Exam 2 Study Guide - Community Health

7/24/2019 Exam 2 Study Guide - Community Health

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Exam 2 Study Guide

Understand the levels of prevention

Families: who, concerns, theories

** Provide cultural competent care when providing care for diverse and changing

families - Family= refers to two or more individuals who depend on one another for emotional,

physical, and/or financial support. The members of the family areself-defined

* may range from traditional notions (biological/genetic blood ties) of the

nuclear and extended families to postmodern structures (adoption,

guardianship, and marriage)

- Family structures changes over time

- Family as client = the family is the primary focus and individual family members are

secondary

- Family as system= implies when something happens to one family member, the other

members of the family system also are affected, and vice versa* viewed as a interactional system(whole is more than the sums of its

parts)

- interactions among family members become the focus (ALL affected)

- Family as context= individual first, family second

* Family has influence on individual health (family = helpers for health)

- Family as component of society

** Family demographics= can be analyzed by looking at data about the families and

household structures and the events that alter these structure

* Nurses can draw on family demographic data to forecast and predictfamily community needs

Theories

1) Family systems theory= families are social systems

- Nurses can learn much from a systems approach

= family as a WHOLE

-view the individual clients as participating members of a

whole family (family interactions)

2) Family development and life cycle theory= focuses on predicted stresses of

families as they change and transition over time

- focuses on the common tasks of family life

3)Bioecologial systems theory= describes how environments and systems

outside of the family influence the development of a child over time

** Health values, health habits and health risk perceptions are effected by and acted out within

the family environment **


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Health risks= factors that determine of influence whether disease or other unhealthy results

occur

Health risk appraisal= process of assessing for the presence of specific factors associated with

an increased likelihood of an unhealthy event or illness

1) Biological risks

- Age-related risks- Social and physical environment risks

2) Environmental risks

- Economic aspects (social and physical aspects)

3) Behavioral risks

Health risk reduction= based on the assumption that decreasing the # of risks or the magnitude

of risk will result in a lower probability of an undesired event occurring

Home-visiting: why, how, challenges, types of visits, tools

Why?= allows for a more accurate assessment of the family, and the role of the

environment on their health (ex. lifestyle, nutrition, and safety)- can identify strengths/barriers, community resources that they are already

using

- families are most comfortable in their own home

Process (How?)

1) Initiation phase = first contact between the nurse and family (foundation)

& clarifies the purpose of the visit

2) Pre-visit phase (initiation phase) = initiate contact with family and establish

shared perceptions of purpose with family

3) In-home visit phase = actual visit to the home which allows the nurse theopportunity to assess the familys neighborhood and community resources,

as well as home and family interactions

4) Termination phase = when the purpose of the visit has been accomplished, the

nurse reviews with the family what has occurred and what has been

accomplished

* provides a basis for planning further home visits

5) Post-visit phase = documenting the visits and services provided; plan the next

visit with the family

Advantages and Disadvantages

Advantages

- Client Convenience

- Client control of setting

- Availability of an option for those clients unwilling or unable to travel

- Ability to individualize services

- Natural, relaxed environment for the discussion of concerns and needs

- Identify barriers and provide support for family health promotion goals


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Disadvantages

- Time spent with one client

- Cost of pre-visit preparation

- Travel to and from the home

- Post-visit preparation

Types of Home Health Care

Home Health care= focus is on the three levels of prevention

Home health nursing= focus is on empowerment for highest possible levels of

function and health

* Provide INTERMITTENT nursing visits

Hospice and palliative care = focus is on optimizing quality of life for those

experiencing life-limiting, progressive illness

Tools

Genogram= displays pertinent family information in a multigenerational familytree format

* shows family history and patterns of health-related generations

(biological risks)

Ecomap= visual diagram of the family unit tin relation to other units in the

community

* shows the nature of the relationship among and between family

members and the community(social risks)

Transitions of Care: errors, contributing factors, teams and members, roles of nurses

Errors- NOT: developing a comprehensive discharge care plan

reconciling patient medication lists from one facility to another

including the family in the planning process

communicating and collaborating with the right people at the new facility

getting in touch with the right community resources to support the patient

starting the planning process soon enough

Contributing Factors

- Use of hospitalists

- Incompatible computer systems

- Staff does not always know drugs well enough to give instructions

- Inconsistent med review before discharge

* Duplicate RXs

* Sent home on discontinued meds

- Unclear role definitions (Who makes the call? Who does the education?)

- Myriad of insurance policies

* What they cover

* In network providers


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WHO FOLLOWS UP ON THE FOLLOW UP???

