Clinical Simulations
For
Community Health
Nursing
J. Carley RN, MSN, MA
Spring, 2008
University of Southern Nevada
http://www.brazos-nurse.org
Read Me First !
A Note or Two About This Presentation:
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This presentation is made for viewing and interaction on an individual and personal level.
Therefore, some often taken for granted tenets of “Power Point-ism” will be ignored or flatly
violated. For instance, when giving a Power Point presentation for a class or group, the rule of
thumb is generally that one only put “Bullets,” or short phrases on the slides, then fill in the
information with lecture and discussion. Since this is an individual assignment, this tenet will be
ignored at times, and much more information than usual will be presented on the slides—including
whole paragraphs.
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Additionally, each slide will generally be set to run through the animations automatically. In most
cases, in order for the slides to progress smoothly, you should not click the mouse until the
navigation arrow appears in the lower right hand corner of each slide.
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Hyperlinks within the program itself and links to world wide web sites have been added: these will
only work when you are playing the slide show presentation which you may access by clicking
“Slide Show,” in the top navigation bar, followed by the drop down command: “View Show.”
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Much of the information on the following slides have been gleaned from a variety of sources,
especially the State of Vermont’s Public Health Nursing Orientation Curriculum. Citations
have been made as they occur within the program.
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Enjoy and learn.
The Three Core Functions of Public Health
Click on link, above for further information on the
Core Functions of Public Health
• Assessment
• Policy Development
• Assurance
Assessment
Policy
Development
Assurance
Content Links
Directions: Click on the link for each exercise, following the arrow
prompts to advance or retreat through slides. If there is no “forward arrow,”
then follow the link provided or return to this page.
Internet access is required to complete many of these modules.
**At the end of each module, (or on any page) click on the return
icon to return to this home page.
(NOTE: Hyperlinks only work when “slide show” is playing.)
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Epidemiology in the Classroom
Environmental Case Study
Scorecard: The Pollution Information Site
Outbreak at Water’s Edge
Is Our Public Health System Equipped to Handle Disaster?
Prevention / Health Promotion
Bioterrorism : Dark Winter Exercise
Disaster Management :
Cultural Competence
Critical Thinking in Public Health
Systems Thinking
MCH Exercise– Immunization
Chronic Disease Intervention
Instructions for Completing the ClinSimms Work Sheet:
a.
Complete Items I-IV, answering questions and following directions as provided.
b.
Choose (at least) one activity from Items V-VIII and complete work sheet,
answering questions and providing answers as directed.
c. Turn in your worksheet prior to leaving campus.
• Epidemiology in the Classroom:
• An Introduction to Epidemiology
(1 hour)
• Go to http://www.cdc.gov/excite/PDF/intro_epi.pdf
to complete this reading.
Environment
Environmental Case Study
• A 35-year-old mother, Mrs. Pearson, comes to your public health
clinic with her four children.
• She’s been to the clinic before and has lived in this rural, lakeside
town all her life. Her husband is a fisherman. He brings home food
from his daily catch. As the nurse in the clinic, your nutritional
assessment indicates the family eats fish about four times a week.
• In the past three weeks, Mrs. Pearson and her daughter Sally, age
7, have been feeling sick with headaches, malaise, nausea, and
vomiting. Because of her symptoms, Mrs. Pearson believes she’s
pregnant again. She thinks Sally’s symptoms are due to the sudden,
unexplained deaths of her cat and dog to whom she was much
attached.
• Both the cat and dog were acting oddly before they died. The
veterinarian thinks they may have been suffering from some type of
seizure disorder.
Environmental Case Study
(continued)
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Everyone else is healthy, except her husband. Recently, he’s been complaining
of occasional numbness around the mouth and fingertips. But he says
everyone that fishes with him feels the same way. Mrs. Pearson thinks it’s due
to his occasional alcohol use or just old age. She said he’s been staggering
and losing his balance lately, and he certainly seems not to hear as well as he
used to.
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Mrs. Pearson is aware of some newspaper stories and warnings that the fish is
not safe to eat. But she says she doesn’t believe them because she and her
family have been eating the fish from the nearby lakes for generations without
any problems. It’s just another effort by the media to get everyone all riled up.
Besides even if she wanted to, she can’t afford to buy meat at the supermarket.
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She explains she just wants to complete her WIC interview in order to get her
food delivery. She states she is not feeling well. Her daughter appears
dehydrated and lethargic.
READING: The “IPREPARE MODEL”
(Click Link to Read)
•Paranzino GK, Butterfield PB, Becker J, Ranger C, editors. I PREPARE Environmental Exposure History Mnemonic. Atlanta (GA):
Agency for Toxic Substances and Disease Registry; 2000.
Environmental Case Study
Questions
• 1. Using the “I PREPARE” model, identify three or four questions
that you would ask Mrs. Pearson in order to obtain a more detailed
family health history.
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IPREPARE Mnemonic
• 2. Mr. Pearson says all of his friends “feel this way.” Is this a trend
that needs investigation?
