NR442 Community Health Nursing

NR442 Community Health Nursing Exam 3 Overview & Outline Note: This outline is not all inclusive but serves as a guide for your study. Please make sure you have read all of the assigned chapter(s), reviewed the power point(s), your lecture notes, and participated in the in-class activities/discussions. Chapter 14 • Define the Critical Theory Approach to Environmental Health o Is an approach that raises questions about oppressive situations, involves community members in the definition & solution of problems, & facilitates interventions that reduce health-damaging effects of environments o Uses “thinking upstream” framework. o Raises questions about oppressive situation. o Involves community members in the definition and solution of problems. o Facilitates interventions that reduce health-damaging effects of environments. o Ask critical questions about clients’ work and home environments to help discern the contributions of specific hazards to health. • Identify the Areas of Environmental Health with examples of each a. Living patterns: are the relationships among people, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs. ▪ Examples: drunk driving, secondhand smoke, noise exposure, urban crowding, technological hazards b. Work risks: include the quality of the employment environment and the potential for injury or illness posed by working conditions. ▪ Examples: occupational toxic poisoning, machine-operating hazards, sexual harassment, repetitive motion injuries, carcinogenic worksites c. Atmospheric quality: refers to the protectiveness of the atmospheric layers, the risks of severe weather, and the purity of the air for breathing purposes ▪ Examples: gaseous pollutants, greenhouse effect, destruction of the ozone layer, aerial spraying of herbicides and pesticides, acid rain d. Water quality: refers to the availability and volume of the water supply and the mineral content levels, pollution by toxic chemicals, and the presence of pathogenic microorganisms. Water quality consists of the balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance. ▪ Examples: contamination of drinking supply by human waste, oil spills in the world's waterways, pesticide or herbicide in filtration of groundwater, aquifer contamination by industrial pollutants, heavy metal poisoning of fish e. Housing: is an environmental health concern and refers to the availability, safety, structural strength, cleanliness, and location of shelter, including public facilities and family dwellings. ▪ Examples: homelessness, rodent and insect infestation, poisoning from lead-based paint, sick building syndrome, unsafe neighborhoods f. Food quality: refers to the availability, relative costs, variety, and safety of foods, and the health of animal and plant food sources. ▪ Examples: malnutrition, bacterial food poisoning, food adulteration, disrupted food chains by ecosystem destruction, carcinogenic chemical food additives g. Waste control: is the management of waste materials resulting from industrial and municipal processes, human consumption, and efforts to minimize waste production. ▪ Examples: use of nonbiodegradable plastics, poorly designed solid-waste dumps, inadequate sewage systems, transport and storage of hazardous waste, illegal industrial dumping h. Radiation risks: are health dangers posed by the various forms of ionizing radiation relative to barriers preventing exposure of humans and other life forms. ▪ Examples: nuclear facility emissions, radioactive hazardous wastes, radon gas seepage in homes and schools, nuclear testing, excessive exposure to x-rays i. Violence risks: violence include the potential for victimization through the violence of particular individuals and the general level of aggression in psychosocial climates. • Describe the Effects of Environmental hazards o Effect on the public’s health is complex & generally interconnected (nuclear power plant emissions may contaminate water & air supplies, affecting water quality, atmospheric quality, & radiation risk) o A direct relationship to the development of some cancers, chronic diseases, & other health-related problems o Effects of environmental risks may also be indirect (global warming) o Effects of environmental hazards may be general or specific (extensive smog, drought, high unemployment) o Can be immediate (burns, gunshot wounds, hurricane damage, & outbreaks of GI distress), long term (occupational hearing loss, black lung in coal miners, & increased rates of thyroid cancer among young victims of the Chernobly accidents, or transgenerational -(female factory workers exposed to radiation at plutonium-processing plants) • Describe how to the Approach Environmental Health at the Aggregate Level o Focuses on health promotion & disease prevention in specific areas o Facilitate community participation in identifying & solving environmental health problems & bring about changes that improve environments & eliminate hazards • Critical Community Health Nursing Practice o Take a Stand: Advocating for Change – must make individual & collective decisions about which interests they want to serve w/ their specialized knowledge & skills ▪ Potential to make increase/decrease these inequities through the decisions they make about the positions they accept & the interventions they undertake o Asking Critical Questions – ask how policies concerning ecological preservation, energy, housing, immigration, civil rights, crime, nutrition, minimum wage, occupational safety, & defense might affect the well-being of people ▪ Addressing who has access to resources in this