Chapter 1:
 Millennium Development Goals/Combat
Malaria
 Causes of Poverty Stricken Countries
o Disparities in the global burden of
disease
 HIV, TB, Staph, MRSA,
Malaria, HTN, ETOH, obesity
o Inequitable distribution of worlds
resources
o Disability adjusted life year
 Indv. Lives in area of increase
malaria risks with no access
to meds
 Years of life lost d/t
premature mortality or time
lived in states of less than full
health
 Other facts from video…
o Climate Change-relationship of
patterns and disease and climate
changes
 Temp, floods, droughts, air
pollution, allergies,
population displacement
(hurricane
effects/evacuations)
o Who does it affect:
 Children, pregnant, elderly,
disabled, homeless,
Nurses Role as global healthcare providers
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Chapter 2:
Population Based Health
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September 2000, 189 representatives
endorsed plan called Millennium Declaration
o “a new vision for humanity”
o 8 goals that target specific areas
 Reduce poverty
 Reduce global inequities
(disparity)
 Promote health and social
welfare
o Goals reported by the UN
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower
women
4. Reduce child mortality
o Increase rates highest in sub-Saharan
Africa
5. Improve maternal health
o Access to prenatal care, skilled birth
attendants
6. Combat HIV/AIDS, malaria
o Presidents Emergency Program for
AIDS relief: our countries effort to
provide meds/treatment in 15
countries
o Most effective way to combat
malaria: insecticide treatment (bed
nets)
7. Ensure environmental sustainability
8. Develop a global partnership for
development
Address challenges associated with shortage
Promote global health equity through
leadership and policy development
Participate in international
exchange/collaboration
Advocate for strengthening nurses and
midwifery
Support and promote standards f/nurse
education
o Prepare nurses in all countries the
same level
Also called public health nursing
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Community Health Nursing Practice
 Healthy People 2020
o Declaration of Alma Alta
o 134 nations
o Health care for all by 2020
o Became US Dept of Health and
Human Service Plan for Healthy
2000, 2010, 2020
 Renew/update goals
every 10 years
Purpose of ACA
 Critical need for health care reform-5
main factors
o High rate of uninsured americans
<65 years old
o Unsustainable health care
spending
o Lack of emphasis on disease
prevention
o Poor health outcomes
o Health disparities
o
Chapter 3:
 Incidence
o Number of people who develop a
condition in a specific time
o Allows the estimation of risk
necessary to assess casual
association (relative risk)
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Mechanisms to deliver and pay for illness
care driving health care changes
Should focus on what can be done to make
our population healthy, rather than pay for
illness
Community health in 21st century must offer
integrated activities that focus on minimizing
threats to health, promote wellness and
focus on illness management
KNOWLEDGE BASED
Focus on prevention rather than illness
Expected to be familiar with scope and
standards of practice
ANA published scope and standards using
term public health nursing
o Practice of promoting and protecting
the health of populations using
knowledge from nursing, social and
public health sciences
New standards released in 2013 converge
o Economic, political and social factors
o Healthy People 2020
o Patient Protection and Affordable
Care Act (ACA)
Epidemiology
o Study of the distribution and
determinants of health related states
o “the study of what is upon people”
o Quantitative based on statistics
Steps in Epidemiology investigation
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o Prospective study required
Prevalence
o Total number of people in the
population who have a condition at a
given time
o Influenced by rate of new cases,
number of existing cases, new
treatments, deaths
o Period prevalence or point
prevalence
Reliability
o Yields same result even when
administered by different screeners
Validity
o Screening test must distinguish
correctly between those people who
have condition vs. those who do not
o Sensitivity and Specificity
o Sensitivity
 Ability of test to correctly
identify people who have the
disease
 High sensitivity = few false
negatives
o Specificity
 Ability of test to correctly
identify those who do not
have the disease
 High specificity = few false
postives
Independent variable
o Presumed “cause” or contributor to
variation
 Exposure to violence
contributed to partner
violence
Dependent variable
o Outcome or result
o Can change
Notifiable disease reports
o CDC reports data
o Criteria to determine if notifiable
 Ability to cause death
 Communicability of disease
o Surveillance is systemic collection of
data
o CDC weekly publication, Morbidity
o
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Critical analysis is required to gain
further insight into public and
community health issues
Levels of Prevention
o Primary
 Health promotion, such as
nutrition, hygiene, exercise
and environment protection
 Immunizations
 Less costly than treating
disease/condition
 EDUCATIION
o Secondary
 Early detection and
treatment
 May result in cure of disease,
prevention of disability and
confinement of spread of
disease
 Pap smear, breast self exam,
skin test for TB
o Tertiary
 After disease, limit disability
or rehabilitate or restore
people to their maximum
possible capacity
 Meals on wheels, physical
therapy, halfway house
Types of Health Data (US Census)
o Comprehensive source of health
related data
o Every 10 years surveyed
o Characteristics- age, race, sex,
employment, income, migration,
education
o Reliable source for denominators in
