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Assessing the Community and its Relationships Among Individuals, Groups, and Health

Competency 11
Nichole L. Hinkel, RN MSN

Overview of the Health Care Delivery System

Structure of the Health Care Delivery System


Public Sector

Divided into federal, state, and local levels Typically concerned with the health of the population and maintaining a healthy environment May be profit or nonprofit Voluntary agencies

Private Sector

i.e. _______________________

Health Care Provider Organizations


Ambulatory Health Care Hospitals Long-term Care Facilities

Health Care Financing


The high cost of healthcare Public financing

Medicare Medicaid

Health Care Financing


Private financing

Traditional health insurance Health maintenance organizations Preferred provider organizations

Caring for the uninsured

Epidemiology

Models of Disease Causation


The epidemiological triangle

illustrates the interrelationships among the three essential components with regard to disease causation A change in any of the three components can result in the disease process

Group Work

Models of Disease Causation (cont.)

Levels of Prevention
Primary Prevention

Preventing a problem before it occurs

Secondary Prevention Early detection and early cure Tertiary Prevention Limiting disability and fostering rehab (where the disease has occurred and resulted in a degree of damage)

Myocardial Infarction
Primary:

Secondary:

Tertiary:

Epidemiological Tools
Rates

Essential tools to identify actual and potential problems in a given community. Allows a nurse to recognize when a health threat or disease in normal or typical In calculating a rate, the numerator is the number of events occurring in a specified period of time and the denominator consists of those in the population at the specified time period

Epidemiological Tools
Measures of Morbidity

Incidence rate Prevalence rate Infant mortality rate Crude death rate Cause-specific death rate

Measures of Mortality

Practice Time..
In the year 1910 there were 3925 cases of

measles in Utah. The population of Utah in the 1910 census was 370,000 people. In the year 2000 there were 30 cases of measles in Utah and the population in 2000 was 2,230,000 people.

What was the incidence rate per 100,000 people of measles in 1910? Assume all of the population was susceptible to measles. What was the incidence rate per 100,000 people of measles in 2000? Assume all of the population was susceptible to measles.

Collection of Data
Windshield survey

People Place

Boundaries Location of health services Natural environment Human-made environment

Housing Social systems

Collection of Data
The census Vital statistics Health statistics

Descriptive vs. Analytical Epidemiology


Descriptive Epidemiology

Person Place Time Focuses on the determinants of disease in a given population

Analytical Epidemiology

Communicable Disease: Prevention and Intervention

Chain of Infection

Communicable Disease Transmission

Application
An elderly patient, hospitalized with a gastrointestinal

disorder, was on bed rest and required assistance for activities of daily living. The patient had frequent uncontrolled diarrhea stools and the nurse provided excellent care to maintain cleanliness and comfort. Following one episode of cleaning the patient and changing the bed linen, the nurse immediately went to a second patient to provide care. The nurse's hands were not washed before assisting the second patient. The second patient receiving care had a Foley catheter
Infectious agent: E. Coli

Reportable Communicable Diseases


Reportable Diseases Who Is Responsible for Reporting What Information Is Required How, When, and to Whom to Report Steps Taken to Control Spread

Vaccine-Preventable Diseases

Immunity

Active Passive

Immunization Schedule Contraindications Parental Education and Consent Documentation Reporting Adverse Vaccine Events Adult Immunization

Sexually Transmitted Diseases


Primary prevention of STDs Secondary prevention and STDs

Trends in Incidence and Prevention of Selected Communicable Disease


Acquired Immunodeficiency Syndrome and

Human Immunodeficiency Virus


Tuberculosis Emerging Infections

International Travel
May increase exposure to a number of

communicable diseases
Should seek medical advice in advance Immunizations may be needed

Biological Warfare
Category A agents

Can be easily disseminated or transmitted from person-to-person Result in high mortality rate Have potential for major public health impact Require special action for public health preparedness

