most important federal publc helath agency today
Shattuck Report: report caused for major innovations, establishment of a state helath dfept and local helath board
in every town
Women’s Board OF the NYC Mission: visit sick poor perosns
Nurisng Council on National Defense: allcaoiton of th enaitonal nuriang organizations that planned and
coornidated activities for the war effort
Cadet Nurses Corp: through the infouence anfd leadership of US representivites, France Bolton of HOio substaional
findings was provided bu the Bolton Act of 1943 to establish he cadets
o Leading to increase dnerollemt in nursing school
Emergency Maternity and Infant Act: provided fundind for mediaca;, hotpiytal nursing care for wives and bbies of
servicemen
o Layered to meetthe hight standards of US childrens beaure, thus increaidng wuality of care for all for helth
services to seek EMICA funds
Multilateral Organizations: major orgnaizations, part of the united nations
Bilateal organization: philanthropic organizations, represented by such angecnies as …
EBP- includes the best available evidence from a variety of sources, including research studies, evidence from nursing
experience and expertise and evidence from community leaders
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Barries to EBP: lack of resources (time, funding, equipment, knowledge); reluctance to accept findings ( findings may
not line up w beliefs); resistance to questioning of long established practices; client non compliance w recommend
interventions
Randomized control health - RCT – generally ranks the highest
Culture Definitions - 11 questions
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Competence – includes adoption of culturally congruent behaviors – acknowledging the fundamental diff in the
ways clients and families respond to illness and tx ,, consider how the nurses own personal beliefs and decisions are
reflective of his or her own culture “tell me about your health care beliefs”
Culturally competence in nursing
o Cultural awareness- requires self examination and in depth examination of ones own beliefs and values as
they influence behavior
o Cultural knowledge; cultural encounters; cultural desire
o Cultural skill- effective integration of cultural knowledge and awareness to meet needs – makes sure
nonverbal communication techniques takes into consideration the clients use of body language and space
– involves the provision of care that is beneficial safe and satisfying to client
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Illict from pts their perception of the helath problem, discuss tx protocol, negotiate acceptable
actions, select intervetnons that incorporate alternative tx plan and colobrate w all stake holders
Barriers to developing cultural competence
o Shock – feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to
understand or effectively adapt to another cultural group that differs in practices, values and beliefs
o Racism - form of prejudice that occurs through the exercise of power by individuals and institutions against
people who are judged to be inferior
o Stereotyping- occurs when soemone attributes certain beliefs and behaviors ab a group to an individual;
overgeneralization
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Block willingness of a person to open and learn about specific indicuals or groupsage/ gender/
culture
o Prejudice: negative feeling
o Cultural blindness- tendency to ignore differences between cultures and to act as they do not existtreating everyone the same
Culturally competent nursing interventions
o Cultural accommodation- involves aspects of patients religious beliefs and or folk practices in the
traditional health care system- nurse assists, supports facilitaes or enables clients in their use of cultural
practices to achieve satisfying health care outcome
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Willingin to work w a pt to integrate pts helath practices
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Cultural repatterning- nurse works w client to help reorder, change or modify cultural practices when their
practice is harmful to them
o Cultural preservation- nurse supports and facilitates the use of scientifically supported cultural practices
from a persons culture along w the biomedical health care system
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Ex: helping a pt contue cultura; traditions while in the hospital
o Cultural brokering – nurse acts as a go between or advoates between groups of people of different groups
of ppl of diff cultural backgrounds to reduce conflict
Race- biological variation w/in a population
Cultural imposition: nurses impose their races onto pt while ignoring their belifs
Culture determinats
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How healthcare information is processed, recived, and
distributed
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How rights and protections are examined
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What is considered to be a helath prboelm
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How symptoms are concerns of the problem expressed
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Who prvides tx for the problem
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What type of tx should be given
Biological varriations
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Genetic physical mrkerse: skin colors, physical features.