country, & whose interests are served in the existing system, provides a way to include social, political, & economic factors in environmental nursing assessments ▪ Can frame the problem & assist in building collective strategies o Facilitating Community Involvement – to help people learn form their own experiences & analyze the world w/an intention to change it ▪ Essential that the affected people participate in the process of identifying & working to solve environmental problems ▪ Nurses must be prepare to take leadership positions & join in mutual exchanges w/ community members that consider each person’s experience • Provide support, information, & expertise to groups to assist them in meeting the goals they set for environmental change • Help community members look beyond immediate environmental problems & explore social, cultural, economic, & political circumstances that contribute to them o Forming Coalitions – to produce social change, join w/communities to eliminate hazards & improve public health ▪ Nurse can expose hazards, assess needs, plan actions, report abuses, & secure appropriate resources, personnel, funding, & legislative changes • Helping community groups make connections w/larger, more powerful organizations • Each issue or problems requires appropriate strategic action based on its own merits o Using Collective Strategies – use a variety of strategies to intervene at the aggregate level & facilitate improvement in a community’s health ▪ Participation action research – nurses, community members, & other resource people to work together in identifying environmental health problems, designing the studies, collecting & analyzing the data, disseminating the results, & posing solutions to the problems • Distinguish between environmental health approaches that focus on altering individual behaviors & those that aim to change health-damaging environments. o Altering individual behaviors –address deleterious personal habits through exercise programs, weight- loss regimens, smoking cessation classes, & stress-reduction tactics o Change health-damaging environments – work w/the public to promote more stringent & actively enforced environmental legislation & regulations ▪ Support actions for biodiversity (pushing back the deserts, replanting the forests, stabilizing the climate, & seeking alternative development pathways that do not destroy plant & animal species ▪ Incorporate that fact that individual & community health ultimately depends on global environmental integrity • Identify aggregates at risk for particular environmental health problems. o Non-English-speaking individuals o Children o Very-low income women & families o Undocumented manual laborers o People from racial & ethnic minorities Chapter 15 • Describe & define the Patterns of Health and Disease o Lifestyles, health and cultural beliefs, infrastructure, economics, and politics affect existing illnesses and society’s commitment to prevention. o Disease patterns vary throughout the world. o Racial, ethnic, and access disparities exist within and between countries. • Describe globalization o The process of increasing social and economic dependence and integration as capital, goods, persons, concepts, images, ideas, and values cross state boundaries, is inextricably linked to the benefits and challenges of our time • Define the role of the community or public health nurse in international care o Seek to ensure the attainment of health for all in a cost-effective, efficient, accessible health care system. o Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation. o Coordinate work with other health care personnel and community leaders as well as local and global community leaders. o Utilize changes in the health environment to form the basis for the nursing role. o Primary health care ▪ Essential services that support a healthy life. ▪ Involves access, availability, service delivery, community participation, and the citizen’s right to health care. o Primary care ▪ First line or point-of-access medical and nursing care controlled by providers and focused on the individual. ▪ May not be the norm as needs of the group outweigh the needs of the individual. o All nurses in the world must understand and learn from one another. Nurses are health care’s most valuable assets. o Community public health nurses can improve access to care for the most vulnerable and hard-to-reach groups in any country. o The future demands evidence-based learning, engagement service, and growth in information technology and global health policy. • Service Learning Pg. 282 Box 15-2 o Providing services to those in need while at the same time learning in your field of interest and having the ability to work with those less fortunate. It is a hand-on learning experience that, for me, was life changing and eye opening. o It is volunteering with doing something that you are in the field of doing or obtaining a degree in. o Service learning is a unique way of learning in and about a community and providing services for the betterment of a community. Service projects provide communities with people who are able to use their time, resources, and expertise in order to improve or help the community in which they are serving. At the same time, the people involved in the service project are learning from their experiences with the project. o Service learning is a volunteering project that is done to help the community in some positive way while the volunteer has the opportunity to broaden their own horizons by learning something new. o Utilizing skills and knowledge acquired in the classroom as a means to enhance