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Community Exam 1
Chapter 1: Global Health Global Health Disparities
“Health disparities are systematic, plausibly avoidable health differences according to race/ethnicity, skin color, religion, or nationality; socioeconomic resources or position; gender, sexual orientation, gender identity; age, geography, disability, illness, political or other affiliation;
or other characteristics associated with discrimination or marginalization.”
Poverty and problems related to lack of access to adequate food, water, shelter and health cate
767 million people living in extreme poverty (less than $1.90 per day)
Most of the decline in poverty rates has occurred in Est Asia and Pacific regions with lower declines in Africa
More than 50% of the extreme poor live in Sub-Saharan Africa
Other factors that contribute to health disparities o
Racial/ethnic status o
Presence of physical or mental illness o
Stigma associated with mental illness or HIV o
Inequitable distribution of global resources (funding for research to address global problems)
10/90 Gap: used to characterize this imbalance referring to the concept that only 10% of
the world’s research resources are used to address the health problems that affect 90% of the world’s population Global Disease Burden
Defined as “the disability-adjusted life year [DALY], which is a time-based measure combining years of life lost due to premature mortality (being subject to death) and years of life lost due to time lived in states of less than full health”
Life expectancy at birth has increased from 53 to 62 years in low-income countries
Life expectancy at birth has increased from 75 to 79 years in high-income countries
The Lancet
series
of papers published describing findings from 2010 Global Burden of Disease Study which was the “first systematic and comprehensive assessment of data on disease, injuries, and risk since 1990” o
Showed life expectancies were increasing across globe and rates of HIV, malaria, TB, and other infectious diseases were decreasing. Deaths due to cancer and road accidents have increased, and nearly 25% of all deaths are due to heart disease. o
Greatest disease risks: HTN, smoking, alcohol, and poor diet
Health Disparities: Socioeconomic
Gaps
in healthcare r/to existence and the quality of healthcare for individuals, families, populations, communities and systems
Unequal distribution of disease within a population among different groups
Endemic, long standing
Health inequities
Disproportionate burden of illness on one subset of a population
Facts About State of Global Health
~10 mil children under 5 die each year and almost all could survive with access to simple and
affordable interventions
Risk of woman dying in a developing country from a pregnancy-related cause is 25x higher than a woman in developed country
Undernutrition
is underlying cause of death for at least ⅓ of all children < 5
More than half of the world’s children who are not attending primary school are in sub-Saharan Africa, where only 76% of children attend
sub-Saharan Africa has highest child mortality rate and there has been less progress in neonatal mortality. Child mortality is closely related to poverty
Factors that contribute to nursing shortage in low-resource countries include challenges related to HIV/AIDS, high stress work environments, gender-based discrimination and violence, and international migration of nurses.
Most important factors to enhance the health care of people from diverse cultures/lower SES:
o
Most important: Improve access
to health information and health care
o
Effective communication between patient and provider
o
Overcoming cultural and linguistic barriers
o
Understanding health care utilization practices
Social disparities: Poverty in the U.S.
o
Poverty level at $24,250/year (2015) for a family of 4
o
(2 adults and 2 children) US Census Bureau
o
The 2016 poverty rate was 13.5%
largest decline of 1.2 %age pts since 1999
1.1 M children living in poverty in 2014, 10% elderly
Rates: African-American
36.9% Hispanic 30.4% White 10.7%
C
hildren living in single female headed households had a poverty level 4
times that of children living in married-couple families
20 million people have incomes less than half of the poverty threshold
Global Health History
???
Chapter 2: Essentials of Practice Public Health Achievements (Box 2.1)
1.
Immunizations 2.
Improvements in motor vehicle safety 3.
Workplace safety 4.
Control of infectious disease 5.
Decline in death from heart diseases and stroke 6.
Safer and healthier foods 7.
Healthier mothers and babies 8.
Family planning 9.
