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Final Review

450 F23 Final Review
Chapters 1-4 - Introduction to Community Health
A. HP 2020 overarching goals → A society in which all people live long, healthy
1. Attain high-quality, longer lives free of preventable disease, disability,
injury, and premature death
2. Achieve health equity, eliminate disparities, and improve the health of all
3. Create social and physical environments that promote good health for all
4. Promote quality of life, healthy development and healthy behaviors across
all life stages
B. HP 2030 overarching goals
1. Attain healthy, thriving lives, and well-being free of preventable disease,
disability, injury, and premature death
2. Eliminate health disparities, achieve health equity, and attain health
literacy to improve the health and well-being of all
3. Create social, physical, and economic environments that promote
attaining the full potential for health and well-being for all
4. Promote healthy development, healthy behaviors, and well-being across
all life stages
5. Engage leadership, key constituents, and the public across multiple
sectors to take action and design policies that improve the health and
well-being of all
C. Core public health functions
1. Assessment → Regular collection, analysis, and information sharing
about health conditions risks, and resources in a community
a) Assess & monitor population health status, factors influencing
health, and community needs and assets
b) Investigate, diagnose, and address health problems and hazards
affecting the population
2. Policy development → Use of info gathered during assessment to
develop local and state health policies and to direct resources toward
those policies
a) Communicate effectively to inform/educate people about health,
influential factors, and how to improve it
450 F23 Final Review
b) Strength, support, and mobilize communities and partnerships to
improve health
c) Create, champion and implement policies, plans, and alws
d) Utilize legal and regulatory actions design to improve and protect
3. Assurance → Focuses on the availability of necessary health services
throughout the community; Includes maintaining ability of both public
health agencies and private providers to manage day-to-day operations
and the capacity to respond to critical situations and emergencies
a) Assure an effective system with equitable access
b) Build and support diverse skilled workforce
c) Improve/innovate
d) Build and maintain strong organizational infrastructure
D. Levels of prevention
1. Primary → Prevention of health problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals
a) General health promotion → Enhance resiliency
(1) Ex: Good nutrition, adequate shelter, regular exercise
b) Specific protection → Reduce/eliminate risk factors
(1) Ex: Immunization, seat belt use, water purification
2. Secondary → Early detection + prompt intervention during early disease
period; AFTER a problem has begun but BEFORE S/S appear; Targets
populations with risk factors
a) Ex: Mammography, BP screening, COVID testing, PSA tests,
dental exams
3. Tertiary → Experience disease/injury & focuses on limitation of disability
and rehabilitation
a) Ex: How to perform insulin injections, referral of pt with spinal cord
injury for OT/PT, support groups
E. Public Health Intervention Wheel
1. Population Based
2. Three levels of practice (community, systems, individual/family)
3. Identifies and defines 17 public health interventions
4. Framework for community and public health practices
450 F23 Final Review
F. Determinants of health
