Community Health & African American Nurses

Chapter 1: Community Health

• Community is what society does together to ensure conditions where people can be healthy.
• The main functions of public health nursing are:
  • Assessment
  • Policy development
  • Assurance
• Essential services of public health include:
  • Monitor
  • Diagnose
  • Inform
  • Mobilize
  • Develop
  • Enforce
  • Link
  • Ensure
  • Evaluate
  • Research
• Community-oriented nursing focuses on the "health care" of individuals, families, and groups in the community.
• Community-based nursing focuses on the "illness care" of individuals and families across the life span.
• Public health nursing focuses on the community as a whole.
• Public health nursing focuses on the health status of a community.
• Quality improvement is NOT a core function of public health.

Chapter 2: Challenges for African American Nurses

• African American nurses faced segregated nursing education in the South until the 1960s.
• African American nurses had lower salaries in the South compared to White nurses.

Chapter 3: Healthcare Costs and Access

• The aging baby boomers are affecting healthcare costs because employer contributions to insurance premiums grew by 55% in 2007.
• The inability of workers to pay the increased insurance costs led to a rise in the percentage of uninsured working families.
• The largest minority group in the United States is whites at 76.3%.
• The goals of the Affordable Care Act are:
  • Improve access and quality of care
  • Decrease cost
  • Provide consumer protection

Chapter 4: Government and Healthcare

• The branches of government are:
  • Executive: Enforces and implements laws
  • Judicial: Interprets laws and ensures they are applied fairly
  • Legislative Branch: Makes laws
• World Health Organization (WHO) is responsible for international public health.
• The Pan American Health Organization is a regional office of the WHO focused on the Americas.
• The World Health Assembly is the WHO's policy-making body that meets annually.
• The U.S. Department of Health and Human Services (USDHHS) is involved with the health and welfare of U.S. citizens.
• The Centers for Medicare and Medicaid Services (CMS) provides health insurance.
• The National Institute of Nursing Research (NINR) focuses on nursing research activities.
• Professional malpractice requires proof of an act or failure to act that leads to injury of a client.

Chapter 5: Poverty, Healthcare Access, and Ethics

• Factors that link poverty and poorer health outcomes:
  • Being uninsured
  • Accessing health services
  • Rationing health care
• Medicaid recipients have difficulty accessing health care, in part, because reimbursement for services is low for providers.
• Healthcare rationing involves reduced access to care and potential decreases in acceptable quality of services offered.
• The U.S. Preventive Service Task Force makes evidence-based recommendations about clinical preventive services to improve health.
• Challenges for the 21st Century:
  • Foodborne illnesses
  • Acts of terrorism
  • Chronic diseases
  • Infectious diseases like HIV, AIDS, and tuberculosis
• Poor, malnourished individuals in unsanitary conditions have a compromised capacity to withstand bodily insults.
• Factors influencing the cost of health care:
  • Inflation
  • Changes in population demographics
  • Technology and intensity of services
• Medicare covers:
  • Part A: Inpatient hospital care, home health care, hospice care, and skilled nursing care
  • Part B: Health care provider services, outpatient care, and home health
  • Part C: All benefits of Part A and Part B, often includes additional benefits
  • Part D: Brand-name and generic drugs
• Retrospective reimbursement sets fees after services are delivered.
• Prospective reimbursement establishes payment before services are offered to the client.

Chapter 6: Ethics and Bioethics

• Ethics is a process and body of knowledge for reflection on morality.
• Bioethics involves studying ethical issues in research or clinical practice.
• Unethical issues in the Tuskegee Study:
  • 600 black male participants; 399 with Syphilis, 201 without Syphilis
  • Treatment available in 1940's but not given to participants
• In the Zika Outbreak, there was a lack of support, informed consent in research, discrimination against affected individuals, and global collaboration.
• The Nuremberg Code was instituted after the Nazi medical experiments during World War II to establish ethical guidelines for human experimentation.
• The Hastings Center, established in 1969, is attributed to the first formal study of bioethics.
• The Belmont Report was written to establish ethical principles for research involving human subjects in response to the Tuskegee Study.
• In the Tuskegee Study, participants were not informed about the true nature of the study.
• The Belmont Report stresses that participants must be fully informed about the nature of the study, the risks, and their right to withdraw at any time.
• Ethical decision-making involves:
  • Problem-solving processes
  • Providing guides for making sound ethical decisions
  • Remember that when all is said and done we each make our own decisions
  • Identify, place, obtain, reformulate, consider, make, and then evaluate
• Ways to handle moral distress at the workplace:
  • Identify situations that lead to distress
  • Communicate that concern to your manager on ways to address the stressor
  • Seek support and be proactive
  • Express one's voice on ethically concerning matters
• Consequentialism means the right action produces the greatest good or least harm.
• Utilitarianism is a consequentialist theory that prioritizes maximizing benefit and minimizing harm.
• Deontology means the action is right or wrong in itself, regardless of the outcome.
• Distributive justice refers to fairly allocating benefits and burdens in society based on needs and contributions of its members.
• Ethical principles:
  • Respect for Autonomy: Permitting individuals to choose actions that fulfill their life plans unless harm results to others
  • Nonmaleficence: Requires that we do no harm
  • Beneficence: Requires that we do good
• There are 12 principles of the public health code of ethics.

