Population Kaplan review PDF

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Kaplan Community Nursing ...

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Community Based Nursing (CBN) o Collaborative model of health care delivery o For individuals and families within a community o Addresses primary health needs for acute and chronic conditions in a variety of settings ▪ Community ▪ Nursing centers ▪ Institution-based facilities o Identify client and family needs o Advocate for client o Collaborate with members of health care o Manage and coordinate needed resources and services o Establish and maintain a therapeutic relationship with the client and family o Enable client and family to view nurse as advocate in health care system o Address needs that may impair access to health care services ▪ Cultural ▪ Social ▪ Financial ▪ Legal ▪ Make referrals as needed o Provide direct care and teaching o Primary goal as a client advocate is to maintain client independency Community Health Nursing o Population-based nursing practice in various community settings o Promotes and protects the health of the community o Primary goal for client advocacy is to maintain client independence ▪ Advocacy consist of actions that inform, support, and affirm clients in their goal of self-determination Population focused practice o Population – a group of people sharing at least one characteristic such as age, gender, race, risk factor, or disease o Emphasizes all levels of prevention to promote healthy communities o Interventions for population focused practice ▪ Community organizations ▪ Health teaching ▪ Case management ▪ Advocacy ▪ Screening ▪ Disease and health even investigations o Primary goal is to provide evidence-based care to targeted groups of people with similar needs to improve health outcomes o Primary mission is working with groups in the community Community Assessment o The act of becoming knowledgeable about the community o Community has a location, a population, and a social system o Assessments: ▪ Familiarization assessment (windshield)

Problem-oriented assessment Community subsystem assessment Comprehensive assessment Qualitative assessment • Requires discussion, listening, and gathering insights and opinions • Example ⎯ attending a meeting with other health care workers to discuss improving the school lunch program ▪ Quantitative assessment • Assessments are investigations in which numbers are used to measure variables such as characteristics, concepts, or things. • Numbers are used to measure variables such as characteristics, concepts, or counting the facilities o Assist at an immunization clinic whose goal is to triple the number of vaccines administered from last year • Assessing and reviewing numbers o Determining what organized sports teams are available for children under the age of 10 • Counting facilities is a quantitative method o Biophysical factors – affects health ▪ Example – a kidney transplant not requiring anti-rejection meds o Psychosocial factors – affect mental health ▪ Example PTSD o Factors that influence violence in a community ▪ Unemployment, social isolation, media influence, rigid religious beliefs, and population density. ▪ Social conditions and multiple demands on populations economic conditions o Rate of growth is based on the number of full-time residents over a specified time frame. o Aggregate ▪ Composed of people with common characteristics such as members of the same religious affiliation, age, ethnic background, shared residence. ▪ Can overlap and some community members may belong to multiple aggregates o Social system ▪ Relationships that community members form w/ each other o Geographical boundaries ▪ Define physical location of a community o Social index ▪ Numerical measures that describe the well-being of a community ▪ Indicators are made up of one or several components combined into one index ▪ Used to describe and evaluate community well-being in terms of social, economic, and psychological welfare ▪ The number of protective services to the number of residents is an example of social index • Ratio of firefighters to residents o Community health status ▪ Indicators • Suicide rate • Location of mental health services • Prematurity birth rate Infection Prevention: Levels ▪ ▪ ▪ ▪

