460 study guide

8/10/2019 460 Study Guide

1/13

Community Health Final

Chapters 27, 28, 29, 30, 31, & 32

Chapter 27: Violence

Violence is a national public health problem.

Interpersonal violence

Homicide (15th

leading cause of death in the united states)o

The united states ranks first in the industrial world in violent death rates

o Who is usually the perpetrator of a female homicide?

An intimate partner- 30% of female murder victims are killed by an

intimate partner

Homicide is the leading cause of death in pregnant women

Suicide is the 8thleading cause of death for all Americans. More people die from

suicide than from homicide in the united states.

Intimate partner violence (IPV)

o Ipv is the single greatest cause of injury to women between the ages of 15-24

o Rape is not about love or sex; its about power and control

o

The most dangerous time for a victim is when the victim leaves or attemptsto leave the relationship, because it is seen as an erosion of the abusers

control. (The victim is most likely to be abused at this time more than any

other time in the relationship)

o Power & control wheel

Professional intervention is required to break the cycle of abuse. I

am legally required to report this.

Child abuse

o Most child abuse occurs within the family

Physical abuse

Shaken baby syndrome

o

Violent shaking of an infant causes brain and spinalcord trauma

o Leading cause of death from child abuse in the us

o In approximately 65-90% of shaken baby cases, the

father or mothers boyfriend is the perpetrator

o An 84 year olf woman lived with her youngest

daughter, the daughters live in boyfriend, and 1

child. On this visit, the nurse noted the woman

appeared depressed and dehydrated. Both wrists

were swollen and scabbed. When asked if she was all

right, the woman protested she was fine and her

daughter took good care of her. What action shouldyou take?

According to the text, working with victims of

elder abuse, the nurse must establish rapport

& trust first; remember that competent adults

have the right to make decisions about their

own care, including to stay in a abusive

situation; the nurse should discuss measures


2/13

to relieve stress and possible respite care

options with the daughter. The second goal is

to report the abuse.

Wisconsin has always had, and will generally retain, a

voluntary reporting system. Voluntary rather than mandatory

reporting was selected based on this states commitment toan adults right to self-determination.

Community violence

o Workplace violence(what are most dangerous for health care staff)

In the health care field, the most frequent areas for the occurrence

of violence are the emergency departments, psych units, geriatric

units, and waiting rooms

o Gangs

Although gang problems declined in the 1990s, they have steadily

increased since that time

In 2007, there were estimated 788,000 youth gang members in

27,000 active gangs. By 2011 there were 30,000 gangs in the usanever-increasing problem!

o Hate Crimes

Often considered worse than other crimes involving violence

because the crime is personal, attacking the victims identity

Chapter 28: natural & man made disasters

Disaster vs emergency

Disaster: any event that causes a level of destruction, death, or injury that affects the

abilities of the community to respond to the incident using available resources

Emergencies differ from disasters in that the agency, community, family, or individualcan manage an emergency using their own resources.

Often times a disaster event may be beyond the ability of the community to respond to

and recover from the incident using its own resources

A disasteraffects the whole community, whereas an emergencyoccurs at a personal

level and the person, family, community can manage the event with their own

resources.

Acts of terrorism

Terrorismis the use of force or violence against persons or property in violation of the

criminal laws of the united states for purposes of intimidation, coercion, or ransom

Threats of terrorismo Assassinations

o Kidnapping

o Hijacking

o Bomb scares & bombings

o

Computer based attacks

o Chemical, biological, nuclear, radiological weapons

Terrorists goal: to coerce and create fear to accomplish their goals


3/13

When should a disaster planned be developed?? Before the disaster occurs!

Local, state, & federal responsibilities

Remember! Agencies and disaster incidents are handled at the lowest possible

organizational and jurisdictional level

Local government

o Responsible for the safety and welfare of its citizens

o The local office of emergency management is responsible to develop a

community disaster plan, have emergency drills to test the plan, and

determine the proper response

Federal government

o Main goal: ensure continuity of essential federal functions during any

disruption

National incident management system (nims): integrates practices in disaster preparedness

and response into a comprehensive national framework for incident management.

Federal emergency management agency (fema):Mission= to lead the efforts to prepare the

nation for all hazards and to manage the federal response and recovery efforts following a

national incident

Fema also initiates proactive mitigation activities, trains first responders, and

manages the national flood insurance program and the us fire administration

American red cross (ARC): though chartered by congress to provide disaster relief, is not a

government agency. Primarily a volunteer organization.

Preparedness/planning State: Individual and family preparedness

Individual and family preparedness includes training in first aid, assembling a

disaster emergency kit, establishing a predetermined meeting place away from

home, and making a family communication plan.