Chapter 7: Culture and Health

• All health care professions need similar information about diversity.
• There are core similarities among cultures, with differences within, between, and among cultures.
• Variant cultural characteristics determine how much one varies from the dominant culture.
• Persons who participate in their choice of health-related goals, plans, and interventions are more likely to comply.
• Each person has the right to be respected for their uniqueness and cultural heritage.
• Guidelines for providing culturally competent care:
  • Knowledge of cultures
  • Education and training in culturally competent care
  • Critical reflection
  • Cross-cultural communication
  • Culturally competent practice
  • Cultural competence in health care systems and organizations
  • Patient advocacy and empowerment
  • Multicultural workforce
  • Cross-cultural leadership
  • Evidence-based practice and research
• Key terms in cultural competency:
  • Culture: Beliefs, values, and assumptions about life transmitted across generations
• Example: Religion; Traditions; Values
  • Race: Biological designation based on shared features
• Example: White, Black, Asian, Hispanic/Latino, Native Indian
  • Ethnicity: Feeling of peoplehood among a group
• Example: Irish, Italian, African American, Jamaican, Filipino, etc
  • Cultural Diversity: Variation among populations based on lifestyle, ethnicity, race, interest, place, and time
• Example: Awareness of differences among group members
• Social determinants of health:
  • Economic instability
  • Education
  • Social environment
  • Health and healthcare
  • Physical environment
• Factors influencing poor health outcomes for immigrants:
  • Fear of immigration reinforcement prevents seeking healthcare
  • Living in low-income and segregated neighborhoods
  • Working in low-wage occupations
  • Unsafe working situations
• Factors to consider when providing healthcare to immigrants:
  • Financial constraints (uninsured)
  • Language barriers
  • Social, religious, and cultural differences
  • Providers' lack of knowledge about high-risk diseases
  • Traditional healing practices
  • How your own background beliefs, and knowledge may be significantly different from theirs
• Dimensions of cultural competence include cultural preservation, accommodation, repatterning, and brokering.
• Inhibitors to developing cultural competence include stereotyping, prejudice, racism, ethnocentrism, cultural imposition, conflict, and shock.
• Nursing cultural assessment includes:
  • Initial contact with client: ethnic background, religious preference, family patterns, cultural values, language, education, politics, and health practices.
  • Data collecting phase: self-identifying data, client's perception of health, and cultural factors.
  • Organizing phase: examining views on treatment and identifying differences between needs and goals of Western medicine.
  • Conducting: being sensitive to cues, knowing resources, focusing on specific areas, selecting a strategy, identifying a confidante.

Chapter 8: Environmental Health

• Toxicology studies health effects associated with chemical exposures.
• Epidemiology helps understand the strength of association between exposures and health effects.
• The epidemiologic triangle explains relationships among agents, hosts, and environments.
• Geographic information systems are used in environmental health studies to code data spatially on Earth.
• Climate change affects social determinants of health such as socioeconomic status, education, physical environment, access to healthcare, and social support networks.
• I PREPARE:
  • I - Investigate potential exposures
  • P - Present work
  • R - Residence
  • E - Environmental concerns
  • P - Past work
  • A - Activities
  • R - Referrals and resources
  • E - Educate
• Poor environments affect young children and pregnant women due to factors such as pollution, poor housing, and limited access to healthcare.
• Ways to reduce environmental risk factors:
  • Apply disease prevention principles
  • Three R's (Reduce, Reuse, Recycle)
  • Dispose of materials appropriately
  • Conduct risk communication
  • Enforce governmental environmental protection
• Nurses can be community advocates by:
  • Writing letters
  • Participating in blogs
  • Serving as a credible source
  • Volunteering on commissions
  • Reading and asking questions

