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Community Health Final

Chapters 27, 28, 29, 30, 31, & 32

Chapter 27: Violence
Violence is a national public health problem.
Interpersonal violence
Homicide (15th leading cause of death in the united states)
o The united states ranks first in the industrial world in violent death rates
o Who is usually the perpetrator of a female homicide?
An intimate partner- 30% of female murder victims are killed by an
intimate partner
Homicide is the leading cause of death in pregnant women
Suicide is the 8th leading cause of death for all Americans. More people die from
suicide than from homicide in the united states.
Intimate partner violence (IPV)
o Ipv is the single greatest cause of injury to women between the ages of 15-24
o Rape is not about love or sex; its about power and control
o The most dangerous time for a victim is when the victim leaves or attempts
to leave the relationship, because it is seen as an erosion of the abusers
control. (The victim is most likely to be abused at this time more than any
other time in the relationship)
o Power & control wheel
Professional intervention is required to break the cycle of abuse. I
am legally required to report this.
Child abuse
o Most child abuse occurs within the family
Physical abuse
Shaken baby syndrome
o Violent shaking of an infant causes brain and spinal
cord trauma
o Leading cause of death from child abuse in the us
o In approximately 65-90% of shaken baby cases, the
father or mothers boyfriend is the perpetrator
o An 84 year olf woman lived with her youngest
daughter, the daughters live in boyfriend, and 1
child. On this visit, the nurse noted the woman
appeared depressed and dehydrated. Both wrists
were swollen and scabbed. When asked if she was all
right, the woman protested she was fine and her
daughter took good care of her. What action should
you take?
According to the text, working with victims of
elder abuse, the nurse must establish rapport
& trust first; remember that competent adults
have the right to make decisions about their
own care, including to stay in a abusive
situation; the nurse should discuss measures

to relieve stress and possible respite care

options with the daughter. The second goal is
to report the abuse.
Wisconsin has always had, and will generally retain, a
voluntary reporting system. Voluntary rather than mandatory
reporting was selected based on this states commitment to
an adults right to self-determination.

Community violence
o Workplace violence (what are most dangerous for health care staff)
In the health care field, the most frequent areas for the occurrence
of violence are the emergency departments, psych units, geriatric
units, and waiting rooms
o Gangs
Although gang problems declined in the 1990s, they have steadily
increased since that time
In 2007, there were estimated 788,000 youth gang members in
27,000 active gangs. By 2011 there were 30,000 gangs in the usan
ever-increasing problem!
o Hate Crimes
Often considered worse than other crimes involving violence
because the crime is personal, attacking the victims identity

Chapter 28: natural & man made disasters

Disaster vs emergency
Disaster: any event that causes a level of destruction, death, or injury that affects the
abilities of the community to respond to the incident using available resources
Emergencies differ from disasters in that the agency, community, family, or individual
can manage an emergency using their own resources.
Often times a disaster event may be beyond the ability of the community to respond to
and recover from the incident using its own resources
A disaster affects the whole community, whereas an emergency occurs at a personal
level and the person, family, community can manage the event with their own
Acts of terrorism
Terrorism is the use of force or violence against persons or property in violation of the
criminal laws of the united states for purposes of intimidation, coercion, or ransom
Threats of terrorism
o Assassinations
o Kidnapping
o Hijacking
o Bomb scares & bombings
o Computer based attacks
o Chemical, biological, nuclear, radiological weapons
Terrorists goal: to coerce and create fear to accomplish their goals

When should a disaster planned be developed?? Before the disaster occurs!

Local, state, & federal responsibilities
Remember! Agencies and disaster incidents are handled at the lowest possible
organizational and jurisdictional level
Local government
o Responsible for the safety and welfare of its citizens
o The local office of emergency management is responsible to develop a
community disaster plan, have emergency drills to test the plan, and
determine the proper response
Federal government
o Main goal: ensure continuity of essential federal functions during any
National incident management system (nims): integrates practices in disaster preparedness
and response into a comprehensive national framework for incident management.
Federal emergency management agency (fema): Mission= to lead the efforts to prepare the
nation for all hazards and to manage the federal response and recovery efforts following a
national incident
Fema also initiates proactive mitigation activities, trains first responders, and
manages the national flood insurance program and the us fire administration
American red cross (ARC): though chartered by congress to provide disaster relief, is not a
government agency. Primarily a volunteer organization.
Preparedness/planning State: Individual and family preparedness
Individual and family preparedness includes training in first aid, assembling a
disaster emergency kit, establishing a predetermined meeting place away from
home, and making a family communication plan.
Who should create a disaster plan including emergency supplies and where to
meet in case of emergency? Your family!
Community disaster planning
The plan should indicate who has the power to declare there is a disaster and has the
power to initiate the disaster plan.
Response stage
30-2 can do
o where 30 is the # of respirations, 2 is the # of seconds needed to check
perfusion, and can do relates to checking mental status
o to assess an individual within the 1 minute guideline, the system uses three
First, respirations are checked;