Fluoridation of drinking water 10. Tobacco as a health hazard
Essential Public Health services and selected Nursing activities (Table 2.1)
Essential PH Services Selected Nursing Activities/Competencies Monitor health status to identify community health problems Participate in community assessment; identify potential environmental hazards Diagnose and investigate health problems and hazards in community Understand and identify determinants of health and disease
Inform, educate, and empower people about health issues Develop and implement community-based health education Mobilize community partnerships to identify and solve health problems Explain the significance of health issues to the public and participate in developing plans of action
Develop policies and plans that support individual
and community health efforts Develop programs and services to meet the needs of high-
risk populations as well as members of the broader community Enforce laws and regulations that protect health and ensure safety Regulate and support safe care and treatment for dependent populations such as children and frail elderly Link people to needed personal health services, and ensure the provision of health care when otherwise unavailable Establish programs and services to meet special needs Ensure a competent public health and personal health care workforce Participate in CE and preparation to ensure competence Evaluate effectiveness, accessibility, and quality of personal and population-based health services Identify unserved and underserved populations in communities Research new insights and innovative solutions to
health problems. Participate in early identification of factors detrimental to the community’s health Health Care and Life expectancy
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Determinants of Health
40% Behavior o
Tobacco use o
Diet and activity pattern o
Alcohol use o
Exposure to microbial agents o
Sexual behavior o
Firearm use
30% Genetic – not controllable o
Familial history o
Colon cancer can be genetic
15% Social circumstances
o
Economic stability o
Education o
Neighborhood and community
10% traditional health care system
5% environment o
Toxic agents
Occupational exposures (Asbestos)
o
Environmental exposures
Particulates
Carbon monoxide
Environmental tobacco
Lead Health People 2020 on Health Disparities
Healthy People
is a program of nationwide health-promotion
and disease
-prevention goals set by the United States Department of Health and Human Services
. The goals were first set in 1979 “in response to an emerging consensus among scientists and health authorities that national health priorities should emphasize disease prevention”. The Healthy People program was originally issued by the Department of Health, Education and Welfare (DHEW). This first issue contained “a report announcing goals for a ten-year plan to reduce controllable health risks
Goals:
o
Improving health for ALL groups o
Eliminating disparities o
Achieving health quality
Public Health Figures
Lillian Wald and Mary Brewster founded Henry Street Settlement House in NYC
Wald first coined term public health nurse and is regarded as “mother of public nursing” o
Contributions- establishing nursing schools, advocating better housing, working to change child labor laws, teaching preventive practices, advocating occupational health nursing, and improving the education of public health nurses.
1940s- discovery of antibiotics
o
Public health credited with adding 25 years to the life expectancy of people in US
1960s- as communicable diseases declined, turned to prevention of chronic diseases and related risk factors (smoking, diet)
1980s- shifted to health promotion promoted by Health for All era est. by WHO
1990s- emphasis on clinical care and high-tech medicine to increase life expectancy
o
High cost of health care
Variables Impact Health
I think this is talking about the determinants of health??? Look at the pie chart above
Chapter 3: Epidemiology Descriptive Epidemiology
Study and describe the amount and distribution
of disease
Used by public health professionals
Compares affected groups and unaffected groups
Identified patterns frequently indicate possible causes of disease and suggests hypotheses (
rates/ratios/proportions mortality and morbidity statistics)
Key variables: person, place, time
Analytic Epidemiology
Examine and describe complex relationships among the determinants of disease
Investigation of the causes
of disease, or etiology
Test hypotheses or answer specific questions (retrospective or prospective)
Key variables: host, agent, environment
Screening
Presumptive identification of unrecognized disease or defects by the administration of tests, examinations, or other procedure that can be applied rapidly
Screening tests DO NOT provide a conclusive diagnosis of a disease
The purpose of screening is to rapidly and economically identify people with high probability of having a particular illness so that they can be referred for DX and TX Specificity
test’s ability to CORRECTLY identify those WHO DO HAVE DISEASE (true +)
If it is not specific there will be people who do not have the disease be referred