Category A Agents
Anthrax

Types

Cutaneous Inhalation Gastrointestinal Antibiotics

Treatment

Category A Agents
Botulism

Agent: clostridium botulinum Types


Foodborne Wound Infant botulism Inhalation

Treatment Paralysis

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Category A Agents
Plague

Agent: bacteria (Yersinia pestis) Types


Pneumonic Bubonic

Treatment: antibiotics (to be reviewed for clinical SIM)

Smallpox

Category A Agents
Tularemia

Agent: Francisella Tularensis Treatment: antibiotics Viruses


Viral hemorrhagic fevers

Arenaviruses Filoviruses Bunyaviruses Flaviviruses

Treatment: supportive therapy

The Role of Nursing and Environmental Hazards and Community Crisis


Competency 12
Nichole L. Hinkel, RN MSN

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Areas of Environmental Health


Living Patterns Work Risks Atmospheric quality Water quality Housing Food quality Waste control Radiation risks

Housing and Living Patterns


Common concerns overcrowding Household chemical exposure Potential for poisoning Presence of firearms Indoor Air Quality Second hand smoke Carbon monoxide Indoor biological contaminants Lead Exposure Nursing Interventions

Work Risks
Job hazards

Use of heavy equipment Exposure to chemicals, biohazards, sunlight, heat, cold, and noise Potential for assault or violence

OSHA & NIOSH Nursing Interventions

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Atmospheric Quality
Effects of air pollution

Threaten the health of humans and animals Harm crops and other vegetation Contribute to the erosion and economic devaluation of buildings and structures

Ozone Depletion Nursing Interventions

Water Quality
Microbial Contamination

Waterborne diseases

Chemical and Metal Contaminants Community and Nursing Interventions

Food Quality

Microbiological Contamination Intentional Food Additives Unintentional (Incidental) Food Additives Seven commandments of food safety

Wash hands before handling food Keep it safe-refrigerate Do not thaw food on the kitchen counter wash hands, utensils and surfaces after contact with raw meat and poultry Never leave perishable food out over 2 hours Thoroughly cook raw meet, poultry, and fish Freeze or refrigerate leftovers promptly

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Waste Control
Two major concerns in the issue of waste control Solid Waste Management Landfills Incineration recycling Toxic and Hazardous Waste Control Tips to reducing solid waste Reduce Reuse Recycle Respond

Radiation Risks
Radon Gas Ultraviolet Radiation and Skin Cancer Signs, Symptoms, and Detection of Skin

Cancer

Asymmetry Border irregularity Color Diameter

Community Crisis
Disaster Any event that causes destruction and devastation that cannot be alleviated without assistance.

Result of natural occurrences Result of human war, chemical & biological terrorism (intentional) and accidents NA-TECH

Multiple vs. mass casualty

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Community Crisis
Emergencies

External

Occur in the community, outside of a defined business, industrial complex, residence, or other facility. Initiate within a facility

Internal

Impact of a Disaster Impact on Individuals Impact on the Community

Impact on the Community: Hurricane Katrina


Heroic Phase:

Honeymoon Phase:

Disillusionment Phase:

Reconstruction Phase:

Community Crisis
Disaster management Governmental agencies

_________________________________

American Red Cross

Role of the nurse during disasters Triage Emergency care Shelter assistance

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Community Crisis
Nurse and disaster preparedness

Personal preparedness Professional preparedness Community preparedness Prevention/mitigation Preparation and planning Response Recovery

Emergency and Disaster management


Label that disaster (N, I, or A)


2005 Earthquake in Indonesia killed 300 2004 Florida hurricanes killed 124 2005 freight train collision-11500 gallons of

chlorine gas released


2004 Indian ocean-Tsunami 225,000 deaths

in eight countries
2001 world trade center attack kills 2726 Wildfires

A, B, C, or D
A community health nurse is a first responder

to a bombing incident and is assigned to the triage area. Which of the following victims with life-threatening injuries should be given the highest priority? A-The most seriously injured victims B-Victims with the highest probability for survival C-Victims needing immediate transportation to a trauma center D-Victims at the highest risk for systemic complications

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