calculations
o Underrepresents low income
residents, minorities, transients
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o
and Mortality Report, valuable
resource for community health
practice
STD, TB, HIV, Hepatitis
Chapter 4:
Understand how neurotoxins affect health
Define Biomagnification
Understand human ecology
Interventions to decrease environmental
Influences on Health
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Human ecology
o Law of gravity
 Everything that goes up must
come down
 Everything is connected to
everything else, but some
things are connected more
tightly than others
 Everything has to go
somewhere
 Everything is constantly
changing
Biomagnification
o Accumulation of a pollutant greatly
exceeds the rate at which an
organism eliminates it
Other impt notes from videos:
 Deforestation: trees cut down, soil
erosion, increase air pollution, climate
change
 Desertification: land becomes dry, unable
to grow, climate change
 Global warming: Greenhouse effect,
increase in atmospheric pressure, carbon
dioxide from oil burned from cars
 UV light and ozone: refrigerator, AC,
aerosols; as ozone deplets UV lights get
through can cause cataracts, decrease
immune and cancer
 Climate change: increase in malaria or
gangue fever
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Neurotoxins
o Immediate or long term
o Harm selected tissues or entire
organism
o Most significant toxic substance
o Associated with environmental
factors
o Insecticides
 Manufactured for deliberate
release into environment
Decrease Environmental Influences on Health
o Primary
 Reduce/eliminate
environmental hazards
 Educate about sunscreen and
earplugs
 Become involved with
political actions
 Promote immunizations
o Secendary
 Monitor for signs of hazards
like blood lead levels
 Monitor for increased
asthma
 Treat and monitor asthma
and blood lead levels
o Tertiary
 Eliminate hazards to prevent
reexposure
 Remove asbestos, lead and
mold
 Manage long term effects in
communities such as extra
care costs associated with
mental retardation
 Participate in political
activities including strict
adherence to emission
regulation
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Chapter 5:
Define Justice and Ethics
Define Beneficence and Autonomy
Define Retributive Justice
Compare deontology and teleology
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Justice
o Fair distribution of rights and
resources
o Try to offer greatest benefit to
most people
Ethics
o Proposes what a person should
do
o Considers people as inherently
good
Beneficence
o Desire to act in best interest of
others
Autonomy
o Right to self determine own
decisions (advanced directive)
Retributive Justice
o Award and punishment
o Political power/control
o Distributive justice
o Allocation of resources
determined politically
o Provide transportation to polls
and assurance of improved living
if elected
Deontology
o Rule based, decisions made by
applying set of rules of good
conduct
o Examples: personal moral codes
and professional codes of ethics
(ANA), Code of Ethics for nurses
and American Public Health
Association
o Grounded in philosophy
(Immanuel Kant)
o “no person should be treated as
a means to an end”
Teleology
o Outcome based decision making
o Philosophy of John Stuart Mill
o Decisions are made on the basis
of greatest good for the greatest
number
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Chapter 6:
 Participatory Research
o Problem focused
o Context specific
o Active participants
 Each person or group
engaged in the process is
committed to improvement
through continuous
interaction among dialogue,
action, research, reflection
and evaluation
o Six core principles
 Participants determine
agenda
 Project should benefit
community
 Collaboration among HCP
and community
 Community members should
have access to ALL info
 Democratic process and
empower participation
 Members and researchers
should strive to achieve
mutual goals
CHN Empower Community
 Build effective partnerships through
community participation
 Caring for and supporting communities,
families, and individuals
Collaboration in Community Empowerment
Chapter 7:
 Assess for Cultural Awareness
o Cultural competency is evident when
all people are treated in ways that
respect their uniqueness and
preserve their dignity
o Understanding how cultural and
ethnic beliefs and practice influence
our daily lives
o Acknowledge and aware of one’s own
culture and willingness to explore
ones own feelings and biases
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Empowerment through Community
Rifkin approach
o Community participation is a social
process involving people from
specific geographic localities who
share common values in identifying
their needs
o 3 approaches
 Medical approach
 Curing disease and
controlled by medical
profession
 Health Services approach
 Mobilizes people to
take an active role in
the delivery of
services based on
modifying unhealthy
behaviors
 Community development
approach
 People are involved
in the decisionmaking process to
improve health
 Grassroots approachmembers of
community decide
what services are
provided
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Cultural Competence in the 21st Century
o Goals and objectives of Healthy
People 2020
o US Department of Health and Human
Services
 Health disparities
 Type of health difference or
disadvantage that adversely
affects groups of people
based on any characteristic
historically linked to bias and
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o
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Developing an awareness and
acceptance of cultural difference is
required as a first step in the process
of becoming culturally competent
Cultural Competent
