Public Health Nursing Revision

Course Information

• The department is Nursing.
• The course code and name is HEY442ET-Public Health Nursing-T.
• The course week is revision.
• The course is on Thursday from 09:00 to 12:50.
• The course credit or ACTS information value is 4.
• The exam type is MCQs.
• The instructor is Dr. Hina Zahoor with the email [email protected].
• The instructor's room number is 305.
• Office hours are from 9:00 to 5:00.
• The GBS Link is https://gbs.gelisim.edu.tr/en/lesson-details-5-160-17306-2.
• The ALMS Link is https://avesis.gelisim.edu.tr/researcher/lesson.
• The AVESIS Link is https://lms.gelisim.edu.tr/almsp/u/Home/Index.

Public Health

• Public Health as defined by CEA Winslow in 1920 is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort.
• The Oxford Textbook of Public Health defines Public Health as the process of mobilizing and engaging local, state, national, and international resources to assure conditions in which people can be healthy.

Mission of Public Health

• The mission is to fulfill society's interests in assuring conditions in which people can be healthy (Detels & Breslow, 2002).

Health Policy and Management

• Strategic planning, organization, and administration of health systems and services are part of health policy and management.
• Professionals navigate healthcare complexities, ensure resource allocation, and develop policies.
• Efforts focus on creating equitable health policies, managing facilities, and optimizing systems.

Environmental Health

• Focuses on the environment-human health relationship.
• It examines air and water quality, sanitation, food safety, and occupational hazards.
• Experts work to prevent diseases by mitigating environmental risks, advocating for cleaner environments, and implementing policies.

Biostatistics

• Statistical methods interpret biological and health-related data.
• Facilitates study design, complex health data analysis, and outcome interpretation.
• Researchers use statistical models to draw correlations, identify trends, and make informed decisions.
• Biostatisticians collaborate with epidemiologists and specialists to ensure the accuracy of health studies.

Public Health Nursing

• Also known as community health nursing, is a specialty focused on public health.
• Lillian Wald of the Henry Street Settlement coined the term.
• Public Health Nurses or Community Health Nurses integrate community involvement and knowledge with understanding of personal health experiences to improve people's health.

Public Health Nurse (PHN) Responsibilities

• PHNs assess health trends to identify community-specific health risk factors.
• PHNs assign priorities for health interventions to provide the most significant benefit.
• PHNs advocate with authorities to improve access to health services in underserved communities.
• PHNs design and implement health education campaigns for disease prevention.
• PHNs provide information on available local health programs and services.
• PHNs record and analyze medical data and develop relationships.
• PHNs manage community health program budgets and refer people to related services.
• PHNs deliver medical care when needed.

Changing Concepts in Public Health

• Disease control, or sanitary phase from 1880-1920 included sanitary legislation and reforms, aimed at controlling man's physical environment for improvement in the health and death control.
• Health promotion occurred from 1920-1960.
• Social engineering happened from 1960-1980.
• Health for all phase started in 1980.

Disease Control Phase (1880-1920)

• Characterized by sanitary legislation and reforms, aiming at the control of man's physical environment such as water supply and sewage disposal.
• Technical knowledge was limited to improve the health of people due to disease and death control.

Health Promotional Phase (1920-1960)

• Goal to improve health of individuals in addition to disease control activities.
• Initiated personal health services including Mother & Child health, school, industrial, mental and rehabilitation services.

Social Engineering Phase (1960-1980)

• Public health entered a "social engineering phase."
• Social and behavioral aspects of disease and health were prioritized to lessen chronic disease burden.
• The concept of risk factors rose.

Health For All Phase (1981-2000 AD)

• Focuses on reducing health gaps by providing healthcare to all to promote productive life.

Modern Public Health

• The 20th-century increase in life span is credited to public health achievements like vaccination programs, infectious disease control, and family planning.
• Better safety policies, such as in motor vehicle and worker safety.
• Emphasis on safe drinking water
• Current focus is on chronic diseases such as cancer, AIDS, diabetes, and heart diseases.

New Concepts in Public Health

• "Public Health 2.0" seeks to make the field more accessible and user-driven through participatory technologies.
• "Public Health 3.0" challenges leaders to include health in all areas of governance.

Epidemiology

• The primary determinant is the disease's causative agent or disorder.
• In communicable diseases, it may be bacteria, virus, or parasite.
• In nutritional disorders, it is the specific nutrient.
• In an automobile accident, it is the vehicle.

Secondary Determinants

• Secondary determinants include a multitude of factors that influence the disease.
• Example of socio-economic factors are causing malnutrition.
• An example of physical environment is its influence of respiratory infections

Descriptive Studies

• The studies generate hypotheses and answers what, who, where, and when.

Analytic Studies

• The studies test hypotheses and answer why and how.

Descriptive Epidemiology

• It examines the distribution of a disease in a population.
• It also observes the basic features of its distribution in terms of time, place, and person.

