Community Exam 1

• assessment
• policy devt
• assurance

• public health role of making sure that essential community-oriented health services are available.
• it's not a guarantee.

keeping healthy people healthy

use of vaccines and disaster preparedness

regulations we have to keep the people from harm; ie: OSHA, FDA, EPA, TSA

synthesis of nursing and science of public health; looking at the big picture; nursing measures that promotes health and prevent disease in the community

looking at a group of people/aggregate; emphasis is on health promotion and prevention

primary focus is TREATMENT; basically a clinic located in the community

• -a health system was developed
• -Elizabethan poor law was used
• -Boards of Health was established
• -Charitable orgs
• -Shattuck report

• -established the care for the sick, poor, mentally ill, disabled, or dependent
• -based on Protestant ethic: everybody puts in the effort
• -became the basis for medicaid

• -published in 1850 by Massachusetts sanitary commission
• -1st proposal for modern approach to pub health
• -laid the groundwork for the Sheppard-Towner act
• Report included:
• -est of state health depts & local health boards
• -sanitary surveys & collection of vital statistics
• -environmental sanitation
• -food, drug, & comm disease control
• -well child care & health educ
• -smoke & alcohol control
• -town planning
• -teaching preventive medicine in med schools
• (not implemented til 1995)

• -est in 1921
• -aka Maternity & Infancy Act
• -ended in 1929
• -established state programs: WIC, EPSDT

• -volunteered to help the sick during Crimean war
• -organized hospital nrsg practice & educ
• -replaced untrained nurses w/ Nightingale nurses

• -est the first District nursing
• -assessed the needs of a particular area

-she was hired by the US to begin the visiting nurses

• -1st publich health nurse
• -est the Henry St Settlement House
• -Met Life Insurance Co
• -American Red Cross: est rural health nrsg
• -Children's Buereau: prelude to WIC & Medicaid

-proposed that there should be advanced education in public health nursing

• -est the FNS (Frontier Nursing Services) in rural Kentucky
• -introduced the 1st nurse midwives

1870s

1st school nurse

• enacted to protect the health of people and included funds for education and employment of public health nurses
• -this was one of the impacts of Depression

1966

• -1977
• -became the basis for HFA (Health for All) and later the Healthy People 200

-recommended that basic nrsg be done in colleges and universities

• 1800-1900
• -epidemics
• -inadequate & unsafe hospitals
• -minimal technology
• -experienced-based training
• -avoids hospitals

• 1900-1945
• -focus on acute infectious disease/trauma
• -shorter life span
• -shift to science-based training
• -improved tech

• 1945-1984
• -focus on chronic diseases
• -increase # of facilities
• -better technology
• -increase in med specialties
• -health insurance

• 1984-present
• -focus on new & old infectious diseases
• -cost containment issues
• -super drugs

• Cost
• Access
• Quality

• -increase years of healthy life
• -eliminate disparities among diff populations

• -prospective standardized fee for services
• -pay up front
• -ie. HMO

• Dx Related Groups
• -used by insurance to tell us how long we receive care and how much money
• -made hospitals & nurses more accountable

• -not the same as Care management
• -this is basically the insurance, handling the amount of time and money the pt's receive

• -Macro: overall spending for health care
• -Micro: consumption & spending of individuals

• -Prospective: capitation; ie HMO; preset amount
• -Retrospective: after service is rendered
• -Fee for service: based on usual, customary or traditional charges

• Medicare
• -for >65 y/o
• -anyone w/ ESRD
• -disabled
• -A: hospitalization up to 60 days
• -B:Dr/outpt (premium & deductible)
• -C:ABD
• -D:prescriptions

• Medicaid
• -for pregnant women, children <5, indigent
• -women & children still quality even if 1 1/2 times above pov line

• Managed Care
• -HMO: capitation
• -PPO: predetermined rates for services

Med savings: account for med expenses that carries over yr to yr

Flex: use it or lose it

• Prim Care:
• -individual focused
• -"comm based nrsg"
• -professional dominance
• -emphasis on cure/tx

• Prim health care:
• -comm focused
• -"comm health nrsg"
• -self reliance
• -emphasis on promotion/prevention

• Care:
• 1: when a person first enters the health system (got sick, go to Dr)
• 2: diagnostics & testing
• 3: rehab

• Prevention:
• 1: healthy person receving educ
• 2: person @ risk receiving educ or early screenings/diagnostics
• 3: already have disease

• Perseveration: allowing pt's to hold on to their values
• Accomodation: making adaptations or taking into consideration the cx of another
• Repatterning: thinking about things differently
• Brokering: negotiating w/ pt

• D: deals w/ what, who, when, where
• A: deals w/ why, how

-everybody in a particular pt/source

-expect certain diseases to occur @ a certain time

-something triggered a response

• Ecological
• -holistic approach; looking at other factors

• Cross-sectional
• -snap shot; looking @ what is present

• Case-control
• -studying those that have the disease(case) and those that dont (control)

• Cohort
• -prospective: looking forward
• -retrospective: reviewing back

• Clinical trials
• -involve some type of intervention

• Community trials
• -health promotion & prevention

• -father of epidemiology
• -connected that cholera was linked to a faulty water pump

-developed antisepsis

-able to grow cultures of tb, anthrax, cholera

-how many people developed the disease over the people who were exposed

• anthrax
• botulism
• smallpox
• hemorrhagic viruses
• tularemia
• plague
• ebola