1. Biology → Genetic makeup, family hx, physical/mental health problems
2. Behaviors → Alcohol abuse, smoking, colon cancer in family = regular
screenings; Biology influences behavior
3. Social environment → Interactions/relationships with others, social
institutions, housing, safety, public transportation, availability of resources
4. Physical environment → Five senses
5. Policies & interventions → Policies against smoking, seatbelt/child
restraint laws, litter ordinances; Local, state, national levels ⇒
Transportation, Health and Human Services, Veterans’ Affairs, Housing,
Justice Dept
G. Models
1. The Health Belief Model → Explain behavior change and maintenance
a) Perceived susceptibility → Belief regarding chance of getting a
given condition
b) Perceived severity → Belief regarding the seriousness of a given
c) Perceived benefits → Belief regarding tangible/psychological costs
of advised action
d) Cues to action → Strategies or conditions in one’s environment
that activate readiness to take action
e) Self-efficacy → Confidence in one’s ability to take action
2. Milio’s Framework for Prevention → Upstream view = SOCIETY is
focus of change
a) Health deficits = Imbalance btwn population’s health needs and
health-sustaining resources
b) Personal/societal resources
3. Pender’s Health Promotion Model → Biopsychosocial factors
influencing health promotion activities; Threat is NOT a motivator
4. The Transtheoretical Model → Behavior change takes place over time
a) Precontemplation - No intention to take action toward behavior
change in next 6 mo; Lack of info regarding consequences; Not
b) Contemplation - Some intention; Weigh pros and cons
450 F23 Final Review
c) Preparation - Intends to take action within next month + taken
steps toward behavior change; PLAN of action
d) Action - Changed overt behavior for < 6 mo; Changed behavior
sufficiently to reduce risk of disease
e) Maintenance - Changed overt behavior for > 6 mo; Relapse
H. Relationship of risk to health and health promotion
1. Modifiable risk factors → Control over health actions
a) Smoking, sedentary/active lifestyle, type/amount of food eaten,
types of activities engaging in
2. Non-modifiable risk → Little to no control
a) Genetic makeup, gender, age, environmental exposure
Theoretical perspectives that address social, political, and environmental
determinants of population health
J. Upstream and Downstream thinking and intervention
Chapter 5 - Epidemiology
A. Epidemiology key terms → Beginning of chapter
B. Epidemiological Triangle
1. Data collected to determine factors that lead to disease
2. Natural history of disease
3. Web of causation
4. Ecosocial epidemiology
5. Wheel model
C. Calculation of rates
D. Establishing Causality of Disease
E. Sensitivity vs specificity
F. Epidemiological methods
1. Descriptive epidemiology
2. Analytic epidemiology
3. Observational studies
4. Cross-sectional studies
5. Retrospective studies
6. Prospective studies
7. Experimental studies
450 F23 Final Review
Chapter 6 - Community Assessment
A. Define “aggregate”
B. Data collection sources
1. Key informant data
2. Windshield survey
a) observations/questions
3. Socioeconomic conditions of the community
Chapter 7 - Community Health Planning, Implementation & Evaluation
A. Assessment
B. Identification of key informant
C. Health Planning model
1. Predisposing → Factors = Knowledge, attitudes, behaviors, beliefs and
values before intervention that affect willingness to change
2. Reinforcing → Factors = Positive or negative effects of adopting new
behavior (incl social support)