A test with specificity will have a few false positives Sensitivity
the test’s ability to CORRECTLY identify those who DO NOT HAVE THE DISEASE (true -)
A test with high sensitivity will have a few false negatives Web of Causation
Views a health condition as the result not of the individual factors but of complex interrelationships of numerous factors interacting to increase or decrease the risk of disease
It attempts to identify all the possible influences on the health and illness processes
It is multifactorial
Synergism: the whole is more important than the sum of its part o
Example: the effects of shigella infection of the infant combined with the effects of poverty, youth and low educational level of the mother are more deleterious to infant health than the sum of the effects of the individual factors
allows to determine the most feasible point of intervention to improve infant mortality in the community
Be more thorough and it will provide sufficient information for the initiation of useful actions to improve community health Criteria for Causation
Association is strong
(measured statistically with RR or odd ration)
Association is consistent (exists repeatedly in other studies, settings or populations)
Association is temporally correct (the hypothesized cause of health condition should occur before the onset of the condition) ** has to precede**
Association is specific (should be associated with relatively few health conditions)
Association is not the result of a confounding variable
Association is plausible and consistent with current knowledge
(congruent and compatible) Prevalence
The total number of people in the population who have the condition at a particular time
Can be calculated as a cross-sectional or retrospective study
It examines the extent of morbidity in a community # of existing cases of disease
x 100,000
# in total population
Incidence
The number of people in a population who develop the condition during a specified period of time
For analytical epidemiology, it allows the estimation of risk necessary to assess casual association
Used in prospective study
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# of new cases of disease
x 100,000
Total population at risk Understanding Incidence and Prevalence
Consider the number of passengers on a train o
The # of passengers = prevalence (existing disease, old and new cases)
o
The number of boarding passengers represents prevalence (new cases)
o
The passengers who get off the train are the people who recovered or died
Factors that Increase prevalence o
Longer duration of the disease
o
Prolongation of life of patients without cure
o
Increase in new cases
o
(increase in incidence)
o
In-migration of cases
o
Out-migration of healthy people
o
In-migration of susceptible people
o
Improved diagnostic facilities o
(better reporting)
Factors that decrease prevalence o
Shorter duration of disease
o
High case-fatality rate from disease
o
Decrease in new cases (decrease in incidence)
o
In-migration of healthy people
o
Out-migration of cases
o
Improved cure rate of cases
Endemic
The habitual presence (or usual occurrence) of a disease within a given geographic area
Epidemic
The occurrence of an infectious disease clearly in excess of normal expectancy, and generated from a common or propagated source
Infectious
A disease likely to be transmitted to people or organisms Pandemic Disease
A worldwide epidemic affecting an exceptionally high proportion of the global population
Chlamydia
Endemic, Epidemic, Pandemic Patterns of Disease
o
Avian Flu in China- US scare in 2009 was swine-related
Endemic in poultry
In US – would be epidemic
o
H1N1 (Swine Flu) virus in 2009
Pandemic; now post-pandemic and just part of seasonal flu
o
Malaria in Africa
Endemic
o
Cholera and Plagues
Several pandemics
o
Yellow fever in Sub-Sahara Africa
Endemic with some epidemics
o
Ebola Virus in West Africa
Epidemic; not as infectious as measles; need direct contact with body fluids
o
HIV/AIDS
Pandemic (world-wide)
o
SARS
Epidemic spread to 24 countries
o
Meningococcal Meningitis in Sub-Sahara Africa
Endemic with several sporadic outbreaks in areas after travel
o
Smallpox
Was endemic; now eradicated after 1977 last naturally occurring case
o
Viral Hepatitis
Endemic in some countries
o
Dengue Fever in Puerto Rico
Endemic in 100 countries (mosquitos)
o
Pertussis (Whooping Cough) in CA 2010
Epidemic since 500% over expected cases
o
Measles in California in 2014 and 2019 in US
Epidemic (Outbreaks)
Screening Decision Issues
2 tests available o
High sensitivity and low specificity o
High specificity and low sensitivity
To save the most lives
high sensitivity
To minimize unnecessary referrals
high specificity Crude, Specific and Adjusted Rates
Crude- rates computed for a population as a whole
Specific- rates calculated for subgroups (can related to demographic factors such as age, race, gender or may be for an entire population but specific for some single cause of death/illness)
o
Can aid in identification of groups at increased risk within the population and facilitate comparison between populations that have different demographics compositions