Jair textuere
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Growth and development
Race
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Ethnicity
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Susceptibility to diease
Lab test findings
Same race may be different cultures
Shared feelings of peoplehood among a given group of
ondivuals relaytes to cultural factors
Nationality
Georgrpahic region
Culture
Ancestory
Beleifs
Traditions
Equally influenced by education, income, and cross
cultural exprenessness
History (9)
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Past, present (focus)- improvement in control of infections, diseases thorugh immunizations, sanitation led to
increase in life expectancy
o Early conlonal health efforts in US included – collection of vital statistics, improved sanitation and control
of communicable disease
o Stronger commitment to pop focused services – emergence of new or drug ressistant infectious disease ;
emphasis on overall healthcare needs rather than on acute treatment; threat of bioterrorism
o Late 1800s local health departments in urban areas were developed to target enviornmental hazards
associated with crowded living conditions and dirty streets
o National Organization for public health nursing- standardizing public health nursing education
o American Public health association- provides a forum for nurses to discuss their pubic health concerns
o Social security act- provison of funding to support employment and eduction
Important women and contributions to health care
o Elizabthe poor law of 1601- guaranteed medical care for poor, blind and lame individuals – similar to
medicaid – provided care for the disenfranchised
o Lilian wald- first public health nurse ,famous for creating public health nursing in US – introduced the
concept of school nursing to address the problem of school absenteesim- - provided and obtianed medical
treatment for absent students
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Established Henry street settlement
o Florence Nightingale – helped bring about community health nursing by improving the enviormental
conditons and nurisng care, using simple epidemology measures she documented a decreased mortality
rate to demonstrate the outcomes; contributed to the expansion of the role of nursing to include health
promotion practices, introduced professional nursing education
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Implemented principles of nursing (proper nutrition, rest, sanitation)
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Community oriented nursing began w organizations formed to meet urban healht care needs
o Mary breckenridge established the Frontier Nursing service – introduced the first nurse midwifery training
o Lystra Gretter- wrote first code of ethics
Public health – functions, purpose, services, core
US Department of health and human services (DHHS)- federal agency most responsible for improving the health of the
american people
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A part of executive branch
Agency most heavily involved with the health and welfare concerns of US citizens
Economics (8)
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Health Economics: concerced w how source resources affect health care industry
Public Health Economics: focusses on producing, distributing anf consuming goods/services as allcoatde to ublic
health and where limited public resources best be spendt to save lives or cause the most increase in wuality of life
Medicaid (financed by federal/state gov) - intended to improve access to health care for those that meet
qualifications – vary from state to state
Medicare (financed through taxes) – health insurance for anyone age 65 and older, to permanently disabled persons
and to persons with end stage renal disease
o A (hospital insurance)- covering hospital stay/care, some hospice, home care, some skilled nursing facility
o B (non institutional care insurance)- covers medical necessary services- outpatient care, diagnostics,
doctors services, mental health
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Paying your personal HCP
How provides in hospitals get paid, contracts, predetermined amount, reimbursement
o Select public health programs receive reimbursement for services as follows: through grants given by
federal government to states for prenatal/ child health; medicare/medicaid for home health nursing
homes, WIC
o Retrospective reimbursement- based on organization costs or charges- fees set after delivery of care
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Fees for delivery of healcare services in qn organization are set after services are delivered
o Charged method- reimbursement organzation of the basis of price set by organization for delivery of
services- price set by organization and billed- client pays what agency does not
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Basis of the price set by the organization for delivery of services
o Prospective reimbursement “payment” - third party establishes fee before offering services- requires pre
approval
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More recent method, 3rd party payer established the amount og money that will be payed for the
delivery of appropriate services before offering the service to the pt
o Paying hc practitioners
Fee for service – similar to retrospective, practioner determines cost fo service, delivers the
service, submits bill for service, and payer pays the bill
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Capitation- similar to prospective reim – 3rd party payer determines amount practioners will get
paid for a unit of care
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Nurses who dunction In certain capacities such as NP or midwives also prive primary care to the
pts, and recive reimbursement for their service
National Organization for public health nursing – sought to standardize public health nursing education to ensure
that nureses received more than hospital training, collaborated to secure health insurance reimbursement for
nursing services
Nurses working in hospice and home care settings need to be knowledgeable of health policy to receive payment for
the services provided
What does allocate means and how we allocate resources
o Allocating resources - the dominant needs of the populations the needs of the aggregate rather than a few
inidividuals
Organiszations
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WHO- provides services worldwide to promote health, cooperates w member countires in promoting health efforts,
coordinates collaborative activities between countries and disseminates information on biomedical research
o WHO policy statements- guides for in-country initiatives and priorities
CDC- serve as the national focus for development and application of measures to advance disease prevention and
control
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o Mission is to promote health and qulaity of life by preventing and controlling disease, injury and disabilty
Healthy people- best resource that provides a broad vision of the goals and objective of many health care
stakeholders in our nation and identifies the current national health policy fo the US