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o The purpose of prevention is o prevent disease from developing. o Primary prevention ▪ Precedes the development of disease ▪ Education about health promotion activities ▪ Immunizations ▪ Wear protective devices to prevent injury ▪ Family planning ▪ Teaching parenting classes to pregnant women o Secondary prevention ▪ Early detection and treatment of disease ▪ Screening ▪ Contact investigation ▪ Case finding o Tertiary prevention ▪ After disease has resulted in damage ▪ Limiting disability ▪ Rehabilitating client to highest level of functioning o Risk factors: ▪ Age – children are at higher risk due to immature immune systems ▪ Breaks in the skin such as surgery or insertion of IV device ▪ Injury or illness – limits the physical resources available to combat an infection ▪ Smoking – interferes with normal resp function ▪ Substance abuse – may interfere with intake of a healthy diet ▪ Multiple sex partners – increases the risk of sexually transmitted diseases ▪ Environmental factors such as work, healthcare settings, chronic disease – decrease the ability to fight off infection ▪ Medications – some reduce the immune response ▪ Nursing and medical procedures such as insertion of an indwelling catheter Illness prevention o Primary ▪ Activities that promote health and prevent illness ▪ Example – giving immunizations, using seatbelts, flu shot o Secondary ▪ Identify health issues at earliest opportunity ▪ Prevent complications ▪ Example – screening for cancer, self-breast exam o Tertiary ▪ Restore individuals, families, or communities to highest level of functioning ▪ Example – providing rehabilitation services, meals on wheels o Implementation ▪ Provide education • Various topics that promote health • Illness prevention specific to the identified individual/family/community health risk ▪ Assist clients in identifying a specific health risk ▪ Help client set realistic health goals ▪ Provide needed support to meet goals • Counseling

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• Social services • Support groups ▪ Provide support to promote behavior changes o Assessment ▪ Health hx ▪ Physical examination ▪ Lifestyle ▪ Physical fitness ▪ Support systems ▪ Spiritual health ▪ Health beliefs ▪ Health risk ▪ Coping abilities ▪ Emotional well-being ▪ Client motivation to change related to identified health risk ▪ Barriers to change o Health promotion/illness prevention education/activities based on ▪ Health needs ▪ Personal preferences ▪ Client goals Disease progression o 4 stages ▪ Stage 1: susceptibility • Disease is not present, and individuals have not been exposed • Primary prevention occurs in this stage ▪ Stage 2: sub-clinical disease • Exposed to disease but asymptomatic • Primary prevention is the focus ▪ Stage 3: clinical disease • Disease symptoms have manifested • Active tx and actions to halt and reverse progression occur • Secondary prevention occurs int his stage ▪ Stage 4: recovery, disability, death • Recovery from disease or condition • Tertiary prevention o 2 phases ▪ Phase 1: • Prepathogenesis • Stage 1 and 2 ▪ Phase 2: • Pathogenesis • Stage 3 and 4 o Primary prevention occurs during stages 1 & 2 o Secondary prevention occurs during stage 3 o Tertiary prevention occurs during stage 4 o Incubation – when the organism multiplies to enough to produce a host reaction ▪ Exposure to the virus has occurred and it is now multiplying

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o Susceptibility – The pre-exposure period in which the individual is vulnerable or at risk to acquire an infection ▪ The disease is not present, and exposure has not occurred o Clinical stage – period at the onset of S/S of the disease. Can range from mild S/S to moderate symptoms or to severe expression of the illness ▪ Example ⎯ cough and fever ▪ Also known as the onset stage o Culmination stage – hospitalization is or may be necessary Health promotion o Purpose is to move individuals, groups, and communities closer to optimal well-being by educating ▪ Hand hygiene education o Activities that assist a person to develop resources that improve quality of life o Altering of personal habits. Lifestyle, or environment to reduce risks and enhance health and well-being ▪ Nutrition classes o Involves changing patterns of behaviors for individuals and populations ▪ Smoking cessation o Purpose ▪ Increase the healthy life span of all groups ▪ Reduce health disparities among groups ▪ Achieve access to preventative services for all groups o Programs ▪ Health education ▪ Demonstrations ▪ General wellness ▪ Smoking cessations ▪ Exercise/physical conditioning ▪ Weight control ▪ Stress management ▪ Nutritional awareness ▪ Work safety. o Encourage 30 min of moderate exercise at least 5 times per week Hospice o Interdisciplinary program of palliative care and supportive services o Addresses the physical, spiritual, social, and economic needs of terminally ill clients and their families. o Focus is for client to maintain integrity and dignity while dying peacefully o Family support is essential o Multidisciplinary team provides medical and nursing care, personal care, spiritual care, and socioeconomic support. o Provides medications and equipment that are reasonable and necessary to manage terminal illness and ensure relief of sx o Not a 24 hr services with the exception of situations req crisis care (clients condition req constant care) Prevalence rate o All people with a particular health condition existing in each population at a given point in time ▪ Example – the number of people currently diagnosed with pancreatic cancer in the community o Calculate by diving the number of persons with the characteristics by the total number in the population ▪ Example ⎯ 300 students and 6 develop H1N1: 6/300 x 100 = 2% Vital Statistics o Information from registrations – births, deaths, adoptions, divorces, marriages