the community • International Agencies and Organizations (Be sure you know about each agency listed) o World Health Organization (WHO) ▪ Is an international health agency of the United Nations ▪ Directs & coordinates international health efforts, producing & disseminating global health standards & guidelines, helping countries to address public health issues, & supporting health research o Pan American Health Organization (PAHO) ▪ Is an international public health agency w/ nearly a century of experience in working to improve the health & living standards of the Americas. ▪ It serves as the regional office of WHO & is recognized as part of the United Nations system. o United Nations International Children’s Fund (UNICEF) ▪ Created in 1946, was founded to assist millions of sick & hungry children in war-ravaged Europe & China. ▪ In 1950, the UNICEF mandate was expanded to address needs of children & women throughout the world. ▪ Works for children's survival, development, & protection by developing & implementing community-based programs w/ well-documented achievements in child health, nutrition, education, water, sanitation, &women's rights o Centers for Disease Control (CDC) ▪ Founded in 1946, for protecting the health & safety of all Americans & for providing essential human services ▪ The forefront of public health efforts to prevent & control infectious & chronic diseases, injuries, workplace hazards, disabilities, & environmental health threats. ▪ Recognized for conducting research & investigations & for its action-oriented approach. ▪ Applies research & findings to improve people's daily lives & responds to health emergencies ▪ Committed to achieving evidence-based health improvements. o International Center for Primary Health Care (ICPHC) ▪ Provide the entire population with universal coverage; relevant, acceptable, affordable, and effective services; a spectrum of comprehensive services that provide for primary, secondary, and tertiary care and prevention; active community involvement in the planning and delivery of services; and integration of health services with development activities to ensure that complete nutritional, educational, occupational, environmental, and safe housing needs are met ▪ Primary health care seeks to obtain the highest level of health care for all people. ▪ The program promotes seven elements of primary health care, including health education regarding disease prevention & cure, proper food supply & nutrition, adequate supply of safe drinking water & sanitation, maternal & child health care, immunizations, control of endemic diseases, & the provision of essential drugs Chapter 16 • Discuss the individual & societal costs of poor child health status. o Childhood health status ▪ Accidental injury is the leading cause of death in children. ▪ Childhood obesity can lead to numerous health problems. ▪ Childhood immunization is a benchmark of child health. ▪ Lead poisoning is a preventable cause of childhood death and disability. ▪ Child maltreatment is an indicator of children’s physical and emotional health status. ▪ Children with special health care needs frequently need multiple health care services. o Adolescent health status ▪ Adolescent sexual activity is often unprotected and can result in pregnancy and STIs. ▪ Adolescent childbearing and parenting often have long-term negative consequences for both child and mother. ▪ Violence among youth is a multifaceted problem. ▪ Teenagers are more likely than adults to acquire STIs; some are treatable with antibiotics, but they can still have long-term health consequences. ▪ The use of tobacco, alcohol, and illicit drugs has serious and long-lasting consequences for adolescents and for society. • Describe the factors affecting child and adolescent health o Parents’ income, education and stability ▪ Low birth weight & infant mortality due to less educated mothers ▪ Prenatal care, delay childbearing until after adolescence, & breastfeed their babies for women w/higher education ▪ Less than 12 years of education = 10x more likely to smoke during pregnancy o Security and safety of the home o Nutritional and environmental issues o Health care access and use o Poverty ▪ Less access to nutritious food, shelter, & health care ▪ Deprived of advantages (good schools, libraries, community resources) ▪ Live in substandard housing, stressful home lives, may live surrounded by drugs & crime ▪ Lack of positive & nurturing adult role models ▪ May feel hopeless about the future ▪ Surfer from low birth weight, asthma, dental decay, elevated blood lead levels, learning disabilities, & teenage unmarried childbearing ▪ More likely to move frequently, residential instability & extreme living conditions o Racial disparities ▪ Eliminate health disparities ▪ Needs to provide health care services that culturally competent o Single parenting ▪ More likely to live in poverty ▪ More health risks o Health care use • Define the Strategies to Improve Child and Adolescent Health o Monitoring & Tracking – collect/analyze data tracking well-being of children o Establish goals and set measurable objectives using Healthy People 2020. ▪ Educators use these techniques to organize their teaching materials, measure their students' progress, and evaluate the effectiveness of their teaching strategies and plans ▪ Goals and objectives help the nurse and family evaluate progress and make necessary midcourse corrections o Implement health promotion and disease prevention strategies. ▪ More significant and cost-effective for children than other age groups ▪ Help prevent costly problems, suffering, & lost