Descriptive Studies Characterization of Outcome

• Person: Includes age, sex, and occupation of affected individuals.
• Place: Includes geography like residence, work, and hospital of affected individuals.
• Time: Includes when events like diagnosis, reporting, and testing occurred.

Analytic Studies and Hypotheses

• A hypothesis is an educated guess about a testable association in a scientific investigation.
• Descriptive data provides information to develop hypotheses.
• Hypotheses refine to have a narrower focus.

Types of Cohort Studies

• Prospective cohort studies group participants to past, current and future exposure to determine outcome.
• Retrospective cohort studies measure potential exposure and outcomes already occurred.

Case-Control Study

• The purpose is to study rare diseases and multiple exposures related to a single outcome.
• Participants selected are based on outcome status.
• Case-subjects have outcome of interest.
• Control-subjects do not have outcome of interest.

Competition, Anti-Corruption, and Transparency

• The Turkish Criminal Code No. 5237 regulates bribery and official misconduct.
• Offering any benefit to influence the execution of a legal transaction is prohibited via Bribery (Article 252).
• Public officials avoid receiving gifts and benefits.
• Sector-specific rules for pharmaceutical companies regulate interactions with healthcare professionals.
• Transparency Requirements enforce pharmaceutical companies to report value transfers exceeding 10% of the current monthly wage.

Article 280 of the Turkish Penal Code

• Healthcare professionals are legally obligated to report crimes encountered during their work.
• Failure to report a crime can be sentenced to up to one year in prison.
• Healthcare professionals include physicians, dentists, pharmacists, midwives, nurses, and other healthcare providers uncovering criminal activity.

Prevention Definition

• Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability.
• Prevention is defined traditionally of levels, primary, secondary, and tertiary.

Levels of Prevention

• Primordial Prevention is applied preventing the emergence of risk factors and is achieved by providing education.
• Examples includes teaching children good eating habits to prevent childhood obesity and building bikeways to avoid road traffic accidents.

Primary Prevention

• Health promotion is important and an important term followed by many countries and strategy enables people to lead a healthy lifestyle.
• Ottawa Chapter in November 1986 states Health Promotion was adopted in a conference held in Ottawa in Canada in November.
• The Jakarta Declaration that happened in July of 1997 conveyed health promotion.

Health Promotion Includes:

• Health education
• Environmental modification
• Nutritional intervention
• Lifestyle and behavioral changes

Examples of Primary Prevention

• Providing safe water and sanitary latrines.
• Controlling insects and rodents.
• Promoting breastfeeding and small family norms.
• Improving overall socioeconomic status.
• Using helmets and seat belts.
• Chemoprophylaxis and vitamin A prophylaxis.

Primary Prevention Approaches

• The WHO recommends specific approaches for the primary prevention of chronic diseases.
• The approaches are a population (mass) strategy and high-risk strategy.

Population (Mass) Strategy

• It is directed at the entire population irrespective of individual risk levels
• A study indicates reduction average blood pressure would reduce cardiovascular disease incidence.
• A population approach is directed towards socio-economic, behavioral and lifestyle changes.

High-Risk Strategy

• Aims to bring preventive care to individuals at special risk.
• Requires detection of individuals at high risk by the optimum use of clinical methods.

Secondary Prevention

• Mode of intervention involves diagnosing the disease early and starting treatment.
• Here diagnosis made and treatment given, but no complications occurred yet.
• Examples of secondary treatment include active search for Malaria cases, school health exam, PAP smear, leprosy, tuberculosis treatment.
• In industries, workers examined to monitor if disease has developed on yearly basis.

Tertiary Prevention

• Addresses irreversible complications present in disease stages and aims to limit further damage.
• Achieved through disability limitations and rehabilitation.
• Disease is when a person suffers from a health issue.
• Impairment is a loss of abnormality of physiological or psychological structure
• Disability is the restriction or inability to perform an activity.
• Handicapped is the person that cannot fulfill their roles and responsibilities.

Objectives of Rehabilitation

• Restoration of function
• Restoration of capacity earn a livelihood
• Restoration of family and social relationship
• Restoration of personal dignity and confidence.

Vocational Rehabilitation

• Aims to help individuals return or maintain employment.
• Includes job training, counseling, and assistance with job placements, accommodations, and career planning.

Social Rehabilitation

• Focuses on helping individuals reintegrate into their social environment.
• Involves building social skills, accessing community resources, and developing support networks.

Psychological Rehabilitation

• Addresses mental health recovery, focusing on therapies.
• Involves counseling and support to improve psychological well-being, manage symptoms, and enhance quality of life.

Key Aspects of Health Protection Levels

• Risk-Based determines public health threats.
• Preventative, reactive measures range from hygiene to lockdowns.
• Governmental health guidance provides policies to assess protection.

Health Protection Levels and Air Quality Index

• The European Environment Agency (EEA)'s air quality index levels include Good (Green), Moderate (Yellow), Poor (Orange), Very Poor (Red), and extremely poor (Purple.)
• Good (Green) means that there is no risk to public health.
• Moderate (Yellow) means sensitive groups may experience minor effects.
• Poor (Orange) means there are health effects for vulnerable individuals and recommendations to limit outdoor activity.
• Very Poor (Red) means significant health impacts; advisories to stay indoors.
• Extremely Poor (Purple) means there is an emergency health measure required.