Adjusted- a summary measure in which statistical procedure remove the effect of differences in the composition of the various population o
Helpful in making community comparison but they are only imaginary so caution is necessary when interpreting
Epidemiological triangle
A traditional view of health and disease developed when epidemiology was concerned with communicable diseases o
Agent: an organism capable of causing disease o
Host: the population at risk for developing the disease o
Environment: the combination of physical,
biologic and social factors that surround and
influence both the agent and the host
This is used to analyze the role and interrelatedness of
each of the factors
Disease and injury only occur when there is an
interaction or altered equilibrium between them Reading tables to interpret information
Question will ask you to read a chart and interpret
what it says (percentage, comparison, etc.) Chapter 7: Cultural Culturally Competent Care
Define
: “Appropriate knowledge, understanding, and appreciation of all cultural distinctions”
Culturally acceptable causes for illness
Rules for symptoms expression
Interaction norms
Help-seeking strategies
Determining desired outcomes
HP 2020 Goals
The imperative to achieve and sustain cultural competence is found in the goals and objectives of Healthy People 2020 (the nation’s health promotion and disease prevention agenda)
Despite the expansion of HP goals and objectives, critical reviews show that little progress has been made toward reducing health disparities and achieving health equity for all Americans
During the Obama Administration, programs were put in place to enhance efforts of HP 2020 such as strengthening infrastructure and workforce, advancing scientific knowledge
and innovation. These programs aim to improve cultural competence education for professionals, agencies, and communities and improve access by designing health promotion and intervention services that are available, acceptable, and appropriate to the population groups they seek to serve
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An example of such a population is the LGBTQ population. Although several goals of HP 2020 address the LGBTQ population, they aim to increase the inclusion of sexual identity
questions in health risk screening questionnaires rather than direct actions to increase access to care and reduce disparities
Culturally Competent Assessment
Assess your cultural knowledge and ask for help. Be able to adapt to diversity and willing
to accept different approaches to the same problem
Recognize, value and respect the cultural and language backgrounds of your patients and co-workers. Also respect the healthcare beliefs, rituals, and customs of your patients
in the delivery of all health care
Provide professional interpreters and translation
Goal
: To reduce health disparities among all individuals regardless of race, religion, culture, ethnicity, gender identity, and lifestyle
Define Culture
“The learned and shared values, beliefs, and behaviors of a group of interacting people”
“
integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutional associated, wholly or partially, with racial, ethic, or linguistic groups, as well as with religious, spiritual, age, gender, biological, geographical, or sociological characteristics”
Klein’s Three Sectors of Health Care Systems
Popular
: informal healing relationships within one’s own social network
o
Family, neighbors, co-workers, other members of social/religious network
Folk
: includes the interaction between a client and sacred and secular healers
o
Source of Holistic Health Problems in Folk Sector
Relationship with other people
Relationship with the natural environment
Supernatural forces
o
Source of Folk Healers’ Power
Family position
Inheritance
Signs
Revelations
Gifts
Professional
: organized health professionals who are formally educated and legally sanctioned
o
Client and providers typically differ in their social and cultural values, beliefs, and assumptions
o
Client-provider relationship may be one of mistrust, suspicion, and conflict
o
Dominated by a biomedical disease and treatment orientation. Suggests that disease is a physiologic and psychological abnormality
Conflict Among Sectors
o
Often labeled “unorthodox,” “subjective,” and “nonscientific”
o
Association with non-Western societies, client’s preference for such healing practices may have been dismissed by some healthcare professionals. This dismissal is problematic because if recommended treatments do not fit the perceived cause, then the client may not follow suggested protocols
Chapter 11: Assessment Primary Prevention
Health Promotion, Preventing Exposure and Preventing Disease
Safe environment
Healthy lifestyles
Primary Prevention keeps the disease process from becoming established by eliminating causes of disease or increasing resistance to disease
It is less costly than crisis interventions and tertiary preventions.
Reduce or eliminate environmental hazards enforcement of laws or policies
Promotion of immunizations, BUT SCREENING IS SECONDARY PREVENTION!