• 3. What data are available regarding fish safety in Nevada ?
• 4. How can you link this individual assessment with populationbased health? (Hint: several individuals and friends have
symptoms.)
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Paranzino GK, Butterfield PB, Becker J, Ranger C, editors. I PREPARE Environmental Exposure History Mnemonic. Atlanta
(GA): Agency for Toxic Substances and Disease Registry; 2000.
Assignment: On a sheet of paper, write your answers to the above
questions. Provide specific citations where relevant & required.
“Outbreak at Water’s Edge”
• Reflect upon your trip to the Waste Water
Treatment Plant in Las Vegas.
• Read the next page of this presentation, noting
the questions you need to answer in regard to
“Outbreak at Water’s Edge.”
• With this and other concepts of community
health in mind—including the three core
functions of assessment, policy
development, and assurance --go to the
website listed on the next slide, interacting and
reflecting on the questions listed on the next
page.
“Outbreak at Water’s Edge”
• (1) Name each member of the public health team in this
exercise, including their duties and job description.
• (2) Describe the activity, including surveillance,
investigation, and follow-up.
• (3) Although the title of this exercise would seem to
indicate that a water-borne illness is in play, what other
types of illnesses (sources) must be addressed to
ensure that the outbreak is properly studied?
• (4) Which model would be most useful in studying this
problem? (e.g., Epidemiological Triangle, Web of
Causation, others…)
• (5) What is your perception of this website in relation to
meeting the educational needs of the new Public Health
Nurse? Is it helpful?
Outbreak at Water’s Edge:
http://mclph.umn.edu/watersedge/
Is Our Public Health System
Equipped to Handle a Disaster?
• View the webcast ( 7 minutes) by Dr. Kristine Gebbie:
http://www.columbia.edu/cu/news/media/02/kristineGebb
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• Supplementary Reading / Resource:
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Disaster Response: Principles of Preparation and Coordination
(Chapters 1-2 of this online text). Erik auf der Heide. Center for Excellence
in Disaster Management and Humanitarian Assistance
• Reflect on the reading and the following definition of
critical thinking in nursing:
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“Unlike the ‘mindless’ thinking we do when we go about our daily routines,
critical thinking is purposeful, goal-directed thinking that aims to make
judgments based on evidence (fact), rather than conjecture (guess work).
Based on principles of science and the scientific method (e.g., maintaining a
questioning attitude, following an organized approach to discovery, and
making sure information is reliable), critical thinking requires developing
strategies that maximize human potential (e.g., tapping on individual
strengths) and compensate for problems caused by human nature (e.g. the
powerful influence of personal perceptions, values, and beliefs).”
• 1. How do public health nurses apply critical thinking to
the analysis and interpretation of data?
• 2. How do public health nurses support critical thinking in
their work with community partners to define health
priorities?
Prevention / Health Promotion
• Go to the article:
• A Guide to Community Preventive Services:
• See http://www.thecommunityguide.org for a list
of community organization resources.
• Develop an outline of relevant information from
these resources (or others that you research)
that you could use to assist the community in
planning a local response to a FIT and Healthy
Kids Initiative.
• Review the Best Practice Checklist (next page) as a
guide.
• Best Practice Checklist
• Questions to ask when researching intervention options:
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Where has this intervention been tried before, and what
has been the outcome?
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What does expert opinion say on the probability of this
intervention being successful?
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Have there been research studies showing that this
intervention works or is likely to work?
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Does this situation match others where this intervention
has been successful?
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Does this community have experience using this kind of
intervention?
Systems Thinking
• Read this overview of systems thinking by Daniel Aronson:
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http://www.thinking.net/Systems_Thinking/Intro_to_ST/intro_to_st.html
• Most of the challenges that public health nurses face are
complex and do not have easy solutions. You have
already read about critical thinking. Systems thinking is a
critical-thinking approach. Using a systems- thinking
approach will enable you to look at all of the component
parts and multiple perspectives.
• Try a critical-thinking/systems-thinking approach in the
following activity (next page).
Case Study
• Health data for your community indicates that
intravenous heroin use is on the rise. The
potential for an increase in blood borne diseases
such as hepatitis and HIV are of concern.
• You have been asked to facilitate a community
group that will be considering the need for one
of two services that are currently unavailable in
your service delivery area:
• A mobile opiate treatment clinic
• A needle exchange program
• What public health nursing interventions and
essential public health service will you use in
completing this work?
Case Study (cont.)
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You are scheduled to facilitate a discussion with community partners about
the feasibility of providing this service in your community. Use critical
thinking and a systems-thinking approach to develop a list of issues and
assumptions, as well as information and resources that you will need to
explore before your meeting.
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1. What are some of the issues you anticipate will be raised by your
partners?
2. What assumptions are you making about concerns they may raise?
3. What assumptions do you think they may come to the meeting with?
4. What data and other information do you want to have on hand to share
with them?
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For this activity you are being asked to create a research “to do list “only.
You do not need to have the answers to your questions.