Who should create a disaster plan including emergency supplies and where to

meet in case of emergency? Your family

Community disaster planning

The plan should indicate who has the power to declare there is a disaster and has the

power to initiate the disaster plan.

Response stage

30-2 can do

o where 30 is the # of respirations, 2 is the # of seconds needed to check

perfusion, and can do relates to checking mental status

o

to assess an individual within the 1 minute guideline, the system uses three

characteristics:

First, respirations are checked;


4/13

Second, perfusion by pinching the nail bed and observing the

reaction;

Third, mental status, by asking simple questions beginning with,

who are you? Then where are you hurt?

o Remember! Before search and rescue begins, safety must be considered

Disaster triage

Start: Simple Triage And Rapid treatment

Red-life threatening; requires immediate care

Yellow- urgent, but can wait an hour, such as someone with an open fracture but

controlled bleeding

Green-walking wounded, can delay for three hours

Black- mortally wounded, no care required (dead)

The classic 4 phases of a communitys reaction to a disaster

1. heroic phase

a.

during this phase, nearly everyone feels the need to rush to help peoplesurvive the disaster

b. medical personnel may work hours without sleep, under very dangerous

and life threatening conditions, in order to take care of their patients.

2. honeymoon phase

a. individuals who have survived the disaster father together with others who

have simultaneously experienced the same event.

b. Bonds are formed between victims, between health care workers, and

between victims and health care workers who have shared experiences.

3.

disillusionment phase

a. when time has elapsed and a delay in receiving help or failure to receive the

promised aid has not occurred, feelings of despair occur. Depression mayset in.

4. reconstruction phase

a.

once the community has restored some of the buildings, businesses, homes

and services, and some sense of normalcy is occurring, feelings of despair

will subside

b. counseling support for victims and helpers may need to be initiated to help

people recover.

On an individual level, common responses to a traumatic event include:

cognitive: poor concentration, disorientation, indecision, shortened attention span,memory loss, unwanted memories, difficulty making decisions

emotional: shock, numbness, feeling overwhelmed, depression, feeling lost, fear of

harm to self/loved ones, feeling nothing, feeling abandoned, uncertainty

physical: nausea, light headedness, dizzy, gi probs, rapid HR, tremors, grinding of teeth,

fatigue, poor sleep, pain, hyperarousal, jumpiness


5/13

behavioral:suspicion, irritability, arguments with friends/loved ones, withdrawn,

excessive silence, inappropriate humor, increased or decreased eating, change in sexual

desire or function, increased smoking, increased substance use or abuse

*it would not be normal to have no unusual feelings

post traumatic stress disorder (PTSD)

psychiatric disorder that can occur following an individuals experiencing or witnessing a

life threatening event, such as a disaster

people who suffer from ptsd often relieve the experience through nightmares and

flashbacks

sometimes occurs 1-3 months post event

the reactions mentioned usually resolve in 1-3 months after the disaster event, but in

some cases may lead to ptsd

research has ided 4 keys to gauging the mental impacts of such events, any two of

which may result in severe, lasting, and pervasive psychological effects:o 1. Extreme and widespread property damage

o 2. Serious and ongoing financial probs

o 3. High prevalence of trauma in the form of injuries, threat to life, and loss

of life

o 4. When human intent caused the disaster

in the case of arson- when a fire was deliberately set & lives were lost, that disaster will

be more disruptive than disasters when only property was damaged.

Chapter 29: School Health

National School Lunch program (1946)

o

Legislation marked the first entry of the federal government into school

health programs

o School health services goals and objectives vary from state to state,

community to community, and school to school. These differences reflect

wide variations in student needs, community resources, funding sources,

and school leadership preferences.

# of children seen my school health nurse increasing bc many children do not have

a regular source of health care.

Injury prevention

schoolyard & playground safety

over 200,000 children a year are injured on playgrounds in the us (comes in 2ndafter

injuries in homes)

smoking

single leading preventable cause of death in the united states


6/13

most commonly used drug among children and adolescents is alcohol

most commonly used illicit drug among young in us in marijuana

dental health

one of the most frequent health complaints of school aged children in dental caries

causes- poor oral hygiene, lack of fluoridated water, and lack of funds or insurance fordental care

half of children aged 12-15 years will have dental caries

approx 75% of those between the ages of 12 & 19 yrs have had tooth decay

Immunizations

Because states require proof of current immunization status or evidence of immunity

before school entrance

School nurse plays an important role in verifying compliance, educating children and

parents about immunizations, and coordinating school immunization programs

As a result of these laws, vaccine preventable deaths (VPD)are at or near record low

levels. According to the CDC many vaccine preventable communicable diseases have

been reduced by greater than 95% as a result of immunizations

Early Periodic Screening, Diagnostic, & treatment services

Medicaid-eligible children are guaranteed access to comprehensive health care services

and routine dental exams.