Education of environmental hazards, ear plugs, masks, PPE
A nurse can use primary prevention to decrease pollution in a number of ways:
o
Reduce/eliminate environmental hazards, such as with enforcement of legal codes and standards
o
Educate community residents, business owners, and government officials on how to avoid environmental hazards, such as the routine application of sunscreen and use of ear plugs and safety glasses
o
Become involved with political actions that provide strategies to minimize environmental exposure in populations
o
Promote routine immunizations to minimize diseases caused by biologic agents
Examples: an environmental community action group, in collaboration with citizens of its community, in conducting a public education project on pesticide use in their community. Their goals are to increase public awareness of pesticide use and their environmental and health impacts, provide the publics’ right to know about pesticide use, and take steps to reduce pesticide use and health risks, particularly to children. First, they collect information regarding pesticide use in the area; then, they seek changes in pest management practices to reduce chemical pesticide use, and they build support in the community for implementation of new policies. They utilize parent-
teacher organizations to build support in the community and to support their pesticide reduction campaign’s legislative agenda.
Birth and Death Statistic
Part of the community core data
Community members/population
Population: Group that shares one or more characteristics.
Community: Group that shares
geography, demography, or need
.
o
From the textbook chapter on assessment: “An individual, group, or community can be considered an open system in that there is constant interaction with the environment through boundaries. Neuman’s total-person approach and, subsequently, the community-as-partner model, are considered systems models. Person is a population or an aggregate.
Everyone in a defined community (total population) or aggregate (the elderly, teens, nurses) represents the person. Environment may be thought of as community (a network of people and their surroundings).
” *SOMETHING I REMEMBER FROM THE QUIZ!
Community Core: Something that is essential, basic, and enduring. The core of a community (the FIRST thing you assess) is its people -their history, characteristics, values, and beliefs.
o
Normal Line of Defense: The level of health a community has reached over time.
o
Flexible Line of Defense: Broken line around the community and its normal line of defense, a buffer zone representing a dynamic level of health resulting from a temporary response to stressors.
Community Members/Population
o
Demographics: Represent People, the core of the assessment wheel
Age and sex characteristics
Racial distribution
Ethnic distribution
Sources: census of population and housing, planning board (local, city, county, state), chamber of commerce, city hall, city secretary, archives, and own observation.
Population/aggregate represents “the person”
Core components
Figure 11.1
The core of the assessment wheel represents the people who make up the community. Includes their history, characteristics, values, and beliefs.
Included in the core are: Demographics
What sorts of people do you see? Young? Old? Homeless? Alone? Families? What races do you see? Is the population homogeneous?
Values and Beliefs
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Are there churches, mosques, temples? Does it appear homogeneous? Are the lawns cared for? With Flowers? Gardens? SIgns of art? Culture? Heritage?
Historical markers?
Ethnicity
Do you note indicators of different ethnic groups (restaurants, festivals)? What signs do you see of different cultural groups?
History
What can you glean by looking (e.g., old established neighborhoods; new subdivision)? Ask people willing to talk: How long have you lived here? Has the area changed? As you talk, ask if there is an “old-timer” who knows the hx of the area.
Community Core Data
History- library, historic society; interview “old-timers,” town leaders
Demographics
Age and sex characteristics- Census of population and housing; planning board (local, city, county, state)
Racial Distribution- Chamber of Commerce
Ethnic distribution- City hall, city secretary, archives; observation
Household type
s by family, nonfamily, group- Census
Marital Status
- Census
Vital Stats
(births, deaths by age and leading causes)- state department of health (distributed through city and county health departments)
Values and beliefs
- Personal contact, observation (to protect against stereotyping avoid the library for this portion)
Religion
- Observation; telephone book
These people all affect the 8 subsystems of the community. The subsystems include:
Physical environment
Education
Safety and Transportation
politics/government
Health and social services
Communication
Economics
Recreation
Solid line surrounding community represents its normal line of defense
or level of health the community has reached over time.
May include high rate of immunity, low infant mortality, or middle-income level
. Also includes patterns of coping, along with problem-solving capabilities
Flexible line of defense
, depicted as a broken line around the community and its normal line of defense is a buffer zone representing a dynamic level of health resulting from a temporary response to stressors.
Might be neighborhood mobilization against an environmental stressor such as flooding or social stressor such as an unwanted adult bookstore.