Team and Members of Comprehensive Collaborative Care

- Pharmacists

- Dieticians

- Someone from the transitioning agency

- Family- Primary care provider

- Community resources

Role of Nurses

- BE PART OF THE D/C PROCESS THE MOMENT YOU ENTER THE

ROOM

- Find out what went on in the hospital

- Act like an conductor w/ family, facility, primary care, and community

- Monitor for any health changes (~ during first 48-72hrs)

- Promote and evaluate the patients ability to self manage their conditions

Chapt 38 - Violence and Human Abuse

Prevention of violence

Primary prevention (PREVENT)

- Addressing social determinants

- Teaching parents positive child-rearing and management skills and

strategies that are safe and nurturing

- Educate young children on conflict resolution, health relationships

Secondary Prevention (SCREEN & PROMPT)

- Screening for violence - ask the questions

- Crisis Lines- Respite Care

Tertiary Prevention (TREAT)

- Counseling - providing a safe place to talk

- Mandatory reporting (Referral)

- Family support and resilience training

Community violence

* Contributes to significant mortality and morbidity often results

* Unemployments is a factor

* HIGH CRIME RATE = only community characteristic of violence

* Mostly occur in recreational facilities, jails, care settings, schools, gangs,

terrorism, war, workplaces, bullying

Child Abuse

* Mostly occurs :when parents have a lack of social support

- history of abuse as a child

- have minimum education

- tendency towards depression

- multiple stress factors


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- unemployed

Emotional Neglect= omission of basic nurturing, acceptance, and caring

of a child

Physical Neglect= failure to provide adequate food, shelter, proper

hygiene, or necessary medical care

* Required by law that all nurses report any SUSPICION OF CHILD ABUSE* Increased risk= less than 4yo & children with special needs

Intimate Partner Violence

* Greatest risk factor for suicide for women

* Feel grief for leaving the relationship

* Signs = physical marks; low-self esteem, PTSD, or depression

* Abuse as a process

1) Victim initially downplays/denies seriousness; period of self-blame;

moral conflict; leave or stay?

2) As violence escalates - abusers remorse lessens

3) Moment of leaving the relationship is moment of greatest risk forhomicide

Elder Abuse

* Risk for financial abuse through fraud

- coercion to relinquish property rights

- money mismanagement

* Prevention = increased training in screening and awareness

* Frequently underreported

- Victims are reluctant to report it

- Elders bruise easily - can be misinterpreted

- Elders are frequently socially isolated- Many providers do not consider it or report it


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Motivational Interviewing

= tool used to help clients state their motivations to change

- collaborative partnership between the teacher and the learner designed to help people

make their own decisions

- Seeks to help clients resolve their ambivalence about change and uses the techniques of

elaboration, affirmation, reflection, and summary to engage people in talkingabout change

Techniques and Strategies

- Use open-ended questions

- Ask for permission

- Reflective listening

- Exploring Ambivalence

- Developing a discrepency

- Readiness to change ruler

- Exploring importance and confidence/scaling questions

- Affirmation statements

Distributive Justice (social justice)

= allocation of benefits and burdens to members of society

* Benefits refer to basic needs including material and social goods, liberties,

rights, and entitlements.

- Wealth, education and public services

* Burdensinclude such things as taxes, military service, and the locations of

incinerators and power plants

* Justice requires the distribution of benefits and burdens in society be fair or

equal

Chapter 44 - Forensic Nursing: Jobs, purpose, collection of evidence

Jobs

- Sexual Assault Nurse Examiner (SANE)

- Clinical forensic nurse

- Forensic nurse examiner

- Forensic psychiatric nurse

- Forensic correctional nurse

- Legal nurse consultant

- Nurse attorney

- Nurse coroner or death investigator

Purpose= Address social justice as well as care for offenders

- Synthesis of biopsychosocial and spiritual aspects of nursing care with an

expert understanding of forensic science and the criminal justice process


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Trace of Evidence from victims of violence

- clothing

- bullets

- bloodstains

- hairs

- fibers- small pieces of material (fragments of metal, glass, paint, and wood)

Collaborate with:

- correctional officers and law enforcement

- epidemiologist

- emergency department providers

- psychiatric practitioners

- public health nurses

Communicable Disease Transmission: Processes, time periods, communicable disease movementin populations, chain of infection, epidemiologic triad, immunity

Epidemologic Triad

Immunity = species-determined resistance to an infectious agent (Host)

Documents

Exam 2 Study Guide - Community Health