human potential o Utilize public health programs targeted to children and adolescents. • What are the Public Health Programs Targeted to Children and Adolescents o Health Care Coverage Programs ▪ Medicaid – health insurance program for the poor & low-income people ▪ EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) – receive a range of health & health-related services beginning in infancy, is designed to assure availability & accessibility of health care resources & to help Medicaid recipients & their parents effectively use these resources: • Health, developmental, and nutritional screening • Physical examinations • Immunizations • Vision and hearing screening • Certain laboratory tests • Dental services ▪ State Children’s Health Insurance Program (SCHIP) – health insurance program for children (“gap group”) who family income is above Medicaid limits but who families do not receive health insurance through the parents’ employment o Direct health care delivery programs ▪ Maternal and Child Health Block Grant – provided health care services for mothers, children, & families ▪ Community and Migrant Health Centers Programs – provide comprehensive primary & preventive health care ▪ National Health Service Corps – helps children & adolescents receive primary health care services ▪ School-based and school-linked health services – school based health clinics for adolescent who may be uncomfortable seeing their pediatrician/their childhood provider to discuss sensitive topics ▪ Special Supplemental Food Program for Women, Infants, and Children (WIC) – provides highly nutritious foods, nutrition education & counseling, & screening & referral to needed services for low-income pregnant & breastfeeding mothers, their infants, & their children under 5 years of age each year Chapter 17 • Describe (be familiar with) Health problems among women of all age groups (i.e., from adolesence to old age). o Acute Illness ▪ UTI & Dysuria • By age 32, half of all women report a history of at least one UTI • Peak incidence in women is ages 20 – 24 years • Dysuria is most prevalent in women 24 – 45 years of age & those who are sexually active ▪ Disease of the Reproductive Tract • Vaginitis & vulvovaginitis – may starts in girls before puberty & more common than in women of reproductive age • Pelvicinflammatory disease (PID) – initiated by STDs • Toxic shock syndrome (TSS) – most often associate w/tampon use during menses, nonmenstrual TSS risk is increased for women who use vaginal barrier methods for birth control o Chronic Illness ▪ Coronary vascular disease (CVD) & metabolic syndrome ▪ Hypertension ▪ Diabetes ▪ Arthritis ▪ Osteoporosis ▪ Cancer (breast, lung, gynecological) ▪ Mental disorders and stress o Reproductive Health Concerns ▪ Nutrition - Includes total life nutritional experience ▪ Dysmenorrhea ▪ Family planning - Includes fertility control and infertility • Need multiple safe options designed to meet the individual needs of all women ▪ STIs, HIV, and AIDS • Women need age-appropriate STI prevention, education, and counseling. • Worldwide, AIDS is a leading cause of death among young women. o Other Issues in Women's Health ▪ Unintentional injury or accidents • Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States. ▪ Disabilities resulting from acute and chronic conditions • Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment. • What are the Leading causes of death for all age groups o As age increases, the leading causes of death change ▪ Adolescent to early adulthood years = leading cause is unintentional injuries (motor vehicle accidents, drug overdose ▪ Middle age = leading cause is cancer ▪ After the age of 65 = leading causes are cancer and cardiovascular disease even out as #1 • Describe Health Promotion Strategies for Women o Women should receive services that promote health and detect disease at an early stage. o Many women seek information that will allow them to be in control of their own health. o Women desire to become more knowledgeable about their own health. o Health promotion for low-income, underserved women may differ from that for middle-class women. o Knowledge deficits about one’s own health prevail among women regardless of socioeconomic or educational level. • Be sure you understand Mortality & Morbidity among women o Mortality – death rate ▪ Cardiovascular disease (CVD) continues to be the number one killer of women. ▪ Cancer rates are increasing due to lifestyle choices, environmental carcinogens, and age. ▪ Diabetes mellitus causes the premature death of many women and is a risk factor for CVD. ▪ Gaps exist in the availability and quality of reproductive health care services globally. o Morbidity – acute & chronic illness rate ▪ More women than men are hospitalized each year in the United States. ▪ Women are more likely than men to be disabled from chronic conditions. ▪ Women are more likely than men to have surgery; many surgeries relate to reproductive health. ▪ The most frequently occurring interruption in women’s mental health relates to depression. ▪ • Identify barriers to adequate health care for women. o Health care access ▪ Lacking economic means for meeting the costs of health care, these women are not likely to seek health care until they or a family member is in acute distress. ▪ May rely on home remedies, over-the-counter drugs, or folk healers for health care. ▪ Older women on fixed incomes may have difficulty meeting co-payments required by Medicare & paying for prescription medications. o Education and work ▪ Increasing number of women earned degrees in traditionally male-dominated professions o