8 subsystems are divided by broken lines bc they are not discrete and separate but influence and are influenced by one another.
Within the community are lines of resistance
, internal mechanisms that act to defend against stressors. Ex: an evening recreational program for young people implemented to
decrease vandalism, and a free-standing, no-fee health clinic to diagnose and treat STIs
Exist through each of the 8 subsystems and represent the community’s strengths.
Stressors are tension-producing stimuli that have the potential of causing disequilibrium in the system. Ex: air pollution or closing a clinic; inadequate, inaccessible, or unaffordable services
Penetrate the normal and flexible lines of defense
Stressors and lines of resistance (strengths) become part of community nursing diagnosis by giving rise to the degree of reaction (amt of disequilibrium or disruption that results from stressors impinging on lines of defense).
May be reflected by mortality/morbidity rates, unemployment, or crime statistics. Windshield Survey Elements
Windshield Survey has each component of the community assessment wheel (the assessment is facilitated by using this)
Has 3 parts: The core, the subsystems, and community perceptions
The community core
o
History – what can you glean by looking? Ask people willing to talk: How long have you lived here? Has the area changed? As you talk, ask if there is an “old-
timer” who knows the history of the area
o
Demographics – what sorts of people do you see? Young? Old? Homeless? Alone? Families? What races do you see? Is the population homogenous?
o
Ethnicity – do you note indicators of different ethnic groups? What signs do you see of different cultural groups?
o
Values and Beliefs – are there churches, mosques, or temples? Does it appear homogenous? Are lawns cared for? With flowers? Gardens? Signs of art? Culture? Heritage? Historical markers?
The community subsystems
o
Physical Environment – how does the community look? What do you note about air quality, flora, housing, zoning, space, green areas, animals, people, man-made
structure, natural beauty, water, and climate? Can you find or develop a map of the area? What is the size?
o
Health and Social Services – evidence of acute or chronic conditions Shelters? “Traditional” healers? Are there clinics, hospitals, practitioners’ offices, public health services, home health agencies, emergency centers, nursing homes, social
service facilities, and mental health services? Are there resources outside of the community but accessible to them?
o
Economy – is it a “thriving” community or does it feel “seedy”? are there industries, stores, place for employment? Where do people shop are there signs that food stamps are used/accepted? What is the unemployment rate?
o
Transportation and Safety – how do people get around? What type of private and
public transportation is available? Do you see buses, bicycles, and taxis? Are
there sidewalks, bike trails? Is getting around in the community possible for people with disabilities? What types of protective services are there? Is air quality monitored? What types of crimes are committed? Do people feel safe?
o
Politics and Government – are there signs of political activity? What party affiliation predominates? What is the governmental jurisdiction of the community? Are people involved in decision making in their local governmental unit?
o
Communication – are there “common areas” where people gather? What newspapers do you see in the stands? Do people have TVs and radios? What do they watch/listen to? What are the formal and informal means of communication?
o
Education – are there schools in the area? How do they look? Are there libraries?
Is there a local board of education? How does it function? What is the reputation
of the school(s)? What are major educational issues? What are the dropout rates? Are extracurricular activities available? Are they used? Is there a school health service? A school nurse?
o
Recreation – where do children play? What are the major forms of recreation? Who participates? What facilities for recreation do you see?
Community perceptions
o
The Residents – how do people feel about the community? What do they identify
as its strengths? Problems? Ask several people from different groups and keep track of who gives what answer
o
Your Perceptions – general statements about the “health” of the community. What are its strengths? What problems or potential problems can you identify?
Can be used to assess a community within a community, if necessary (school, industry, or business)
o
Assess aggregate by providing the context in which this group is found
o
The process of assessment, regardless of where it is applied, always remains the same
Where to find what? o
The census collects data on marital status and financial characteristics, including the percentage of households below poverty level in the Community. Educational
status information, including years of school completed, school enrollment by type of school, and language spoken, can be located in the social characteristics section of the census data. The population and housing characteristics section of census data provides information about private transportation sources and the number of persons with a transportation disability
o
The Chamber of Commerce would have demographic information such as racial diversity and ethnic distribution. Extra-community or intracommunity facilities are identified best through the chamber of commerce.
o
The library would have historical data on the community.
o
To monitor, maintain, and promote the public's health, each state has a state health department and accompanying regional, county, and sometimes city health departments.