Screening services must include:

o

Comprehensive health and developmentalhistory

o

Unclothed physical exam

o Immunizations & lab tests that are age appropriate

o Lead toxicity screenings (because these children have very low income it is

likely that they live in older housing that may have lead paint (private

physicians caring for kids with insurance unlikely see this problem)

Most common chronic school age chronic health problem that a school nurse manages

Asthma

o More than 6.7 million children (9%) under the age of 18 have asthma

o One of the most common chronic childhood conditions and accounts for

some 14 million lost school days every year

o Obesity, htn, heart disease, and diabetes continue to rise d/t sedentary life

style

Category of meds administered in schools the most meds to treat adhd

Care of children with special health needs

o Several legislative acts focus of the right to public education in the least

restrictive environment possible regardless of mental of physical disabilities

Individuals with disabilities education act 1990

o Children with special needs include those with severe sensory or motor

challenges, mental and emotional challenges, and chronic illnesses. Some


7/13

require specialized equipment and treatments with which nurses must be

familiar

o Nurses must maintain thorough records while ensuring hipaa confidentially

standards- this includes interacting with school administration

Delegation of tasks Necessary; however when tasks are delegated, the nurse still maintains responsibility for

care and outcomes. A nurse cannot delegate:

o

Assessments, Diagnosis, Goal Setting, Evaluation

when tasks are delegated the nurse must provide appropriate education, written

procedures, and ongoing supervision and evaluation of the caregivers.

Family educational rights and privacy act (FERPA)

a strong privacy protection act, protects students education records, including the health

record

sharing confidential information with others (even school principals & administrators)

without approval is considered unethical and improper except in emergency situations what would you do if your principal asked to see the health records of several severely

handicapped kids?

o Respond with, Ive very glad youre interested in our students, however

student health records are confidential, but ill give you a overview of our

students without sharing any iding information

Everyday a child comes into the school nurses office with vague complaints, most of the

time it seemed to the nurse the child needed to be listened to. Unfortunately the child

usually took 15 mins of the nurses time each day..what should she do?

o A nurse or teacher may be the only stable adult in the childs life who will

listen without being judgmental. One of the most important roles of the

school nurse is to be a counselor and confidante. Children may come to theschool nurse with various vague complains such as recurrent stomach aches,

Has, or sexually promiscuous behavior, and the nurse must look beyond

the initial complaint and spend time with the child to id underlying probs.

A female coach comes to your office and shares that she is worried about one of her

female students. the student doesnt seem to move right and she wont put on her gym

clothes. What would you do?

o Meet with student and ask directly about sexual or physical abuse

The school nurse can assist the faculty and staff by giving workshops on exercise and

nutrition, screening for increased bp and establishing weight management programs

o Providing these types of workshops are an excellent way for a school nurse

(especially a new one) to get to know the school staff through these activitieshe/she will be building trusting relationships with the staff.

Chapter 30: Occupational health

An occupational health nurse works in a state that requires continuing education units

per year for renewing a nursing license. A course that would be helpful in the role


8/13

Ergonomics and toxicology; bc inherernt in the science needed to function in

occupational health

Demographics in the workplace were also dramatically different during WWII as

increased numbers of women entered the workforce and the us surgeon general

reported the health conservation of the industrial army was the most urgent civilianneed during war

Ohn jobs expanded through 20thcentury bc employers realized that ohns worked to

avoid injuries and keep employees healthy

These actions allowed employers to achieve savings in costs

By 2010 the baby boom generation reached the ages of 45-64 and middle and older

age groups in the labor force now outnumbered younger workers; with this increase in

age we see increase in hc costs

Corporations have become driving forces in shaping the development of alternativeapproaches to health care. Rapidly increasing health care costs have spawned a number

of alternative approaches to providing health care such as managed care

Women with children and aging parents. Implications?

o Female employees who believe their employers are interested in their well

being are more productive and satisfied workers

Ergonomics: adaptation of the work site to the worker to establish the best fit

between the human and job conditions to maximize health and well being

Ethical dilemmas arise because the nurse is loyal to both workers and management

Use aggregate-focused intervention strategies-such as walk throughs

o Performing a walk through on a regular basis is a critical component of a

ochns success- by engaging in this activity, he/she is able to recognize

potential and existing hazards, and maintain communications with safety

and industrial hygiene staff to prevent illness and injury from occurring

Primary prevention strategies

o

Providing education regarding cardiovascular health, cancer awareness,

personal safety, immunization, accident prevention, ergonomics, retirementhealth, stress management, and relaxation techniques

tertiary prevention strategies

o rehab and restoration of the worker to an optimal level of functioning

avoiding disability syndrome

ex- when the nurse works with the employer to create a transitional

duty pool. The goal is to provide temporary work that is less

physically demanding in nature than the employees regular work.