Used as source of information for epidemiological studies Information found on state websites Part of existing data is used as source of data for epidemiological study Example ▪ Incidence of death from heart disease with age Population o All the people living within the boundaries of a community o Variables ▪ Size ▪ Density • Number of residents in the physical space of land available ▪ Composition • Reflects the demographic information of residents including age, sex, marital status, and occupation. ▪ Rate of growth or decline • People moving in and out of a community on a seasonal basis • Estimate of the number of full-time residents over a period of time ▪ Cultural differences ▪ Social classes ▪ Mobility • Example – people living somewhere on a seasonal basis • Migrant workers present in summer months o Rate of decline – the number of full-time residents who leave a community over a rate of time Host-Agent-Environment Model o All interact to cause disease or conditions that harm the community o Host: Human or animal who nourishes the disease-causing agent ▪ Genetic susceptibility ▪ Immutable characteristics – family hx, age, sex ▪ Acquired characteristics – immunologic status, heart disease, obesity ▪ Lifestyle factors – diet, exercise, drug use, intake of caffeine, use of tobacco products ▪ Example – herd of infected cattle, people living in a “crack house” o Agent: Factor that causes or contributes to the illness or condition ▪ Infectious – bacteria, viruses, fungi, parasites ▪ Chemical – heavy metals, toxic chemicals, pesticides ▪ Physical – radiation, heat, cold, machinery, power tools ▪ Example – waste products dumped into a lake o Environment: External factors that contribute to the hosts susceptibility or resistance ▪ Climate – temp, rainfall, number of days of sun ▪ Plant and animal life – agents or reservoirs or habitats for agents, types and numbers ▪ Human population distribution – crowding, social support, apartments versus subdivisions, number of people per acre/block of land ▪ Socioeconomic factors – education, sources, access to care, income ▪ Working conditions – levels of stress, noise, satisfaction, factory inside air pollution ▪ Example – water contaminated with E.coli Caregiver role strain o Caregiver feels or exhibits difficulty in performing caregiver role o S/S o o o o

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Apprehension of institutionalization of care receiver Future of care receiver’s health and ability of caregiver to provide care that is needed and/or anticipated ▪ Altered caregiver’s activities and/or providing care needed ▪ Inability to complete caregiving task ▪ Preoccupation with care routine o Evidenced by feelings of depression ▪ Crying ▪ Decreased interest in activities of pleasure or interest ▪ Insomnia ▪ Anger at having to provide care Epidemiology o Study of distribution and determinants of health-related states and events in populations o Applications of this study to the control of health problems o Determines the scope of health problems, identifies ways to prevent disease and improve the health of the population o Data obtained through existing data, informal investigations, scientific studies. o Tracks incidence of communicable disease, searchers for causal relationships bt health and illness, reduces debilitating injuries in the workplace o Existing data found through vital statistics, census data, reportable diseases, disease registries, environmental monitoring, national center for health statistics o Epidemiological rates ▪ Statistical measures expressing proportion of people with a defined health problem among a population ▪ Includes prevalence, incidence, morbidity, and mortality rates ▪ General mortality rates can be reported as crude mortality rate, cause-specific mortality rate, case fatality rate, proportion mortality ratio, age-specific mortality rate. o Causality ▪ Relationship between cause and effect which allows community health nurse to understand why conditions/illness develop. ▪ Example ⎯ After using marijuana a construction worker falls on a roof Home care (Community home health nurses) o Nursing care provided in the home setting o Part of the community-based nursing focused on individuals and families o Care usually focused on illness or injury o Much of care is like that provided in the acute care setting o Must be able to practice autonomously o Care may be more challenging since the care is provided in a less structured environment Substance abuse: codependent behaviors o Codependents – family members living with a person abusing drugs or alcohol o May do for dependent person what they can do for themselves o Behaviors ▪ Attempting to control drug/alcohol use ▪ Making excuses for persons substance abuse ▪ Assuming abusers’ responsibilities ▪ Enabling behavior • Acts of not allowing addict to experience consequences of addiction ▪ ▪