Employment and wages ▪ inequalities in wage and salary scales o Working women and home life ▪ A working woman is less likely to have a spouse or partner help w/ the home & children. ▪ Even when a spouse or partner is present, the burdens of housework & child care usually fall more heavily on women, regardless of ethnicity. ▪ Mothers generally spend more time than fathers preparing meals & training & disciplining their children. o Family configuration and marital status ▪ Causes changes in women’s roles w/in families ▪ Most women do whatever is necessary to maintain the integrity of their families Chapter 18 • Be sure you understand Morbidity & Mortality among men o Longevity and mortality in men ▪ Mortality rates for men remain higher than those for women. ▪ Gender differences place men at greater risk for death. ▪ Males continue to be at risk for death due to unintentional injury. ▪ Gender disparity for life expectancy and mortality has decreased. o Morbidity ▪ Men tend to perceive themselves to be in better health than do women. ▪ Women are more likely to be ill, whereas men are at greater risk for death. ▪ Incidence rate for acute and chronic conditions is higher for women than for men; injuries are higher for men than women. ▪ Women have higher morbidity rates than men, but men have higher morbidity and mortality rates for conditions that are the leading causes of death. • What is Socialization as it pertains to men? o Society emphasizes assertiveness, restricted emotional display, concern for power, & reckless behavior in males ▪ Internalization of these norms of masculinity reduces the likelihood of engaging in health promotion behaviors for fear these behaviors might be interpreted as a sign of weakness o Men enculturate their sons to believe that risking personal injury demonstrates masculinity. o Peer pressure plays an important role in adhering to masculine norms o Men are more likely to change health behaviors when supported by female family members. • Describe the Factors that Impede Men’s Health (attitudes, beliefs, behaviors, etc.) o Health care climate is not male-friendly. o Access to care ▪ Focused on maintaining an effective workforce ▪ Financial support for curative—not preventive—care ▪ Reluctance to take time off from work for care o Lack of health promotion ▪ Disease prevention and health promotion not often reflected in a man’s perception of health ▪ Focus on disease cure in the present health care system o Men’s Use of Medical Care ▪ Men do not engage in health protective behaviors at the same frequency as females. ▪ Most men do not have routine check-ups, including screenings. ▪ Men seek ambulatory care less often than women. • Males delay medical treatment  are sicker when they do seek health care  therefore they require more intensive medical care. ▪ Males tend to have longer lengths of stay in the hospital than females. o Biological factors ▪ Genetics, effects of sex hormones, and physiological differences ▪ Influenced by genetics, hormones, and environment o Socialization ▪ Men enculturate their sons to believe that risking personal injury demonstrates masculinity. ▪ Men are more likely to change health behaviors when supported by female family members. o Orientation toward illness and prevention ▪ Stereotypical view of men as strong and invulnerable is incongruent with health promotion. ▪ Men lack the somatic awareness and are less likely to interpret symptoms as indicators of illness. ▪ Men may have a desire to rationalize symptoms and deny their susceptibility to disease, thus delaying treatment. o Data collection on health behaviors may not be accurate: ▪ Males are less likely than females to participate in the data collection process. ▪ Social pressure for males to be less expressive (suppress their emotions) may help explain gender differences in reporting health behaviors. • Describe Health Promotion Strategies for Men o Utilize gender-specific interview techniques to obtain the most accurate health history. o Be aware of personal gender bias in data collection. o Be aware of the accuracy & interpretation of secondary sources of information. o Help men learn how to provide support to the caregiver or to develop a caregiver role. o Acknowledge that gender-linked behaviors increase risks: ▪ Lifestyle factors (e.g., use of tobacco, substance abuse, poor preventive health habits & stress, lack of emotional channels) ▪ Men’s unwillingness to seek preventive care ▪ Men’s unwillingness to seek health care when a symptom arise • Apply knowledge of men’s health needs in planning gender-appropriate nursing care for men at the individual, family, & community levels o Permission to have concerns about health & talk openly to others about them o Support for the consideration of gender role & lifestyle influences on their physical & mental health o Attention from professionals regarding factors that may result in illness or influence a man’s expression of illness, including such things as occupational factors, leisure patterns, & interpersonal relationships o Know how their bodies function, what is normal, what is abnormal, what action to take, & the role of proper nutrition and exercise o Self-care: testicular & genital self-exams o Physical exam & history taking that include sexual & reproductive health & illness across the life span o Treatment for problems of couples, such as interpersonal problems, infertility, family planning, sexual concerns, & STDs o Help w/ fathering (i.e., being included as a parent in child care) o Help w/ fathering as a single parent, particularly w/ a child of the opposite sex, in addressing