Second, perfusion by pinching the nail bed and observing the

Third, mental status, by asking simple questions beginning with,
who are you? Then where are you hurt?
o Remember! Before search and rescue begins, safety must be considered
Disaster triage
Start: Simple Triage And Rapid treatment
Red- life threatening; requires immediate care
Yellow- urgent, but can wait an hour, such as someone with an open fracture but
controlled bleeding
Green- walking wounded, can delay for three hours
Black- mortally wounded, no care required (dead)
The classic 4 phases of a communitys reaction to a disaster:
1. heroic phase
a. during this phase, nearly everyone feels the need to rush to help people
survive the disaster
b. medical personnel may work hours without sleep, under very dangerous
and life threatening conditions, in order to take care of their patients.
2. honeymoon phase
a. individuals who have survived the disaster father together with others who
have simultaneously experienced the same event.
b. Bonds are formed between victims, between health care workers, and
between victims and health care workers who have shared experiences.
3. disillusionment phase
a. when time has elapsed and a delay in receiving help or failure to receive the
promised aid has not occurred, feelings of despair occur. Depression may
set in.
4. reconstruction phase
a. once the community has restored some of the buildings, businesses, homes
and services, and some sense of normalcy is occurring, feelings of despair
will subside
b. counseling support for victims and helpers may need to be initiated to help
people recover.
On an individual level, common responses to a traumatic event include:

cognitive: poor concentration, disorientation, indecision, shortened attention span,

memory loss, unwanted memories, difficulty making decisions

emotional: shock, numbness, feeling overwhelmed, depression, feeling lost, fear of

harm to self/loved ones, feeling nothing, feeling abandoned, uncertainty

physical: nausea, light headedness, dizzy, gi probs, rapid HR, tremors, grinding of teeth,
fatigue, poor sleep, pain, hyperarousal, jumpiness

behavioral: suspicion, irritability, arguments with friends/loved ones, withdrawn,

excessive silence, inappropriate humor, increased or decreased eating, change in sexual
desire or function, increased smoking, increased substance use or abuse

*it would not be normal to have no unusual feelings

post traumatic stress disorder (PTSD)

psychiatric disorder that can occur following an individuals experiencing or witnessing a
life threatening event, such as a disaster
people who suffer from ptsd often relieve the experience through nightmares and
sometimes occurs 1-3 months post event
the reactions mentioned usually resolve in 1-3 months after the disaster event, but in
some cases may lead to ptsd
research has ided 4 keys to gauging the mental impacts of such events, any two of
which may result in severe, lasting, and pervasive psychological effects:
o 1. Extreme and widespread property damage
o 2. Serious and ongoing financial probs
o 3. High prevalence of trauma in the form of injuries, threat to life, and loss
of life
o 4. When human intent caused the disaster
in the case of arson- when a fire was deliberately set & lives were lost, that disaster will
be more disruptive than disasters when only property was damaged.
Chapter 29: School Health

National School Lunch program (1946)

o Legislation marked the first entry of the federal government into school
health programs
o School health services goals and objectives vary from state to state,
community to community, and school to school. These differences reflect
wide variations in student needs, community resources, funding sources,
and school leadership preferences.