Chapter 9: Evidence-Based Practice

• The public nurse tells the subjects that their names will not be used and only the research team will have access to their information, this is an example of confidentiality
• Randomized Controlled Trial is the gold standard research method.
• The initial step in evidence based practice is to have a curiosity to know.
• PICOT question components:
  • (P)opulation of interest
  • (I)ntervention or practice strategy
  • (C)omparison
  • (O)utcome desired
  • (T)ime frame
• Key terms include:
  • Integrative review: A systematic review that does not have the summary statistics found in the metaanalysis because of the limitations of the studies that are reviewed
  • Narrative review: Is a review done on published papers that support the reviewer's particular point of view or opinion and is used to provide a general discussion of the topic reviewed.
• What clinical trial method is the most reliable and has the highest ranking when it comes to evidence-based practice?
  • randomized controlled trial

Chapter 10: Epidemiology

• Descriptive epidemiology identifies what, who, where, and when (person, place, time) of a disease.
• Analytic epidemiology explores origins, causes, and determinants of health events.
• Purpose of epidemiology includes:
  • Monitor the health of the population
  • Understand the determinants of health and disease in communities
  • Investigate and evaluate interventions to prevent disease and maintain health
• Key study types:
  • Prospective Cohort: Researchers follow a group of individuals (a cohort) over time
  • Retrospective Cohort: A retrospective cohort study involves looking backward in time
  • Case-Control Study: Individuals with a particular condition are compared to individuals without the condition
• A clinical trial tests the safety, efficacy, or effectiveness of an intervention.
• The term "study" is more broad and general than "clinical trial"

Chapter 11: Communicable Diseases

• Chronic diseases have replaced infectious diseases as the leading cause of death due to advances in public health.
• Key terms include:
  • Natural: Species-determined, innate resistance
  • Acquired: Resistance acquired after exposure
  • Passive: Immunization through antibody transfer
  • Herd: Immunity of a group or community
• Incubation is the time between invasion and first symptoms, while the communicable period is when an agent can be transferred.
• A pandemic is a worldwide epidemic, while an epidemic is an excess of normal expectancy in a community or region.
• Vertical transmission is parent to offspring, horizontal is between unrelated individuals, and vector is through an arthropod or insect.
• The National Notifiable Diseases Surveillance System (NNDSS) is used to report communicable diseases.
• Primary prevention seeks to reduce disease incidence, secondary aims to prevent spread, and tertiary works to reduce complications.
• Key ways to safer food include washing hands, separating raw and uncooked foods, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials.
• Ways to prevent tick bites include using repellents, wearing protective clothing, and avoiding tick habitats.
• Pinworms are diagnosed by pressing cellophane tape to the perianal region.
• Examples of healthcare-related infections include invasive diagnostic procedures, surgical procedures, and broad-spectrum antibiotics.
• Universal precautions include PPE, hand hygiene, needle and sharp safety, and cleaning and disinfection.

Chapter 12: HIV and STIs

• Ryan White was diagnosed with hemophilia, contracted HIV through a blood transfusion, and contributed to the Ryan White CARE Act.
• HIV is transmitted through blood, semen, vaginal secretions, and breast milk.
• After a positive HIV screening test, it is confirmed with a Western blot test or HIV nucleic acid test (NAT).
• HIV disproportionately affects minorities, men who have sex with men, and transgender women.
• People with HIV are living longer due to medical treatment, improved healthcare access, and increased awareness/prevention.
• The Human Papillomavirus (HPV) accounts for 70% of cervical cancer cases.
• Gardasil 9 is the only approved HPV vaccine in the U.S.
• The Americans with Disabilities Act (ADA) protects individuals with HIV/AIDS in school and workplace.
• Hepatitis is transmitted:
  • Hepatitis A: Transmitted through fecal-oral route
  • Hepatitis B: Transmitted through blood and body fluids
  • Hepatitis C: Transmitted through blood and body fluids
• The Mantoux Test for TB involves injecting purified protein derivative, reading the reaction, measuring induration, and recording results in millimeters.

Chapter 13: Community Assessment

• Active participation involves direct engagement and contributing ideas, while passive participation involves less active involvement.
• Community assessments aim to learn more about community needs and strengths.

Chapter 15: Nursing Care and Interventions

• Continuity of Care: consistent and seamless healthcare services over time
• Care Management: helping achieve better health outcomes by anticipating and linking populations with the services they need.
• Case Management: activities with clients in the system
• Advocacy: supporting or representing patients

Chapter 16: Disaster Preparedness

• Nurses are trained in triage to quickly assess patients' medical needs and prioritize care, especially when resources are limited.

Chapter 28: Community Health

• Family as Client, Family as system,Family as a components of society nursing approches and theroies
• Theroretical Framework

Other Sections

• Cultural considerations