the child’s sexual development & concerns o Recognition that feelings of confusion & uncertainty in a time of rapid social change are normal & that they may mark the onset of healthy adaptation to change o Adjustment of the health care system to men’s occupational constraints regarding time & location of health care sources o Financial ways to obtain these goals Chapter 19 • Define some of the major Health/illness concerns common to the older adult population o Psychological Issues ▪ Retirement – must cope w/ a change in social status & possible income level ▪ Relocation – occurs a result of health & functional impairment, lack of ability to maintain one’s home, unsafe neighborhoods, & lack of assistance w/ ADLs or IADLs, may be prompted by the older adult’s desire to be closer to family/medical care, or interest in moving a new location or more supportive housing ▪ Widowhood – consequences of widowhood are loss of one’s sexual partner; loss of companionship & intimacy; feelings of grief, loneliness, & emptiness; increased responsibilities & dependency on others; loss of income & less efficient financial management; & changes in relationships w. children, married friends, & other family members ▪ Loss of family and friends ▪ Possibly raising their grandchildren – may contribute to both physical & psychological problems o Physiological Changes ▪ Occurs in all body systems ▪ Rate & degree of changes are highly individualized ▪ Influence by: genetic factors, diet, exercise, the environment, health status, stress, lifestyle choices, & many other elements o Common Health Concerns ▪ Chronic illness – leading causes of death among persons 65 yrs & older, is major cause of disability & may cause limitations w/ ADLs & IADLs ▪ Medication use by elders • Older adults consume more than one-third of all Rx drugs, OTC drugs, and “folk” remedies. • Age-related changes influence the effects of drugs. • Polypharmacy may lead to drug interactions and dangerous adverse reactions. • Errors involving client adherence are common. • Preventions strategies should target prescribing and monitoring stages of pharmaceutical care. • Interventions should focus on client adherence to prescribed regimens. ▪ Sensory Impairment • Visual acuity and visual accommodation normally decrease with age (presbyopia) o Cataracts, macular degeneration, and glaucoma • Hearing loss may lead to withdrawal, isolation, and depression o Discern conductive vs. sensorineural loss • Serious dental problems are related to age and income. • Incontinence affects quality of life and is a symptom of underlying problems. ▪ Elder safety & security needs • Falls • Traumatic brain injury (TBI) • Driver safety • Residential fire-related injuries • Cold and heat stress disorders • Elder abuse • Crime • Psychosocial disorders o Anxiety disorders o Depression o Substance abuse • Suicide • Alzheimer’s disease • Define the Nursing actions that address the needs of older adults o Health promotion and illness prevention interventions for older adults may be beneficial in reducing death and disability and improving quality of life. o Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. o Encourage recommended health promotion screenings and examinations o Encourage physical activity and fitness o Evaluate the nutritional status and needs of older adults o Monitor chronic illnesses o Monitor medication use o Monitor and accommodate sensory impairments Chapter 28 • Disaster Definitions A. 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. B. Mass casualty: An event in which 100 or more individuals are involved C. Multiple casualty: An event in which more than 2 and less than 100 individuals are involved. o Direct Victims o Indirect Victims • Types of Disasters Disasters are identified as a natural disaster, a man-made disaster, or a combination of both. A. Natural disasters include: Earthquake; hurricane; tornado B. Man-made disasters include: Bioterrorism; bombings, explosions BIOLOGICAL AGENTS: (You should have learned this in the online course) ▪ Anthrax ▪ Smallpox ▪ Plague ● MASS triage (tag victims in the field)(you should have learned this in the online course) ● Black- (VICTIMS ARE Deceased) ● Respirations absent, Perfusion 2 seconds, Unresponsive ● Red- (VICTIMS require immediate care) ● Respirations30, Perfusion2 seconds, Mental Status changes ● Yellow- (VICTIMS CARE CAN BE Delayed) ● Open fractures, can delay care ● Green- (VICTIMS HAVE Minor injuries and are typically are able to walk) ● Walking wounded ● Eventually need to be assessed ● DISASTER PLANNING/ MANAGEMENT STAGES (P.571) A. Prevention Stage 1. The first stage in disaster management occurs before a disaster is imminent. During this stage potential disaster risks should be identified and risk maps created. The population demographics and vulnerabilities, as well as the community’s capabilities, should be analyzed. 2. Primary prevention measures that should be instituted must include education regarding what actions to take to prepare for disasters at the individual, family, and community level. B. Preparedness and Planning Stage 1. 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. 2. All community disaster plans should address the following elements: authority, communication, control, logistical coordination of personnel, supplies and equipment, evacuation, rescue, and care of the dead. The plan should indicate who has the power to declare there is a disaster and has the power to initiate the disaster plan. C. Response Stage 1. This stage begins immediately after the disaster incident occurs when community preparedness plans that have been developed are initiated. D. Recovery Stage 1. The recovery stage begins when the danger from the disaster has passed and all local, state, and federal agencies are present in the area to help victims rebuild their lives and help the community restore public services. 