MGDS: developed to receive lower health conditions around the world and to estab;ish positive steps to improe long
conditions
o Goals: help w natural distaters and preoerdness
ACA: new law provide for a 4 tyoe of plan, Bronze, Silver, Gold, Platnium, and catrostrophic
o Persons at different levels of povertt will have reductions in out of pocket expenses bases on income uo to
400% poverty level, and may reuse tax credits and substances to assist w/ out of pocket epxenses
Public health agencies: plan for cost by annual budget
TriCARE: active military
Indian Health Services: native American and some military personnel
WHA: WHO’s policy making body
Enviorment (7) questions
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Enviornmenal heatlh is important to nurses bc chemical, biological and radiological materials are- often found in air,
water and products we use
Enviornemental Justice: refers to the disportportinate environmental exposure that poor ppl and ppl of color
experience in the US and elsewhere
Permitting- process by which the government places limits on the amount of pollution emitted into the air on water
Air quality – greatest single source of air pollution is US is from motor vehicles
Pollution sources:
o Point source (of air pollution): point sources of pollution are identifiable sources of air- a single place from
which pollution is released - (a smoke stack)
o Nonpoint source: more diffuse source ( animal waste from wildlife)
Enviornmental standard- an acceptable level of emissions or a maximum contaminant level allowed or maximum
contaminant level is allowed
Clean water act- environmental law that setas basic structur for regulating pollutants to US waters
Hazard Communication standards – requires employers to maintain a list of all hazardous chemicals that are used
on site
Enviormental Exposure
o Land and oils can remain contaminated after use and exposure to contamination
o Use of land, regulated by zoning laws
o Food: animlas given GH and antibiotics, humans consuming those chemicals
o Water: pubic water supplie must test water and provide results to the public
o EDA: exposure data by zip code
Toxicology- the study of the health effects associated with chemical exposures – basic science studies the poisonous
effects of chemicals
o Most chemicals cross placental abrriers abd can affect the fetus
o Chemical exposure can change DNA, changing gene epresion, which in turn can predict disease
(epigenetics)
Epidemiology- studies the incidence and prevalence of disease, helping nurses understand the strength of the
association between exposure and health effects
o Epidemiologic triangle- consists of an agent (chemical), host (community), and environment (air, water,
soil)
o Geographic Information system- allows public health nurse to apply the principles of epidemiology into
practice
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Ex: study of the realtionsip between air pollution and unnecessary vovts for vcardiovascualr and
pulmonary diagnosis
Nursing Process to Environmental Health
o Assessment: observationl skills, interview, web
o Planning: community policy/law, methods to faciliatate care nned for the pt
o Intervention: coordinate nures/ medical or actions to meet pt needs
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o Evaluation: exams criteria that ibclue immediate and long term resolution of pt as well as problem for pt
I- PREPARE- prompts clinicians to ask questions specific to environmental and work exposure
o I – investigate
o P – present work
o R- residence
o E- environmental concerns
o P- past work
o A- activities
o R- referrals and resources
o E- educate
Risk assessment: process to determine the probability of a health threat associated with an exposure – 4 phases
o Assess toxicology and epidemiologic data
o Has the chemical been released
o How much and by which route of entry of the chemical ?
o Risk assessment process
The precautionary principle- calls for action to reduce potentially toxic exposure to humans in light of data or other
indicators
Healthy people documents- propose a national strategy to improve significantly the health of Americans by preventing or
delaying the onset of major chronic illness, injuries and infectious disease
Goals from 2020 – builds on earlier versions to identify a national health agenda to
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attain quality, longer lives free of preventable diseases, disabilty, injurty and premature deaths,
achieving health equity, eliminating health disparities and improving health for all
Creating social and physical environments that promote good health for all
Promoting quality of life, healthy development and health behaviors across all life stages
Health policy – a set course of action to obtain a desired health outcome for an individual, family, group, community or
society
Policy: set course of action
Public policy: government actions affecting all
Health policy: set actions aimed specifically at healthy outcomes for the individual or group
Politics: influencing others to accept a policy
Law: established rules and privileges
WIC – Women, Infats and children: receives oversight from department of agricultrue (DOA)
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DOA: involved in health care primarily through administering the food and nutrition services - which oversees a
varity of food assistance activities
Levels of government responsibel for carrying out the five government health care functions of direct services, financing,
information, policy setting, and public protection are – federal, state and local
Public Health: This is a broad field of practice and the infrastructure supporting the health of a country, state, city, province, town, or community
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Solid hx of preventive improvements ( sanitation improvements)
Emphasis on
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Funding public services
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Population-based prevention 70%
Vision: helahty ppl in helathy communities
Mission: promote physical and mental helath / prevent diease, injury, and disability
Core Fucntions:
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Assessment: systemic relation of data on the population, montiroring helath status
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Policy Development: support and improve population helaht
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Assurance: insurance services abaviable where and when they’re needed
Primary Prevention: preventing development of dieases, perferbly w education
Secondary Prevention: early detection, screening and tx, stopping disease prevention
Tertiary Prevention: reducinf direct imoact, disability, death by managing disease
Public Health Nursing: aims to focus more on community population-based promotion and prevention
CHIP: method for improving health of the population on a community basis
The Community Guide: at community level for what prevention worls to propmote health
Community Helath Navigator: provides info on evidfecne based info
Core Compretencies of PH Prfofessionals: concoul set ip for CDC, set up skills desired for the broad practice of public health