Community Health lecture 2

Aggregate is a population group with common characteristics

• Homeless
• Mentally ill
• Incarcerated people
• Chronically ill
• Elderly Children
• Unemployed

Homelessness is the condition of not having a regular, safe, secure place to rely on staying overnight.

• single men, families with children led by single heads of households, single women, and children who lack adult supervision.
• In developed countries, the majority of homeless people are male and more likely to be black, veterans, unemployed, struggle with mental health or addiction challenges, and are victims of domestic abuse
• Seek treatment late, deteriorate faster and can be less compliant

• Decreased hygiene, hypothermia, and hyperthermia; suffer from lice and scabies; TB, HIV, substance abuse, dental problems
• Trimorbidity: substance addiction, mental illness, and other chronic health problems such as hypertension.

No access to healthcare, no shelter, dehydration, hunger. Lack of insurance.

A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

• Thought disorders
• mood disorders
• anxiety disorders

• major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD) and borderline personality disorder
• Schizophrenia is one of the 10 causes of disability worldwide

• 6% of the population has what is considered to be a severe mental illness.
• 20-25% of the homeless have a severe mental illness.
• The mentally ill are at high risk for unemployment
• High risk for homelessness
• High risk for commission of violent acts both against and by them

• Exposed to violence, mental health problems, and physical comorbidities.
• Increase risk for communicable diseases do to overcrowding.
• Warden or person in charge may dictate health care needs.
• After incarceration inmates often face social and economic problems. (Finding shelters, a job, social support can lead to repeat or increase health issues)

The federal government/Congress gave prisoners the right to basic health care in 1976

• gave them insurance and it helped decrease risk of communicable diseases,
• Growing problems in the prison population are geriatric problems, organ failure, communicable diseases (resistant TB).
• We have an increasing population in prison that have never been vaccinated against communicable illnesses.

• Chronicle illness is defined as conditions that last 1year or more and require ongoing medical attention or limit activities of daily living or both.
• End stage renal disease, COPD, HTN DM

A disability is a limitation that prevents a person from performing ADL easily.

Physical, intellectual, mental behavior, chronic neurological conditions

American disability act prohibits discrimination to those with disabilities

• Follow the harvest move across the country for work
• Often do farm work or fishing harvesting
• Common Issues? Occupational Hazards?
• Educational background
• Medical insurance
• Chemical or weather occupational hazards
• Unemployed
• Health insurance
• Homeless

• Homelessness
• Education background
• Lack of support
• Low income
• Language barrier
• Transportation

• Nursing role in overcoming the barriers of the at-risk aggregates
• Show respect and use a positive approach
• Support primary, secondary, and tertiary prevention methods
• Specific training that addresses the needs of each particular group pertaining to LGBT population.
• Help establish transportation for those who need it
• Provide education and resources to vulnerable populations

• Get ready.
• Make sure you have orders to be there and that they are understandable. (Your referral is your order set and should be complete).
• Plan out the route (think how long it will take you to get there).
• Get permission to make the visit. ALWAYS CALL AHEAD FOR EVERY VISIT It doesn’t matter if this is your first visit or 131st visit, call!

Patients receiving home visits should be homebound

• a patient is considered confined to the home if his or her condition creates a normal inability to leave home and if leaving home would require a considerable and taxing effort
• • Must have a plan of care with measured outcomes
• • Skilled needs
• • Intermittent needs (renewal must be obtained)
• • Necessity

• Always let your patient know you are coming, what you plan to do and the basic plan of care.
• The visit always has a thorough assessment. You will not always do a head-to-toe assessment, but you will always do a focused assessment based on the existing problems and ABC’s. There is always an education component.
• You will have scheduled tasks each visit. There may be

• How do I decide who to see first?
• Remember your ABCs (airway, breathing, circulation)

• What are parts of assessing safety for your patient and when do you do this assessment?
• Fall hazards
• People in the house
• At arrival and during visit.

• Educate (rugs, cords, smoking,)
• Call appropriate authorities if necessary
• call your supervisor and leave situation

include family, safety method and provide resources

• at initial visit
• Make sure their safety net is in place!
• Give them a chance for closure.

