lOMoARcPSD|27916040
NR 503 EPI FINAL EXAM STUDY GUIDE ACTUAL EXAM
LATEST &GRADED A+
POPULATION HEALTH, EPIDEMIOLOGY & STATISTICAL
PRINCIPLES
Review primary, secondary, & tertiary prevention practices, screening, vulnerable
populations, and the role of the nurse practitioner.
Week 5 (Ch. 2)
1. Discriminatepopulations at risk for development of chronic health conditions while associating the
role of the Advanced Practice Nurse in levels of promotion.
Common risk factors: unhealthy diet, physical inactivity, and tobacco use
Childhood risk: There is now extensive evidence from many countries that conditions before birth and in
early childhood influence health in adult life. For example, low birth weight is now known to be associated
with increased rates of high blood pressure, heart disease, stroke and diabetes.
Risk accumulation: Ageing is an important marker of the accumulation of modifiable risks for chronic disease:
the impact of risk factors increases over the life course.
Underlying determinants: The underlying determinants of chronic diseases are a reflection of the major forces
driving social, economic and cultural change – globalization, urbanization, population ageing, and the general
policy environment.
Poverty: Chronic diseases and poverty are interconnected in a vicious circle. At the same time, poverty and
worsening of already existing poverty are caused by chronic diseases. The poor are more vulnerable for
several reasons, including greater exposure to risks and decreased access to health services. Psychosocial
stress also plays a role.
Preventative health actions are often categorized in three levels:
● Primary prevention - aims to prevent disease or injury before it ever occurs.
▪ This is done by preventing exposures to hazards that cause disease or injury,
altering unhealthy or unsafe behaviors that can lead to disease or injury, and
increasing resistance to disease or injury should exposure occur.
▪ Nurses play the part of educators that offer information and counseling to
communities and populations that encourage positive health behaviors
▪ Examples include:
● legislation and enforcement to ban or control the use of hazardous
products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use
of seatbelts and bike helmets)
● education about healthy and safe habits (e.g. eating well, exercising
regularly, not smoking)
● immunization against infectious diseases.
● Secondary prevention - aims to reduce the impact of a disease or injury that has already occurred
▪ This is done by detecting and treating disease or injury as soon as possible to
halt or slow its progress, encouraging personal strategies to prevent reinjury
or recurrence, and implementing programs to return people to their original
, lOMoARcPSD|27916040
health and function to prevent long-term problems.
▪ Nurses work with these patients to reduce and manage controllable risks,
modifying the individuals’ lifestyle choices and using early detection
methods to catch diseases in their beginning stages when treatment may
be more effective.
▪ Examples include:
● regular exams and screening tests to detect disease in its
earliest stages (e.g. mammograms to detect breast cancer)
● daily, low-dose aspirins and/or diet and exercise programs to prevent
further heart attacks or strokes
● suitably modified work so injured or ill workers can return safely to their
jobs.
● Tertiary prevention - aims to soften the impact of an ongoing illness or injury that has lasting
effects
▪ This is done by helping people manage long-term, often-complex health
problems and injuries (e.g. chronic diseases, permanent impairments) in order
to improve as much as possible their ability to function, their quality of life
and their life expectancy.
▪ Nurses are tasked with helping individuals execute a care plan and make any
additional behavior modifications necessary to improve conditions
▪ Examples include:
, lOMoARcPSD|27916040
● cardiac or stroke rehabilitation programs, chronic disease management
programs (e.g. for diabetes, arthritis, depression, etc.)
● support groups that allow members to share strategies for living well
● vocational rehabilitation programs to retrain workers for new jobs
when they have recovered as much as possible.
●
Members of minorities are overrepresented on the low tiers of the socioeconomic ladder. Poor economic
achievement is also a common characteristic among populations at risk, such as the homeless, migrant workers,
and refugees. However, the APN should be able to distinguish between cultural and socioeconomic class issues
and not interpret behavior as having a cultural origin when the fact is based on socioeconomic class. A good
resource for APNs is the Cross-Cultural Health Care Program (CCHCP), which has a plethora of materials to
improve cultural competency among healthcare providers, including a training program for healthcare
providers. In order to provide appropriate healthcare interventions, culture and all its variants must be
addressed.
(p28)APRNs may be able to access health information needed by working together with other sectors outside
of health, such as housing, labor, education, and community-based or faith-based organizations that offer
services to immigrant communities. This involves the collection, documentation, and use of data that can be
used to monitor health inequalities in exposures, opportunities, and outcomes. Examples of social determinants
that are related to health inequalities include poverty, educational level, racism, income, and poor housing.
These inequalities can lead to
poor quality of life, poor self-rated health, multiple morbidities, limited access to resources, premature death,
and unnecessary risks and vulnerabilities.
(p25) APRNs can best determine the effectiveness of an intervention and long-term impact by focusing on an
accurate assessment and interpretation of data that are generated or collected using individual, population, and
community health indicators.
(p27)APRNs can work in partnership with community members to identify what community members see as
relevant and important, build social capital, use outcome data to advocate for changes in policy, and then
continue to work in partnership to identify strategies to intervene, monitor,and improve those outcomes
(p40-41)APRNs have numerous resources they can access to improve quality and timely access to quality
healthcare and decrease health disparities. The National Partnership for Action (NPA) to End Health
Disparities ( minorityhealth.hhs.gov/npa) was started by the Office of Minority Health
to mobilize individuals and groups to work to improve quality and eliminate health disparities. The National
Priorities includes key private and public stakeholders who have agreed to work on major health priorities of
patients and families, palliative and end-of-life care, care coordination, patient safety, and population health.
The Quality Alliance Steering Committee is another partnership of healthcare leaders who work to improve
healthcare quality and costs. Various strategies to bridge the gaps in healthcare quality are available at the
national level and may be applied or considered at the state, regional, or local level in collaboration with
stakeholders as a means of decreasing health disparities.
(p43) APRNs are better prepared to develop effective interventions to eliminate or reduce health disparities.
Such strategies may include advocating better health insurance coverage
for poor and immigrant populations; ensuring that sufficient services
exist in underserved areas; assessing the interaction among social
environments, genetics,
and population health; encouraging minority participation in research studies with community-based
participatory research and specifically with practice-based research networks; using linguistically and
culturally appropriate communication and written handouts; promoting and facilitating community
partnerships; and implementing strategies to encourage people from minority populations to become
healthcare professionals
, lOMoARcPSD|27916040
2. Compare and contrast variables that differentiate those categorized at being at risk for marginalization
of health care.
Definition: when an individual or group is put into a position of less power or isolation within society because of
discrimination Limits their opportunities and means for survival. When an individual is marginalized, they are
unable to access the same services and resources as other people and it becomes very difficult to have a voice in
society.
Marginalization – major cause of vulnerability, which refers to exposure to a range of possible harms, and
being unable to deal with them adequately.
● Variables: social class, race, homelessness, substance abuse, prison/offending, mental health
problems, HIV positive
● Women are more likely to be marginalized than men, because of their gender. This is evident
through the social, economic, and power imbalances that exist between men and women. For
example, more women than men live in poverty, and men continue to have more secure, full-
time jobs and higher income than their female counterparts.