Food Safety and Disease Control Levels

• The EFSA & ECDC levels for outbreaks and contamination risks are:
• Level 1 is routine safety inspections.
• Level 2 is increased targeted testing.
• Level 3 is public warning of unsafe food.
• Level 4 is recall of products.

Pandemic Preparedness

• The ECDC uses a phased approach, including:
• Phase 1 for routine surveillance and vaccination programs.
• Phase 2 for increased outpatient monitoring.
• Phase 3 pandemic interventions,
• Phase 4 for recovery and reinforcement of systems.

Factors for Screening Tests

• Personal risk factors to determine which health screening tests include age, gender, past, and family medical history and smoking status
• Family history is significant for screenings

Risk Factors and Health Screenings

• Advanced age and family history of diseases increase screening needs.
• With family history of diabetes, regular screenings prioritized.
• Liver cancer screenings is not urgent.

Advice Regarding Health Screening

• Consider regular screenings with a strong family history.
• A doctor can help you understand needs based on risk.

Types of Health Screening Tests

• Singapore's screening guidelines groups three types:
  • Category 1 suitable for Everyone.
  • Category 2 suitable for Individual.
  • Category 3 are Not Recommended.

Category 1 Health Screening Tests

• Health screening tests in this category are proven by good and robust evidence to be clinically effective and cost effective for screening everyone in the population.

Category 2 Health Screening Tests

• Health screening tests in this category may be useful for those with high risk factors or there is evidence proving that the test is clinically effective but it's cost-effectiveness remains unevaluated or is not ideal

Category 3 Health Screening Tests

• Should not be used are not enough evidence to determine their usefulness or there is good evidence that the tests are not cost-effective or that the harm they pose to the individual outweighs any benefit

Community Identification

• Refers to systematically knowing and exploring the community.
• Purpose is to assess health status and causes of health.
• Is the first step of health community nursing.

Approach for Community Identification

• Involves surveys gathering data for community health and careful planning ensuring data.
• Identifies health problems, resources, and social structures.

Steps for Data Collection:

• Define the community based on the name, address and type.
• Determine the objectives by stating the purpose.
• Identify information sources and where data will be collected.
• Selects respondents using families and households if sampling.
• Chooses appropriate sampling techniques.
• Select methods and instruments, such as interview and observation.
• Systematically plan and execute data collection.

Community Communication:

• Increases awareness of health issues.
• Promotes positive behaviors and norms.
• Improves access.

Communication Principles:

• Use simple, clear messages are easy to understand.
• Relevance, ensuring information is helpful and related to the community's needs.
• Cultural sensitivity, respecting the beliefs.
• Participation, engaging community members.
• Feedback, encouraging two-way communication.

Communication Methods:

• Interpersonal communication is face-to-face.
• Mass media consists of radio, TV and newspapers.
• Digital platforms have social media, websites and mobile apps.
• Meetings and forums.
• Posters, pamphlets, and leaflets.

Effective Health Education Strategies

• Identify community needs as the assessment of specific health issues.
• Use multiple channels to combine different media for outreach and adapt to literacy levels.
• Use visuals, storytelling, and demonstrations, also engage community leaders, and measure program effectiveness.

Health Educators

• Give accurate, information and motivate people.
• Advocate and develop programs.

Communication Barriers

• Language, cultural differences, and misinformation.
• Increase media Access to media in communities.

Objectives of Family Health Nursing

• Identify health and nursing needs.
• Ensure family accepts care is provided.
• Support health, development and guide in community.
• Care should be provided and promote healthy personal and cultural practices.
• Maintain physical, psychosocial.

Family Health Nursing Principles

• Provide services without discrimination and healthcare.
• Conduct health evaluations, keep records.
• Integrate education supervision, build relationships and engage.
• Services offer resources, encourage contribute, improvements.

Family Centered Nursing

• Approaches includes family context as the health focus which considers individual to their needs.
• Family clients influence health, and a system where each member effects others.
• Family interaction components of healthcare.

Family Nursing

• Assessment is identifying problems
• Diagnosis is recognizing the needs.
• Planning a care strategy.
• Implementation of nursing care.
• Evaluation measuring success.

Home Visiting

• Plan visits to build trust and give scientific.
• Involve family also should evaluated.

Home Visiting and Purpose:

• Give simple nursing care, prevent promote.
• Assess health socioeconomics provide care.
• Educate family provide services relations.

Home Visiting Advantages:

• Build relationships, assess environment, have family dynamic, improve hidden problems and make patients comfortable.

Bag Technique

• Keep the nursing bag clean organized.
• Clean surface from children.
• Use safe handling equipment, sterilize waste.

Bag Technique: Key Steps

• Before Aseptic Technique
• Cleaning Surface Barrier
• Removing supplies Needed
• Performing Sterile
• Sterilizing Materials
• Repack Disinfecting