• Population and Roles
• School aged children
• Direct caregiver to children who are ill or injured at school

• Asthma most common**
• Playground injuries and other
• Treatment of chronic issues
• ADHD
• Type 1 DM

• Coordination of comprehensive services/care of children with complex health issues
• SWS
• Transportation
• One to one nursing
• Education of parents on health needs and provision of anticipatory guidance of expectations of care at school prior to start of attendance and throughout school year (can occur at home or in the school).
• Communication with outside caregivers- want to know what this child is going to need before getting to school so they are set up for success

• Meet the needs of ALL school age children in the community by planning and collaboration between schools and outside agencies in the community
• Identify the need
• Develop or locate an intervention that will meet the need (CAN, BACKSNACK program that sends kids home with canned goods)
• Collaborate with outside agencies so that we can Intervene in the problem
• Reassess

• Assist families to gather information about health and treatments and decision making
• Need may be from a student request, parent request or from within the school.

• School aged children/teens need someone safe to talk to
• Be that person
• Give good information/good advice that they can safely follow

• Drugs, alcohol, sex?
• Not my Child…oh wait
• The only time you cannot reach out to parents to disclose healthcare information is when a teen is pregnant

• Provide information about health and health decisions
• Dietary education
• Exercise Education
• Medication Education
• Social Education
• Safety education

• Note trends notify health department of increase in infectious disease processes or other concerns
• Contribute to the base of nursing knowledge for school health and educational needs
• Kids with chronic health issues are at increased risk for failure

• Investigates the cause and effect of disease
• Investigates disease trends in populations
• Collect statistics
• Studies the relationship among agent, host and environment
• Epidemiology gives us the information about the diseases that are occurring, where they happen, who is becoming ill, & what other factors are involved.

• Agent-object that causes disease
• Host-living being affected by disease
• Environment- setting or surrounding that sustains the host

• Drugs
• Fumes
• Toxins
• Genetic issues
• Trauma
• Extreme temperatures
• Viruses
• Fungi
• Bacteria

• People
• Susceptible hosts are
• Non-susceptible hosts
• Transmission from hosts is direct or non-direct

modifiable, examples lifestyle, exercise, nutrition, knowledge

nonmodifiable, examples age, race, genetic makeup

Can be physical or social environment. The environment is the setting or surrounding that sustains the host

• Water/food supply
• Reservoirs/vectors

• High-risk working conditions
• Poverty

infectious agent from a reservoir to another host (airborne, direct, indirect contact, and droplet)

Droplet nuclei and aerosols

body surface to body surface, physical transfer of microorganisms between a susceptible host and an infected or colonized persons (or animal)

contact of a susceptible host with a contaminated intermediate inanimate object called vehicles. Vehicles include food, water, needles, toys, soiled clothes, surgical instruments. Indirect also includes vectors such as insects and animals.

generated from coughing, sneezing, and talking, and are propelled and deposited to the conjunctiva, nasal mucosa, or mouth of another individual.

is received through injection of immune factors from another source (ex: immunoglobulin, antitoxins, plasma proteins). It can also be transferred mother to infant via colostrum or via placenta while in utero.

develops when the individual has been exposed to the infectious agent and develops their own antibodies to the disease. This can happen naturally through exposure to the disease, or artificially through immunization.

occurs when the majority of a group of individuals is immune to an infectious disease process.

• Are action plans developed in anticipation of disaster scenarios, providing a framework for response to emergency
• They are proactive planning efforts that provide structure to a disaster response before it happens
• Working relationships can be strengthened by formalizing mutual aid agreements with regional health, police, and fire departments.
• Assessment of at-risk groups, people without the resources to survive a disaster, limited mobility.

• Preparedness
• Identify all hazards, proactive planning, Evaluate possible damage
• Nursing responsibilities in preparedness: know the plan, participate in the drills and mock disasters. Know where your response site is. Maintain communication capability.

Take measures to limit damage, disability, and loss of life

Implementation of disaster plan, provide emergency care, restore communication and transportation

Stabilization, return to normal status

Learn from the past, prepare for the future

• Category A
• Category B
• Category C

• biological agents
• easily transmitted and have high mortality rates
• EX: Smallpox, botulism toxin, anthrax, plague, tularemia, and hemorrhagic viral fevers

• biological agents
• moderately easy to spread and moderate morbidity and low mortality rates
• EX:Typhoid and cholera

• easy to produce, and/or have a high morbidity/mortality rate
• Hantavirus

• RNs are expected to be able to use their critical thinking skills to triage serious versus minor injuries, and who is in need of immediate transport to a higher level of care. Included in this is the prioritization of care. This includes determining who is most likely to survive with care.
• RN’s give first aid care on site, triage out and direct care of less qualified responders
• There are four tags that we are responsible to assess and tag to provide rapid care

critical, unstable requiring immediate intervention

delayed for a bit, urgent, stable but may deteriorate

AKA walking wounded, they are delayed, injured or ill but stable and not likely to deteriorate

expectant, dead or non-survivable given the available resources