# of children seen my school health nurse increasing bc many children do not have
a regular source of health care.

Injury prevention
schoolyard & playground safety
over 200,000 children a year are injured on playgrounds in the us (comes in 2nd after
injuries in homes)
single leading preventable cause of death in the united states

most commonly used drug among children and adolescents is alcohol

most commonly used illicit drug among young in us in marijuana

dental health
one of the most frequent health complaints of school aged children in dental caries
causes- poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for
dental care
half of children aged 12-15 years will have dental caries
approx 75% of those between the ages of 12 & 19 yrs have had tooth decay
Because states require proof of current immunization status or evidence of immunity
before school entrance
School nurse plays an important role in verifying compliance, educating children and
parents about immunizations, and coordinating school immunization programs
As a result of these laws, vaccine preventable deaths (VPD) are at or near record low
levels. According to the CDC many vaccine preventable communicable diseases have
been reduced by greater than 95% as a result of immunizations
Early Periodic Screening, Diagnostic, & treatment services
Medicaid-eligible children are guaranteed access to comprehensive health care services
and routine dental exams.
Screening services must include:
o Comprehensive health and developmentalhistory
o Unclothed physical exam
o Immunizations & lab tests that are age appropriate
o Lead toxicity screenings (because these children have very low income it is
likely that they live in older housing that may have lead paint (private
physicians caring for kids with insurance unlikely see this problem)

Most common chronic school age chronic health problem that a school nurse manages
o More than 6.7 million children (9%) under the age of 18 have asthma
o One of the most common chronic childhood conditions and accounts for
some 14 million lost school days every year
o Obesity, htn, heart disease, and diabetes continue to rise d/t sedentary life
Category of meds administered in schools the most meds to treat adhd
Care of children with special health needs
o Several legislative acts focus of the right to public education in the least
restrictive environment possible regardless of mental of physical disabilities
Individuals with disabilities education act 1990
o Children with special needs include those with severe sensory or motor
challenges, mental and emotional challenges, and chronic illnesses. Some

require specialized equipment and treatments with which nurses must be

o Nurses must maintain thorough records while ensuring hipaa confidentially
standards- this includes interacting with school administration
Delegation of tasks
Necessary; however when tasks are delegated, the nurse still maintains responsibility for
care and outcomes. A nurse cannot delegate:
o Assessments, Diagnosis, Goal Setting, Evaluation
when tasks are delegated the nurse must provide appropriate education, written
procedures, and ongoing supervision and evaluation of the caregivers.
Family educational rights and privacy act (FERPA)
a strong privacy protection act, protects students education records, including the health
sharing confidential information with others (even school principals & administrators)
without approval is considered unethical and improper except in emergency situations
what would you do if your principal asked to see the health records of several severely
handicapped kids?
o Respond with, Ive very glad youre interested in our students, however
student health records are confidential, but ill give you a overview of our
students without sharing any iding information
Everyday a child comes into the school nurses office with vague complaints, most of the
time it seemed to the nurse the child needed to be listened to. Unfortunately the child
usually took 15 mins of the nurses time each day..what should she do?
o A nurse or teacher may be the only stable adult in the childs life who will
listen without being judgmental. One of the most important roles of the
school nurse is to be a counselor and confidante. Children may come to the
school nurse with various vague complains such as recurrent stomach aches,
Has, or sexually promiscuous behavior, and the nurse must look beyond
the initial complaint and spend time with the child to id underlying probs.
A female coach comes to your office and shares that she is worried about one of her
female students. the student doesnt seem to move right and she wont put on her gym
clothes. What would you do?
o Meet with student and ask directly about sexual or physical abuse
The school nurse can assist the faculty and staff by giving workshops on exercise and
nutrition, screening for increased bp and establishing weight management programs
o Providing these types of workshops are an excellent way for a school nurse
(especially a new one) to get to know the school staff through these activities
he/she will be building trusting relationships with the staff.
Chapter 30: Occupational health

An occupational health nurse works in a state that requires continuing education units
per year for renewing a nursing license. A course that would be helpful in the role

Ergonomics and toxicology; bc inherernt in the science needed to function in

occupational health

Demographics in the workplace were also dramatically different during WWII as

increased numbers of women entered the workforce and the us surgeon general
reported the health conservation of the industrial army was the most urgent civilian
need during war

Ohn jobs expanded through 20th century bc employers realized that ohns worked to
avoid injuries and keep employees healthy
These actions allowed employers to achieve savings in costs

By 2010 the baby boom generation reached the ages of 45-64 and middle and older
age groups in the labor force now outnumbered younger workers; with this increase in
age we see increase in hc costs

Corporations have become driving forces in shaping the development of alternative

approaches to health care. Rapidly increasing health care costs have spawned a number
of alternative approaches to providing health care such as managed care

Women with children and aging parents. Implications?