3. Enabling → Factors = Environment/community of an individual that
facilitates or presents obstacles to change
4. Constructs in
5. Ecosystem
6. Diagnosis and
7. Evaluation
8. 9. Policy
10. Regulating/Resourcing
11. Organizational
12. Constructs in
13. Educational and
14. Environmental
15. Development
E. Needs assessment
Chapter 8 - Community Health Education and Engagement
A. Health Promotion Model
B. Framework for developing health communication
450 F23 Final Review
1. Stage I
2. Stage II
3. Stage III
4. Stage IV
C. Health Literacy and assessment of literacy materials
1. Tips for effective teaching
Chapter 9 - Case Management
A. Purpose of case management
1. Disease-specific → Keep pt as healthy as possible and stable at home
2. Goals = Cost-effective care, Increased access to care, Improved patient
functioning, alternatives to institutionalization, coordinate services
3. Transitional care management = Decreasing hospital readmissions
B. Case manager roles and characteristics
1. Utilization review = Right care at the right time
2. Care coordination → Integrate fragmented healthcare and minimize
transition between hcp
C. Application of case management in community health
1. Chronic illness, children low income and using medicaid, elderly
2. Referrals → Pt diagnosis & numerous hospitalizations
Chapter 10 - Policy, Politics, Legislation and Community Health Nursing
A. Definitions
B. Federal legislation (Laws/Acts) → Table 10.3
C. Nurses: Coalitions, Lobbyists, and PACs.
1. Coalitions - Two or more groups join to maximize resources, increasing
influence and improving chances of achieving a common goal
a) Family issues & fluoridation of water supplies
b) Rehab programs
2. Lobbyists - Voluntarily/fee represents themselves, another individual, an
organization, or an entity before the legislature
a) Influence legislators; Persuasion
3. PACs - Political Action Committees → Promote election of candidates
believed to be sympathetic to their interests
Chapter 11 - The Health Care System
A. Key Terms
450 F23 Final Review
B. Quality Care → Degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with
current professional knowledge
C. Accreditation (AHRQ, NCQA, HEDIS)
1. Agency for Healthcare Research and Quality (AHRQ) → Main federal
organization working to improve the safety and quality of the healthcare
a) CAHPS → Helps purchasers of plans compare and contrast plans
+ allows informed consumers to select providers
2. National Committee for Quality Assurance (NCQA) → Oversees
accreditation programs + collects data for a widely used set of
performance measures ⇒ HEDIS
3. Health Plan Effectiveness Data and Information Set (HEDIS) →
Collects data on ~90% of healthcare plans to measure performance and
consumer satisfactions
a) Allows consumers + insurers to compare performance of health
plans and providers to regional/national benchmarks
D. Structure (and function) of the US Department of Health and Human
1. Reform, strengthen, and modernize the Nation’s healthcare system
2. Protect the health of Americans where they live, learn, work, and play
3. Strengthen the economic and social well-being of Americans across the
4. Foster sound, sustained advances in the sciences
5. Promote effective and efficient management and stewardship
E. Telehealth
Chapter 12 - Economics of Health Care
A. Terminology used in healthcare financing → Box 12.1
B. Government grants → National = U.S. Department of Health and Human
Services (HHS)
Chapter 13 - Cultural Diversity and Community Health Nursing
A. Transcultural nursing → Understanding similarities between nursing and
1. Leininger’s theory of culture care diversity and universality
450 F23 Final Review
a) Culture care preservation and maintenance
b) Culture care accommodation & negotiation
c) Culture care repatterning and restructuring
2. Culture universal → Commonalities of values, norms of behaviors, and
life patterns that are similarly held among cultures about human behavior
and lifestyles
Chapter 14 - Environmental Health
A. Key Terms
Chapter 15 - Health in the Global Community
A. Declaration of Alma-Ata → WHO’s statement of beliefs, goals, and objectives
1. Health = Fundamental human right, importance of community
2. Seven elements of primary healthcare:
a) Health education - Disease prevention/cure
b) Proper food supply & nutrition
c) Adequate supply of safe drinking water and sanitation
d) Maternal and child healthcare
e) Immunizations
Control of endemic diseases
g) Provision of essential drugs
3. Universal coverage, effective and affordable services, comprehensive
services on all levels of care, active community involvement
Chapter 22 - Veteran’s Health
A. Key Terms
B. Veteran status
1. Eligibility for VA benefits
Chapter 23 - Homeless Populations
A. Health status of homeless adults
Chapter 26 - Communicable Disease
A. Chain of transmission
B. Prevention
1. Primary/Secondary/Tertiary
Chapter 29 - Natural and Manmade Disasters
A. Disaster triage
450 F23 Final Review
B. Disaster management
1. Federal government agencies
a) Homeland Security, FEMA, CDC
b) Red Cross
c) Role of the National Guard
Chapter 30 - School Health
A. Common health concerns of elementary-aged children
B. EPSDT → Early and Periodic Screening, Diagnosis and Treatment
1. Created by Medicaid
2. Child health program for uninsured under age 21
3. Comprehensive health and developmental history, unclothed physical
exam, immunizations, lab testing, lead toxicity screening
Chapter 31 - Occupational Health
A. Occupational health and prevention strategies
B. Skills and competencies of the OHN
Chapter 34 - Home Health and Hospice
A. Purpose of Home Health Services
1. Nursing care in their homes
2. Home health nurses receive referrals from other sources
a) Physician, NP/midwife, hospital dc planner/case manager,
schoolteacher, clinic hcp, patient/family
3. Public health nurses (from clinics/health depts) → Follow-up
communicable diseases + health education and community referrals
4. Assess individual + family interaction, provide education & interventions,
B. Hospice home care
1. Holistic approach
2. Mental/physical/emotional status, laboratory/diagnostic studies,
pharmacologic/nonpharmacologic therapies, identify goals of
pt/family/caregiver, culturally competent care, coping strats/support
systems, financial resources, spiritual assessment
450 F23 Final Review
3. Hospice = 6 mo or < to live; comfort care! | Palliative = > 6 mo or want to
continue curative tx; Symptom management while still receiving tx
4. At home or in hospital
First Aid