ATI Review PDF

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Nightingale’s Environment Theory:  Focuses on impact person’s environment on their health  Emphasized prevention care. o Washing hands o Sterilizing instruments o Clean environment Health Belief Model  Assumes a person’s primary motivation (preventive) in taking positive health behaviors/actions is to avoid getting a disease.  Describes the likelihood of taking an action to avoid disease is based on: o Susceptibility, seriousness, and threat of disease o Modifying factors  Demographics  Knowledge/education level  Age  Race  Gender  Economy o Cues to action  Media campaigns  Disease effect on ppl  Recommendations from health care professionals o Perceived benefits versus perceived barriers to taking action Goals of community health nursing:  Promote, preserve, and maintain health of populations by delivery of services to individuals, families, and groups to influence community health  Who is the client in community health nursing? o The community or population  Both community-oriented nursing (community focused care, with an emphasis on education and disease prevention) AND community based nursing (illness care for individuals and families). Public Health Nursing  Also known as Community-Oriented Nursing  Population and community focused  Goal: o Promoting health o Preventing disease  They are not providing direct care to individuals!  Key Principles: o Emphasize primary prevention o Greatest good for largest number of individuals o Client is partner in health o Use resources wisely to promote best outcomes

Community-oriented Nursing:  Focused on improving the collective health of the community  Focus of Care: o Aggregates o Communities o Populations (public health) o At-risk or unserved individuals and families  Primary Goal: o Health promotion and disease prevention o Health education  No illness care!  Nursing Activities: o Indirect (programmed management) o Can include direct care of at-risk individuals and populations Community-based Nursing  Focused on illness care for individuals and families  Focus of care: o Individuals and families o Management of acute or chronic conditions o Direct (one-on-one) o Illness care:  School nurse  Camp nurse  Prison nurse  Examples: Home health nurse doing wound care, school nurse administering epi-pen Ethical principles to community health nursing  Autonomy: respect a patient’s right to self-determination  Nonmaleficence: Do no harm  Beneficence: Do what is best (i.e., maximize benefits)  Distributive justice: Fair allocation of resources in community Community Health Education  Obstacles: o Age o Cultural barriers o Poor reading comprehension/illiteracy o Language o Lack of motivation o Lack of access  Effective health education requires planning Learning Styles  Visual (videos, presentations)  Auditory (verbal lectures, discussions)  Tactile-kinesthetic (hands-on, return demonstration)

Epidemiology:  Study of the spread, transmission, and incidence of disease/injury Epidemiological triangle  Agent o What is causing the disease  Drugs  Toxins  Noise  Temperature  Viruses  Bacteria  Host o Human/animal being affected by the disease  Age  Gender  Genetics  Ethnicity  Immunological status  Physiological state  Occupation  Environment o Physical Environment  Geography  Water/food supply  Presence of reservoirs/vectors o Social Environment  Access to health care  High-risk working conditions  Poverty Incidence  Number of NEW cases of disease/injury in a population during a specified period of time Prevalence  Number of ALL cases (new and pre-existing) of disease/injury in a population during a specified period of time Health People 2020  Goals: o Includes national health goals that are based on issues that are considered major risks to health and wellness o Educate on DM, cancer, older adult health, and LGBT health Primary Prevention  Prevent initial occurrence of disease or injury o Education o Immunizations

o Advocation for access to health care o Prenatal classes Secondary Prevention  Focuses on early detection of disease  Limiting severity of disease o Screenings o Disease surveillance o Control of outbreaks Tertiary Prevention  Maximize recovery after an injury or illness o Rehabilitation o PT/OT o Case management o Support groups o Nutrition counseling for management of Crohn’s disease. When to assess cultural beliefs and practices?  When developing plan of care Acculturation  Process of merging with or adopting the traits of a different culture Ethnocentrism  Belief that your current beliefs or cultural is superior and better  Views world from their own cultural viewpoint Cultural Assessment Parameters  Ethnic background  Religious preferences  Family structure  Language and literacy needs  Communication needs  Education  Cultural values  Food patterns  Health practices  Always include pt preferences in assessment/plan of care Using an interpreter  They should have knowledge of health-related terminology  NEVER use family members  Consider preferences of age and gender  Should NOT be from same community as pt  Patient teaching material should be available in their primary language Environmental Risks  Toxins o Lead o Pesticides