9/13

This facilitates the employees return to the workplace earlier than if

required to wait until full strength and health are regained.

Ex might be to help an employee who suffered a heart attack at

work be acclimated back into the workforce by providing a less

physically demanding role

Skills and competencies of the OHN

o

Key practice areas: health promotion and prevention, health hazard

assessment, primary care, and case management

Osha does the following:

o Determines and sets standards for hazardous exposure in the work place

(ex. Noise, hazardous chemicals, blood borne pathogens, fork lift safety,

etc)

o Mandates that employees be educated about occupation health and safety

o Monitors compliance with occupational health and safety standards

o

Osha does not conduct research

Workers compensation acts (state based)

o

State mandated and state funded

o Programs provide income replacement and health care to workers who

sustain a work-related injury, temporary or permanent disability, or death

Chapter 31: Forensic & Correctional nursing

The term forensic means pertaining to the law; legal

o Due to the prevalence of violence and violent crimes- all persons should be

assessed for evidence of abuse, not just vulnerable groups

o

Screening for violence is now considered to be a minimum standard of carefor all client

Forensic nursing responsibilities may include:

o

Screening

o Assessment and collection of evidence from both victim and perpetrator

o Documentation and expert testimony from victims and perpetrators in

settings such as hospitals, community clinics, or death scenes

o Involvement in paternity disputes

o

Cases involving workplace injury, malpractice, vehicle accidents, food or

drug tampering, and medical equipment defects

A SANEnurse was called to the emergency department to help with a woman who has

been severely beaten and raped

o Nurses responsibilities as a forensic nurse is to initiate proper collecting,

preservation, and chain of custody of evidence with appropriate

documentation


10/13

The national association of medical examiners (NAME) ids 5 acceptable options for

recording manner of death:

o 1. Natural

o

2. Accidental

o 3. Suicide

o

4. Homicideo 5. Undetermined

nurse coroner

o Utilizes crucial communication skills and empathy when dealing with

grieving families (this is a specific skill set for a forensic nurse)

o

Nurses are acutely aware of the importance of using open ended questions,

attentively listening, and being fully present with family and friends

An emergency department nurse wasnt sure whether there was enough evidence one

way or the other to suspect child abuse with a child client, as there wasnt much

evidence of physical harm. The forensic nurse agreed to see the child. What would bethe forensic nurses primary focus? observe the childs appearance and behavior and

how the child interacted with other children and adults

Who are the most likely to abuse the elderly?

o The national center on elder abuse reported that adult children are the

most frequent abusers of the elderly

o Neglect is the most common form of elder abuse

Forensic psych nursing collects evidence by determining intent or diminished

capacity in the clients thinking at the time of the incident

Correctional nursing

The primary goal in correctional facilities are security and a safe and humane

environment for inmates

what would be the correctional nurses first and most crucial responsibility if a prisoner

were bleeding where another inmate had attacked him with a fork?

o Unlike any other care setting, clients are inmates and care is negotiated and

provided with recognition of safety and security 1stfor the nurse

o The nurse must be cognizant of an escape route before he/she enters the

area to provide care for the injured inmate-safety always comes 1st

Adolescent in prison

o A particular concern for incarcerated adolescents occurs when they are

incarcerated in adult facilities

o Adult facilities that are ill equipped to deal with the challenges of adolescent

development

o Must be aware of their individual vulnerability


11/13

o Adolescents in an adult correctional facility are 5x more likely to be sexually

assaulted, three times more likely to be beaten by prison guards, and 50%

more likely to be assaulted with a weapon or to threaten suicide when

compared with adolescents in a juvenile center

o Juveniles in detention and correctional facilities are 4 times more likely than

youths in the general public to commit suicide and 50-75% have diagnosedmental illnesses

o To ensure the safety of adolescents in an adult facility, the nurse must be

aware of their individual vulnerability

o A mechanism for adolescents to access medical and mental health care is

essential

o The services provided must also be in the context of the developmental

stage and experience of adolescence- so placing a adolescent in an adult

prison setting is something that should never happen

The correctional health nurse was completing an admission physical for a newly

incarcerated prisoner. The nurse realized the prisoner was talking to someone other

than the nurse. What does the nurse need to remember

o Prisons and jails have become the residence of a very large number of

persons who have mental illness

Respect the inmates right to refuse medication- even if the result is an adverse outcome