o Awareness of, sensitivity to, and
knowledge of the meaning of culture
and its role in shaping human
behavior
o Ability to express an awareness of
own’s own culture, to recognize the
difference between oneself and
others and to adapt behaviors to
appreciate and accommodate those
dfferences
Chapter 8:
o Nightingale roles and influences
o Instrumental in Crimean war in
military hospitals
o Made handwashing and cleanliness
policy
o She believed in being part of the
process and a participant
o Lillian Wald
o Developed Henry Street in NYC for
immigrant to go for health care
o Public Health Nursing
o Margaret Sanger
o Birth control measures
o Affordable Care Act
o Largest change to America
o Put consumers in charge of their own
health care and to provide them with
the stability and flexibility needed to
make informed health care decisions
o Benefits include
 Fewer limits on coverage
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o
discrimination
o Healthy People 2000
 Reduce disparities
o Healthy People 2010
 Achieve health equity,
eliminate disparities and
improve health of all ages
o Healthy People 2020
 Continued growth of cultural
competence education and
implementation for
professional and significantly
improve access to quality
care and reduce disparities
Factors that influence decision making
o Prior learning
o Symptom significant
o Compatibility between philosophies
and sectors
o Evaluation of treatment outcome
o Folk
o Poplar
o Professional
Temporary Assistance for needy families
o Financial and medical assistance to
needy dependent children and
parents or relatives with whom they
live
o Ppl who are pregnant or have a child
< 19 yrs old, low or very low income,
underemployed, unemployed or
about to become unemployed
Medicare
o Health insurance program
o > 65 yrs, pple < 65 yrs with ESRD or
Lou Gerhig disease
Medicaid
o Health care, insurance assistance,
nursing home coverage
o Based on income and family size, low
income, pregnant women, child with
disability, responsible for children <
19 yrs, ppl with disabilities, and some
seniors > 65 yrs
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More affordable plans
Financial help for insurance
Medicaid expansion
Adult and children remain on
same plan until 26
Insurance provides coverage
for preventative service; child
visits, BP and cancer
screening, flu shots
Chapter 9:
o Purpose of CDC
o Electronically organizes health
information that can be accessed
o Topics include
 Prevalence of disease
 Updates for travelers
 Immunization information
o Fast Stats
o Disease information, vital statistics,
and health insurance facts
o Information accessed on Government
Websites
o US Census Bureau
 Community demographic
info
 Updated every 10 years
o State websites have health
information
 Vital statistics, mental health
services, housing assistance,
infectious disease activity
o City websites provide local info
o Larger cities, non profit, United Way
 Community health resources
Chapter 10:
o Prevention and Management of Disease
o Challenge; rapid proliferation of drug
resistant organisms and diseases
o
Institute of Medicine
o Blueprint for future of nursing
o 4 main points (Nurses should…)
 Practice to the full extent of
their education
 Achieve higher education
through seamless academic
progression
 Be full partners with
physicians in redesigning
health care
 Effective workforce planning
and policy making require
improved data gathering
o
URL
o
o
o
o
o
Uniform resource locator is the term
for an internet address and is shown
on your browser in the locator bar
Provides clues about the origin of the
website, whether commercial or
educational
Blog
o
Combination of two terms, web and
log
o Online diary offering chronological
sharing opportunities on a specific
subject
Hyperlink
o Word or phrase, icon or picture that
browser reads and uses to access
another resource
o You will know you accessed the link
when your cursor changes from a
pointer to a hand when it is moved
over the link
Epidemic
o Unexpected increase of an infectious
disease in a geographic area over an
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o
o
connected to ABX resistance
o Second contributor; new pathogens
and new disease
o Third contributor; challenge of
preventing and managing diseases
arises from the recent threat that
deadly pathogens will be used by
terrorists
Spectrum of Disease Occurrence
o Identifying and monitoring the
occurrence of new cases (incidence)
Community Planning for Disaster
Preparedness
o American Red Cross: nongovernment
agency that provides assistance to
humans affected by disaster
nationally and globally
o FEMA: federal agency now part of
DHS to support our citizens and first
responders to ensure that as a nation
we work together to build, sustain
and improve our capabilities to
prepare for, protect against, respond
to, recover from and mitigate all
hazards
o
o
o
o
extended period of time
o Defined relative to the infectious
agent and the history of the disease
in the are
Endemic
o Occur at a consistent, expected level
in a geographic area (STD, TB)
Chain of Transmission
o Infectious agent: organisms capable
of producing infection in a host
o Reservoirs: environment in which a
pathogen lives and multiplies; some
pathogens can be controlled by
eliminating
o Portals: agents are communicated
from the human host through a
portal of exit and invade through a
portal of entry
Passive immunity
o Temporary resistance that has been
donated to the host through
transfusion of plasma proteins,
immunoglobulins and antitoxins or
transplacentally from mother to
neonate
Active immunity
o Body produces its own antibodies
against an antigen either as a result
of infection with the pathogen or
introduction of the pathogen in a
vaccine
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