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• Does not always understand • Enabled to continue the addiction o Counsel spouse of alcoholic ▪ Focus on self ▪ Explore life problems from spouses’ point of view ▪ Encourage to attend al-anon Screening o Methods used to determine disease or potential for developing disease o Usually completed on large numbers of people thought to be at risk for developing disease o If screening is positive, client referred for diagnosis and treatment. o To be effective nurse must have ability to follow up with individuals identified as positive during screenings Research o Quantitative Designs ▪ Descriptive and correlational • No researcher intervention • Descriptive: o Describe characteristics of topic: Individuals, groups, situations o Frequency or occurrence of certain phenomena • Correlational o Examine relationships between variables or subjects o Strength and direction of relationship ▪ Quasi-experimental and experimental • Researcher intervention • Exam causality • Quasi-experimental o No random assignment and/or group • Experimental o Incorporate random assignment of subjects o Both experimental and control groups o Clinical trials ▪ Experimental design ▪ Assess effects of new or revised clinical interventions: clinical tx, meds, med equipment ▪ Safety and efficacy of intervention studied ▪ Randomized controlled (clinical) trials • Probability sampling • Ensures sample is representative of population from which chosen • Allows for generalizability of findings • Mathematical probability methods used to guarantee eachc person in population has equal chance of being selected • Selection process is highly controlled • Focuses on objectivity, elimination of bias • Types o Simple ▪ Tables of random numbers or drawing random numbers used to select subjects from total population o Stratified ▪ Subgroups selected from population based on certain characteristics

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▪ Representative sample from each subgroup or stratum is randomly chosen o Cluster ▪ Entire groups are randomly selected in stages ▪ Subjects randomly selected from only those groups or clusters o Systematic ▪ Predetermined sampling intervals used to select subjects from population o May use random assignment of subjects Cross sectional studies ▪ Look at one phenomenon at one point in time ▪ Explores the relationship of a health condition to the variables in a specified population at a specified time ▪ Across multiple separate populations that differ in clear characteristics: age, developmental status, time periods, position in educational system ▪ No follow-up ▪ Advantages • Compared with longitudinal • Relatively economical • Easy to design and implement • Quick to conduct, obtain results ▪ Disadvantage • Does not capture changes occurring over time ▪ Allows comprehensive picture of a phenomenon as it exist in the present Double blind experiment ▪ Neither subjects nor researchers know who is in the experimental group or control group ▪ Purpose: decrease possible researcher bias and participant Hawthorne effect ▪ Gold standard for experimental research ▪ Control group • Group of subjects in experimental research study comparable to experimental group • Does not receive experimental intervention or tx or is given alternate tx such as traditional one • Provides baseline to measure effects of tx against • Differences in outcome are measured • In differences found, they are assumed to be caused by intervention since all other differences between the groups are controlled • Purpose: decrease threats to external validity • Increases confidence that stud findings can be generalized to other people and settings Experimental Study ▪ Involves the investigator controlling or changing factors suspected of causing the condition and observing the results Prospective Study ▪ Looks forward to find a causal relationship Longitudinal prospective cohort study ▪ Follows subjects over period of time in future ▪ Collects data at two or more different points in time ▪ Prospective study • Presumed cause related to social, environmental, or medical factors is identified in the present • Subjects followed for period of time in the future

Cohort study • Type of longitudinal study • Subjects have all been born in a particular time period or have similar backgrounds o Pilot study ▪ Small scale version of larger planned study ▪ Designed to identify and prevent problems from occurring in larger study ▪ Tests all methods and procedures for feasibility and accuracy ▪ Test instrumentation ▪ Sample has similar characteristics to sample planned for the full study o Retrospective study ▪ Focus on past ▪ Uses data • Already collected about events having already occurred (secondary data) • Identifying present condition and looking to past to determine cause ▪ Record review is possible data source ▪ Good beginning for exploratory research, never experimental. ▪ Example ⎯ comparing incidence of lung cancer in subject’s w/ a hx of smoking to subjects who have never smoked ▪ Looks backwards in time to find a causal relationship ▪...