Primary- occurs before disease or dysfunction has occurred.

General health promotion such as nutrition, hygiene, exercise, and environmental protection. Immunizations and the wearing of protective device to prevent injury (except flu shots) Secondary- Early detection and treatment of adverse health conditions. Screen and initial treatment. (Pap smears, skin tests for TB, hearing test, early STD treatment) Tertiary- Implemented after diseases and events have already resulted in damage. Purpose is to limit disability and to rehabilitate or restore person to best possible health. (Meals on wheels for homebound, PT for stroke, halfway house for drug addicts, counseling for rape victims) Chapter 2 -Elizabethan poor law of 1601 guaranteed medical care for the poor, blind, and lame -The first public health committee was established in New York City in 1800 -The Public health Service, the most important federal public health agency today, was established in 1789 as the marine hospital service. - 1751: first hospital founded in America, the Pennsylvania Hospital in Philadelphia - Other nurses established became a hub for medical care and social services such as Settlement houses and neighborhood centers. Lillian Wald and Mary Brewster established Henry Street Settlement in 1893 -1909- Visiting Nurse Quarterly publication established by the Cleveland Visiting Nurse associationprofessional form of communication for clinical and org. concerns -Florence Nightingale (1894-1946): organized hospital nursing practice and nursing education in hospitals to replace lay nurses with trained nurses -1922: National Organization for Public Health Nursing (**NOPHN allowed both nurses and lay persons), with Lillian Wald as its first president **(Created public health nursing in US). -1909: Metropolitan Life Insurance Company**Created a program using visiting nurse organizations to provided care for sick policy holders-Lillian Wald ** funds were a major problem. -1921: Maternity and Infancy Act (also called the Sheppard-Towner Act)-The Sheppard-Towner Act of 1921 is given credit for shaping the future of public health nursing, emphasizing maternal and child health services. -1930s Depression- Title VI of the Social Security Act of 1935 provided funding to expand opportunities for health protection and promotion through education and employment of community health nurses -1925: Frontier Nursing Services founded by Mary Breckinridge-geared toward improving the health care of a rural and often inaccessible population in the Appalachian sections of Kentucky. Breckinridge introduced the first nurse-midwives into the United States. The work of the FNS led to reduced pregnancy complications and fewer stillbirths and infant deaths. Chapter 3 - Services provided by the public health system are mandated by local, state, and national laws. - Food and Drug Administration **(Know Health Resources and Services Administration Ensures delivery of healthcare to medically underserved.) - Local Health Department- Local State and Federal agencies have now started to cooperate and collaborate due to the need to focus on emergency preparedness and response. - PHC is essential care made universally accessible to individuals and families in a community with full participation and at a cost that the community and country can afford. Chapter 21 - Vulnerability: results from the interaction of internal and external factors that cause a person to be susceptible to poor health. Vulnerability results from the combined effects of limited physical, environmental, personal resources, and bio psychosocial resources - Predisposing Factors- social and economic factors, age, poverty, changes in normal physiology - Many managed care organizations prefer (or must for financial reasons) to care for the healthiest people rather than those who are most vulnerable; vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations - It is helpful to provide comprehensive services in locations where people live and work - Trend toward providing more comprehensive, family-centered services when treating vulnerable population groups; one-stop services

-Wrap-around services: available comprehensive health services, and social and economic services also provided, either directly or through referrals; in this way, social and economic services that will help ensure effectiveness of health services are wrapped around health services -Healthy People 2010 provides a framework for prevention for the Nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats Other -If homeless teach how to read own TB results within 48-72 hours and send results back to Dr. -Disenfranchised due to length of time in the community -1850: Shattuck Reportfirst effort that described a modern approach to public health organization. The called for major improvements in state govt. action for public health. -Lillian Wald suggested nursing practice in schools because newly graduated nurses often were unprepared for home visiting. Nursing schools were inadequately teaching home car e because they were focusing on hospital care. - Primary health care (PHC) includes a comprehensive range of services, including public health; prevention; and diagnostic, therapeutic, and rehabilitative services. PHC is essential care made universally accessible to individuals and families in a community with full participation and at a cost that the community and country can afford. - PHC encourages self-care and self-management of ones health and social welfare. A comprehensive range of services including public health, prevention, and diagnostic, therapeutic, and rehabilitative services. - Social Security Act of 1935: created largest federal support program for elderly and poor Americans - Social Security Act Amendments of 1965, Medicare, and Medicaid: provided for health care needs of elderly, poor, and disabled people - 1925: Frontier Nursing Services founded by Mary Breckinridge-geared toward improving the health care of a rural and often inaccessible population in the Appalachian sections of Kentucky. Breckinridge introduced the first nurse-midwives into the United States. The work of the FNS led to reduced pregnancy complications and fewer stillbirths and infant deaths.