2. Clean up of the damage and repair of homes and businesses begin. 3. Evaluation and revision of the disaster plans based on lessons learned from the experience are made. ● What are the emotions that are going to be felt when an individual goes through a disaster? o Cognitive: poor concentration, confusion, disorientation, indecisiveness, shortened attention span, memory loss, unwanted memories, difficulty making decisions o Emotional: shock, numbness, feeling overwhelmed, depression, feeling lost, fear of harm to self &/or loved ones, feeling nothing, feeling abandoned, uncertainty of feelings, volatile emotions o Physical: nausea, lightheadedness, dizziness, GI problems, rapid HR, tremors, HAs, grinding of teeth, fatigue, poor sleep, pain, hyperarousal, jumpiness o Behavioral: suspicion, irritability, arguments w/ friends & loved ones, withdrawal, excessive silence, inappropriate humor, increased/decreased eating, change in sexual desire or functioning, increased smoking, increased substance use or abuse • There are 7 primary characteristics that have been used to describe disasters. These are frequency, predictability, preventability, imminence, scope, & number of casualties, & intensity. Discuss & define. ● Frequency - refers to how often a disaster occurs. ● Predictability - relates to the ability to tell when and if a disaster event will occur. ● Preventability - refers to actions taken to avoid a disaster. ● Imminence - is the speed of onset of an impending disaster and relates to the extent of forewarning possible and the anticipated duration of the incident. ● Scope number of casualties - indicates the range of its effect. The scope is described in terms of the geographic area involved and in terms of the number of individuals affected, injured, or killed. ● Intensity - is the characteristic describing the level of destruction and devastation of the disaster event. ● Describe the stages of a disaster. • Prevention stage ▪ Identify potential disaster risks. ▪ Create risk maps ▪ Educate citizens regarding what actions to take to prepare for disasters. ▪ Individual, family, and community level ▪ Develop a plan for meeting the potential disasters identified. • Preparedness/plan stage ▪ Training in first aid ▪ Assembling a disaster emergency kit ▪ Establishing a predetermined meeting place away from home ▪ Making a family communication plan ▪ Plans must include: ▪ Chain of authority ▪ Communication ▪ Logistical coordination of: ▪ Supplies and equipment ▪ Human resources ▪ Evacuation and Rescue ▪ Plans must be dynamic and change as needed. ▪ Plans must be tested in different disaster scenario drills. • Response stage ▪ Response stage begins immediately after the disaster incident occurs. ▪ May include: ▪ Shelter in place ▪ Evacuation ▪ Search and rescue ▪ Staging area ▪ Disaster triage • START triage system ▪ “Simple triage and rapid treatment” ▪ Used in multicasualty or mass casualty incident ▪ To occur in less than 1 minute ▪ Uses people with minor injuries to assist ▪ Person is tagged with a colored triage tag ▪ Victims moved to the treatment area • Recovery stage ▪ Begins when the danger from the disaster has passed. ▪ All local, state, and federal agencies are present in the area. ▪ Help victims rebuild their lives ▪ Restore public services ▪ Clean up of damage and repair begins ▪ Evaluation and revision of the disaster plans ▪ Understand the financial impact • Discuss the impact of disasters on a community. • Heroic phase ▪ Nearly everyone feels the need to rush to help people survive the disaster. ▪ Medical personnel may work hours without sleep, under very dangerous and life-threatening conditions, in order to take care of their patients. ▪ Medical personnel may help out in areas in which they are not familiar and have no experience. ▪ Provide emergency relief during a disaster and may travel long distances to help out in a disaster • Honeymoon phase ▪ Individuals who have survived the disaster gather together with others who have simultaneously experienced the same event ▪ People begin to tell their stories and review over and over again what has occurred. ▪ Bonds are formed among victims and health care workers. ▪ Gratitude is expressed for being alive. • Disillusionment phase ▪ May begin to experience depression due to exhaustion from many long days of long hours. ▪ People realize the way things were before the disaster is not the way things are now and may never be the same again. • Reconstruction phase. ▪ Some sense of normalcy is returning, feelings of despair will subside. ▪ Counseling support for victims and helpers ▪ People begin to look to the future • Describe the role & responsibilities of nurses in relation to disasters. • be involved in all stages of prevention and related activities • educate others about disasters and how to prepare for and respond to them • keep up-to-date on latest recommendations and advances in life-saving measures Chapter 29- Community Health Settings • Identify the common Health Screenings performed in the school setting • Height, weight, vision, & hearing screenings • Scoliosis or postural screening – to identify spinal deviations & intervene early to prevent related secondary problems • Blood pressure screening – benefit from early intervention & followup • Immunization • Describe the Role of School Nurse • Supervise others • Practice independently • Delegate cares • Conduct research • Care provider • Student advocate • Educator • Community liaison • Case manager • Define the Eight components of a comprehensive school health program 1. Healthy school environment – is one in which distractions are minimized & free of physical hazards & psychological threats. • Have the expertise & responsibility to promote a healthy physical environment for all members of the school community 2. Health promotion for staff – assist the faculty & staff by giving workshops on exercise & nutrition, screening for increased BP, & establishing weight management programs. 