Education and forensic nursing

Require in depth knowledge and skills acquired through specialized programs of study

Colleges and universities have begun to offer these specialized programs to educate

forensic practitioners

They may obtain a certificate in forensic nursing, a minor or concentration, or agraduate degree

The specialized curriculum includes: nursing fundamentals such as evidence collection,

documentation, and testifying, along with forensic law and science. Plus the nurse must

complete supervised clinical hours or a clinical internship

Chapter 32: Faith Community Nursing

The national health interview survey found that people who attended religious services

weekly or more often had a life expectancy nearly 5 years greater than those people who

never attended an organized religious meeting, these persons experience decreased anxiety,

depression, and stress

Throughout hx, churches have provided care for the indigent and disenfranchised, meeting

basic needs and basic health care

History

Westberg envisioned a partnership between the hospital and all church congregations

in the hospitals community and proposed in 1984 that participating churches would


12/13

make contributions to fund a nurses salary. His plan was implemented in 1985 as a

joint venture with Lutheran general hospital & 6 congregations in Chicago area, thus

was born modern parish nursing

1997 parish nursing recognized as nursing specialty by ana

2005 (spring) the scope and standards for faith community nursing

o

ana revised the standards providing a clearer definition of the practice andchanging the name of the specialty from parish nurse to faith community

nurse. While acknowledging the importance of the Judeo-Christian basis of

the practice, the authors believed the change better reflected the diversity

now found in the specialty.

What is Faith Community nursing?

Faith community nursing is the specialized practice of professional nursing that

focuses on the intentional care of the spirit as part of the process of promoting holistic

health and preventing or minimizing illness in a faith community

a focus on spiritual dimension is central to the practice of a Faith Community Nurse

Key Features of a FCN:

Integration of faith and health

Holistic approach

Focus on health promotion (primary level prevention)

Focus on community

a rn with at least a bsn, several years of experience in clinical practice, plus formal

education as a fcn

Plus taken the basic parish nurse course (most of these nurses have worked >20 yrs)

Works with ministerial team and health committee of his/her parish

Seeks to creatively bridge the gaps ided in health education and health care delivery

*usually does not do hands on care and tries not to duplicate other available health

services

it is crucial fcn have at least a bacc degree as well as several years of experience because

they need to be autonomous with self direction and an independent decision maker

facilitation/networking- a fcn often finds the communities needs overwhelming, a good way

to manage the overwhelming needs involves recruiting, training, and directing volunteers

needed to implement needed programs

Spirituality- an individuals essence as a person; the human desire for a sense of meaning,

purpose, connecting, and fulfillment through intimate relationships and life experiences.

Spirituality is seen as being intertwined with mind, body, and emotions

Spiritual distress: a disruption in the life principle that pervades a persons entire being

and that integrates and transcends ones theological and psychosocial nature adisruption

of ones belief system


13/13

Symptoms of spiritual distress- loneliness, isolation, and hopefulessness

Circle model of spiritual care

1.

Caring

2. Intuition (Acting on instinct- intuitive abilities as responses that expert nurses have

after several years of experience and these abilities enable the nurse to readbetween the lines

3. Respect (Understanding the importance of religious beliefs and practices)

4.

Caution (avoiding proselytizing or preaching religion to clients

5. Listening (allows an understanding of spoken and unspoken words and feelings,

encourages open communication, and supports and empowers patients to

communicate needs and desires)

6. Emotional support (the link between the physical and spiritually; includes working

with feelings, showing love, and using appropriate touch and empathy)

What can you do to provide spiritual support

Dying patient asks you to pray outloudo

Use a traditional prayer you have memorized from the dying persons faith.

If you do not have that knowledge, then use a prayer book from that

individualsfaith and find suitable prayer. A guideline to follow is to keep

the prayer simple and offer the request to the clients higher power

What might cause ethical conflict for a fcn?

o Policies, values, & beliefs

o The nurse must understand the policies, values and beliefs of the

congregation related to specific health issues

Sharing methods dealing with infertility

o Nurse must understand his or her own beliefs and values that are in conflict

with the faith communities beliefs. She must ask to be excused from thestation if a couple wants to obtain information inconsistent with the churchs

teaching.

Plague

Ebola

Anthrax

Small pox

norovirus

460 study guide

Documents