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o
Law enforcement departments have statistics regarding incidence of crime, vandalism, and drugs. o
The county health planning board has information about health needs and practices.
o
Waste and water treatment plants are the best source of information about sanitation in the community.
Assessment info:
o
The systems review of the community reveals information about social systems, including housing, businesses, churches, and hangouts. o
Vital signs provide information about climate, terrain, natural boundaries, and resources. o
Auscultation involves listening to community sounds and residents. o
Inspection is used when walking through the community.
Figure 11.2
Chapter 12: Community Analysis Phases of Community Analysis
The phases we use to help in the analysis are categorization, summarization, comparison, and inference elaboration
To analyze community assessment data, it is helpful to first categorize the data. Data can be categorized in a variety of ways:
o
Demographic characteristics (family size, age, sex, and ethnic and racial groupings) o
Geographic characteristics (area boundaries; number and size of neighborhoods, public spaces, and roads) o
Socioeconomic characteristics (occupation and income categories, educational attainment, and rental or home ownership patterns) o
Health resources and services (hospitals, clinics, mental health centers, and so forth).
Once a categorization method has been selected, the next task is to summarize the data within each category
o
Both summary statements and summary measures, such as rates, charts, and graphs, are required. o
Additional tasks of data analysis include the identification of data gaps, incongruences, and omissions. o
Frequently, comparative data are needed to determine whether a pattern or trend exists, whether data do not seem correct, and whether revalidation of original information is required
The next phase is to draw logical conclusions from the evidence (i.e., to draw inferences that will lead to the statement of a community nursing diagnosis)
o
It is in this phase that you synthesize what you know about the community (i.e., what do these data mean?). o
These conclusions or inferences will identify the community’s stressors and strengths in succinct phrases. o
These phrases, then, form the basis for a community nursing diagnosis.
Community as a partner model
Based on Neuman’s (1972) model of a total-person
approach to viewing patient problems
This model is used to emphasize the underlying
philosophy of primary health care
You consider every system and know they are
interrelated
the whole system is considered
greater than the sum of its parts o
There is an emphasis on the iteraction of
those parts to make up the whole
Person: a population or an aggregate
Environment: community
Health: seen as a resource for everyday life not the
objective of living
Nursing: prevention Food desert
Food deserts are areas that lack access to affordable
fruits, vegetables, whole grains, low-fat milk, and other foods that make up a full and healthy diet
Rural, minority, and low income areas are often the sites of food deserts because they lack large,
retail food markets and have a higher number of convenience stores, where healthy foods are less available.
Studies have shown that food deserts can negatively affect health outcomes but more research must be done to show how that influence occurs. There appears to be a link between access to affordable nutritious foods and the eating of these foods, meaning less access may lead to less incorporation of healthy foods into the populations’ diets
Primary level of intervention
applied to a generally healthy population precedes disease or dysfunction. Primary prevention is divided into two component areas
o
general health promotion such as nutrition, hygiene, exercise, and environmental protection o
specific health promotion, which includes immunizations and the wearing of protective devices to prevent injuries
Secondary level of intervention
the early detection and treatment of adverse health conditions. The goal of secondary prevention is to detect and treat a problem at the earliest possible stage when disease or impairment already exists
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may result in the cure of illnesses that would be incurable at later stages, the prevention of complications and disability, and confinement of the spread of communicable diseases
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Examples of secondary prevention include blood pressure screening for hypertension, skin test for tuberculosis, and phenylalanine test for phenylketonuria in infancy
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On a community basis, initial treatment of people with infectious disease, such as a sexually transmitted disease, may protect others from acquiring infection and thus provides secondary prevention for infected people and primary prevention for their potential contacts
Tertiary level of intervention
is employed after diseases or events have already resulted in morbidity
The purpose of tertiary prevention is to limit disability and to rehabilitate or restore the affected people to their maximum possible capacities
Examples include physical therapy for stroke victims, exercise programs for heart attack victims, and mental health counseling for rape victims