Go to the next page.
Rabinowitz P. & Fawcett S, editor. Thinking Critically. University of Kansas Community Tool Box.
Available at:
http://ctb.ku.edu/tools/en/sub_section_main_1120.htm.
Critical Thinking
• Reminder: Some goals of critical thinking:
• Truth: to separate what is true from what is false, partially true,
incomplete, slanted, based on false premises, or assumed to be true
because "everyone says so."
• Context: to consider the context and history of issues, problems, or
situations.
• Assumptions: to understand the assumptions and purposes behind
information or situations.
• Alternatives: to create ways of approaching problems, issues, and
situations that address the real, rather than assumed or imagined,
factors that underlie or directly cause them -- even when those
factors turn out to be different from what you expected.*
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*Rabinowitz P. Fawcett S, editor. Thinking Critically. University of Kansas Community Tool
Box.
http://ctb.ku.edu/tools/en/sub_section_main_1120.htm
Cultural Competency
Objectives:
• Identify the role of cultural, social, and
behavioral factors in determining the
delivery of public health services.
• Understand the importance of a diverse
public health workforce.
• Utilize appropriate methods for interacting
sensitively, effectively, and professionally
with persons from diverse cultural,
socioeconomic, educational, racial, ethnic,
and professional backgrounds, and
persons of all ages and lifestyles.
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Cultural diversity relates to race and ethnicity as well as regional patterns
and educational and economic factors. The demographics in Nevada show
a large number of minorities in the population as a whole, so we must be
cognizant of some crucial differences.
Cultural diversity manifests itself in many ways, including race, ethnicity,
education, rural lifestyle, poverty. This lesson will provide a brief overview of
cultural competency and discuss national initiatives that focus on health
literacy and the prevention of health disparities.
The assurance function of public health includes exploring accessibility and
acceptability issues for all members of a community. If health services are
not accessible because of language or cultural barriers, the public health
nurse plays a key role in adapting services to meet the needs of all.
The National Standards for Culturally Competent Care define cultural
and linguistic competence as a set of congruent behaviors, attitudes, and
policies that come together in a system, agency, or among professionals
that enable effective work in cross cultural situations.
Culture refers to integrated patterns of human behavior that include the
language, thoughts, communications, actions, customs, beliefs, values, and
institutions of racial, ethnic, religious or social groups. Competence implies
having the capacity to function effectively as an individual and an
organization within the context of the cultural beliefs, behaviors, and needs
presented by consumers and their communities. (The Office of Minority
Health has also added gender, sexual orientation, age, disability,
socioeconomic status, linguistic-minority status, low literacy skills, and
hearing impairment.)
NOTE: The Culturally Competent Nursing Modules Project
Is available for CNE (free of charge) at the link below.
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In Culturally Competent Care, a concept paper written for the Culturally
Competent Nursing Modules Project, the author outlines the skills
needed by nurses in order to provide a cross- cultural approach as defined
in the literature. They include:
· “Being able to recognize the components of one’s own culture formation,
and their potential impact on one’s practice, including the risk of projecting
onto patients.”
“Applied familiarity with models for ascertaining cross cultural
understandings of illness, health and care. Such familiarity is related to skills
for eliciting patient’s explanatory models and related world views,
sometimes formulated as patient’s “health beliefs”.
These skills are crucial for developing greater understanding, enhancing
communication, learning, and adherence.”*
“Being able to discuss CAM, complimentary and alternative medicine, with
patients, and knowing how to locate information about related modalities.”
“Eliciting the patient’s social context, including stressors and supports, and
their impact on the patient’s health and sense of well being.”
“Becoming able to work across cultural differences: forming a relationship,
patient – centered interviewing, assessment, addressing conflict,
negotiation, and case management.”
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The article concluded that, “Growing competence in communication skills
occurs as learners’ transition from one stage to the next. All these strategies
involve negotiation, and jettisoning in the pursuit of patient “compliance” in
favor of compromises that address the goals most deeply at stake for each
party.”
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Another skill addressed in the paper is the ability to recognize ways in which
certain forms of social power and privilege can lead unconsciously to the
perpetuation of disparities.
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The concept paper defines the need for training and skill development.
Training modules will be developed to address those needs.
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In addition to providing culturally competent care, linguistically competent
care is also a need for those with low literacy or Limited English Proficiency
(LEP).
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Title 6 of the Civil Rights Law, recent guidance by the Department of
Justice, and the National Standards for Culturally and Linguistically
Appropriate Services define expectations for institutions and individuals
regarding access to language assistance. Additionally, Healthy People
2010 proposes the elimination of health disparities and in objective (11-2),
Health Communication, stresses the improvement of health literacy for all
persons.
Cultural Competence
• Assignment:
• Go to : Culturally Competent Nursing Modules Project
• Following the directions on the web site, register for
Module 1, complete the activity, then print a copy of the
completion certificate after you finish the post-test.
• Turn in a copy of the certificate.
View Power Point Presentation:
“Dark Winter”