3. Family and community involvement – provide health content to family, parents, & the community on a variety of topics. • Consist of programs that are designed to positively influence parents, staffs, & others in matters related to health 4. Health education - students should be given the opportunity to practice decision-making and communication skills 5. Physical education – should focus on activities that children can continue into their adult years (walking, swimming, biking, & jogging) 6. Health services – health care provided in school (preventive services as immunizations & screening 7. Nutrition services – school-aged children are undergoing periods of rapid growth & development & consequently have high nutritional needs. • Eating disorders – recognize the association between feelings of inadequacy (low self-esteem, anger, anxiety, & depression) & unhealthy eating practices in adolescents & young people o Education & counseling must begin in elementary school o Prevention should concentrate on eliminating misconceptions surrounding nutrition, dieting, & body composition & should stress optimal health & personal performance o Be aware of eating disorders (binge eating, anorexia, bulimia) • Obesity – to be successful, the tx of obesity must begin early & be multifaceted • Nutritional Education Programs – is essential & must include parents, teachers, & the child • Children need to know & understand the food pyramid, how to make healthy snack choices, & the importance of balancing physical activity w/food intake 8. Counseling, psychological, and social services–may help child learn how to solve problems, how to cope, & how to build self-esteem • Identify common health concerns of school-age children & associated health interventions. • Alcohol & drug use o Outlawed the sale of alcohol to anyone under the age 21 years • Injury & violence (including suicide) o Taught very early in schools, & the information should be age appropriate o Sport safety o Use of proper equipment should be mandatory for children & adolescents o Regular hydration & frequent rest periods should be required to prevent heat-related illnesses o Effective warm-up & cool-down exercises should be encouraged to prevent muscle strain o Have school safety committees that make recommendations for sports-related safety o Be aware of risk factors & signs that could indicate a tendency toward violence o Violence prevention programs should begin in elementary schools o Programs targeting stress management, conflict & anger resolution, & personal & self-esteem development • Tobacco use o Education & counseling should be offered to students who use tobacco products o Limiting adolescents’ exposure to tobacco advertising & teaching them the negative consequences associated w/tobacco • Poor nutrition o Diets should include a proper balance of carbohydrates, protein, & fat, w/sufficient intake of vitamins, & minerals o Identifying nutritional problems, counseling, & making appropriate referrals are important in school setting o Federally funded programs (School Breakfast Program & National School Lunch Program) to ensure that all children have access to these meals during the school day • Lack of physical activity o should focus on activities that children can continue into their adult years (walking, swimming, biking, & jogging) o Establish policies that promote enjoyable, lifelong physical activity. o Provide physical and social environments that encourage and enable young people to engage in safe and enjoyable physical activity. o Implement sequential physical activity education curricula and instruction in grades K to o Implement health education curricula. o Provide extracurricular physical activity programs that offer diverse, developmentally appropriate activities—both noncompetitive and competitive—for all students. o Encourage parents and guardians to support their children's participation in physical activity, to be physically active role models, and to include physical activity in family events. o Provide training to enable teachers, coaches, recreation and health care staff, and other school and community personnel to promote enjoyable, lifelong physical activity to young people. o Assess the physical activity patterns of young people, refer them to appropriate physical activity programs, and advocate for physical activity instruction and programs for young people. o Provide a range of developmentally appropriate community sports and recreation programs that are attractive to all young people. o Regularly evaluate physical activity instruction, programs, and facilities. (Nies 590) • Sexual behavior (STDs/unwanted pregnancies) o It is imperative that older children & adolescents have age-appropriate information on sexuality issues (prevention of pregnancy & STDs) before becoming sexually active o School-based education related to sexual orientation is a controversial topic • Cite several resources available to the school nurse.