o Asbestos o Radon  Air pollution o Carbon monoxide o Tobacco smoke o Lead o Sulfur dioxide  Water pollution o Wastes o Erosion after mining o Run-off, from chemicals added to soil  Contamination o Food and food products with bacteria, pesticides, radiation, and meds Environment Assessment questions  What is the condition of the residence? Remodeling activities? o Age and location  What is the pt’s occupation (including exposure to chemicals, toxins?  Do you smoke in the home?  Are you exposed to second-hand smoke?  What is the source/quality of drinking water?  Is there any presence of mold or fungi?  What temperature is the water heater set on? o Should be 65 years  Receiving Social Security/disability for 2 years  Diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-stage Renal Disease (ESRD) and receiving dialysis  Part A o Inpatient hospital care o Home health care o Hospice o Limited skilled nursing care for 100 days/yr.  Part B o Health care provider o Outpatient care o PT/OT o Home health o Diagnostic services o Physiotherapy o Durable medical equipment o Ambulance service o Mental health

o Preventive services  Part C o Known as Medicare Advantage Plan o Combination of A & B o Provided through private insurance  Part D o Prescription drug coverage o D FOR DRUGS Medicaid  Provides health care to those with low socioeconomic status and bo other insurance  Eligibility based on: o Household size o Income o Priority given to children o Pregnant o Disability State Health Agencies  State department of health o Manages WIC o Oversees CHIP  Provides health coverage to uninsured children o Responsible for administration of Medicaid program o Reports communicable diseases within state to CDC (voluntary)  State boards of nursing o Development and oversight of state’s nurse practice act o Licensure of RN and LPN o Oversight of state’s schools of nursing  Local Health Department o Meets health needs of community o Reports notifiable communicable disease to State Department of Health Community assessment components  People o Demographic  Distribution  Mobility  Density  Census data o Biological factors  Health and disease status  Genetics  Race  Age  Gender

 Cause of death o Social factors  Occupation  Activities  Marital status  Education  Income  Crime rates  Recreation  Industry o Cultural Factors  Ethnohistory  Hierarchy  Language  Religion  Values  Customs  Norms  Place or environment o Physical factors  Geography  Terrain  Community  Location of health services  Housing  Animal control o Environmental factors  Geography  Climate  Flora  Fauna  Topography  Toxic substances  Vectors  Pollutants Data Collection  Informant interviews o Direct discussion with member of community  Community forum o Open public meeting (participation challenges)  Secondary data o Review existing data  Death stats

 Birth stats  Census data  Mortality  Morbidity  Health records  Prior health surveys  Participant observation o Observation of formal or informal community activities  Focus groups o Directed talk with a representative sample of the community  Surveys o Specific questions asked in a written format (expensive, low response rate)  Windshield surveys o Descriptive approach that assesses several community components by driving through a community and making observations o Survey Components  What is their general appearance? (Age, dress, well-nourished, obese, frail, unkept)  What is the origin, ethnicity, or race of people?  Is there any evidence of substance use, violence, disease, mental illness?  Is there easy access to health care?  Are there grocery stores which provide fresh produce, or is this a “food desert”?  Is the housing of acceptable quality?  Is the housing in good repair or not?  Is there vacant housing?  Is there public transportation?  What grocery stores or other stores within community?  Presence of schools, parks and churches Steps in developing and managing a community health plan  Preplanning o Brainstorming  Assessment o Collect data  Diagnosis o Prioritize health needs of the community o Analyze data to determine health needs  Planning o Develop interventions to meet identified outcomes o Establish goals and objectives for the selected solution o Identify who will assume responsibility for each intervention o Determine funding opportunities for needed intervention and develop budgets  Implementation o Carry out the plan

Evaluation o Examine the success of the interventions o Determine achievement of desired outcomes Lead Poisoning  Important to ask a pt when house was built? o...