o Female employees who believe their employers are interested in their well
being are more productive and satisfied workers

Ergonomics: adaptation of the work site to the worker to establish the best fit
between the human and job conditions to maximize health and well being

Ethical dilemmas arise because the nurse is loyal to both workers and management

Use aggregate-focused intervention strategies-such as walk throughs

o Performing a walk through on a regular basis is a critical component of a
ochns success- by engaging in this activity, he/she is able to recognize
potential and existing hazards, and maintain communications with safety
and industrial hygiene staff to prevent illness and injury from occurring

Primary prevention strategies

o Providing education regarding cardiovascular health, cancer awareness,
personal safety, immunization, accident prevention, ergonomics, retirement
health, stress management, and relaxation techniques
tertiary prevention strategies
o rehab and restoration of the worker to an optimal level of functioning
avoiding disability syndrome
ex- when the nurse works with the employer to create a transitional
duty pool. The goal is to provide temporary work that is less
physically demanding in nature than the employees regular work.

This facilitates the employees return to the workplace earlier than if

required to wait until full strength and health are regained.
Ex might be to help an employee who suffered a heart attack at
work be acclimated back into the workforce by providing a less
physically demanding role

Skills and competencies of the OHN

o Key practice areas: health promotion and prevention, health hazard
assessment, primary care, and case management

Osha does the following:

o Determines and sets standards for hazardous exposure in the work place
(ex. Noise, hazardous chemicals, blood borne pathogens, fork lift safety,
o Mandates that employees be educated about occupation health and safety
o Monitors compliance with occupational health and safety standards
o Osha does not conduct research

Workers compensation acts (state based)

o State mandated and state funded
o Programs provide income replacement and health care to workers who
sustain a work-related injury, temporary or permanent disability, or death

Chapter 31: Forensic & Correctional nursing

The term forensic means pertaining to the law; legal
o Due to the prevalence of violence and violent crimes- all persons should be
assessed for evidence of abuse, not just vulnerable groups
o Screening for violence is now considered to be a minimum standard of care
for all client

Forensic nursing responsibilities may include:

o Screening
o Assessment and collection of evidence from both victim and perpetrator
o Documentation and expert testimony from victims and perpetrators in
settings such as hospitals, community clinics, or death scenes
o Involvement in paternity disputes
o Cases involving workplace injury, malpractice, vehicle accidents, food or
drug tampering, and medical equipment defects

A SANE nurse was called to the emergency department to help with a woman who has
been severely beaten and raped
o Nurses responsibilities as a forensic nurse is to initiate proper collecting,
preservation, and chain of custody of evidence with appropriate

The national association of medical examiners (NAME) ids 5 acceptable options for
recording manner of death:
o 1. Natural
o 2. Accidental
o 3. Suicide
o 4. Homicide
o 5. Undetermined

nurse coroner
o Utilizes crucial communication skills and empathy when dealing with
grieving families (this is a specific skill set for a forensic nurse)
o Nurses are acutely aware of the importance of using open ended questions,
attentively listening, and being fully present with family and friends

An emergency department nurse wasnt sure whether there was enough evidence one
way or the other to suspect child abuse with a child client, as there wasnt much
evidence of physical harm. The forensic nurse agreed to see the child. What would be
the forensic nurses primary focus? observe the childs appearance and behavior and
how the child interacted with other children and adults

Who are the most likely to abuse the elderly?

o The national center on elder abuse reported that adult children are the
most frequent abusers of the elderly
o Neglect is the most common form of elder abuse

Forensic psych nursing collects evidence by determining intent or diminished

capacity in the clients thinking at the time of the incident

Correctional nursing
The primary goal in correctional facilities are security and a safe and humane
environment for inmates

what would be the correctional nurses first and most crucial responsibility if a prisoner
were bleeding where another inmate had attacked him with a fork?
o Unlike any other care setting, clients are inmates and care is negotiated and
provided with recognition of safety and security 1st for the nurse
o The nurse must be cognizant of an escape route before he/she enters the
area to provide care for the injured inmate-safety always comes 1st

Adolescent in prison
o A particular concern for incarcerated adolescents occurs when they are
incarcerated in adult facilities
o Adult facilities that are ill equipped to deal with the challenges of adolescent
o Must be aware of their individual vulnerability

o Adolescents in an adult correctional facility are 5x more likely to be sexually

assaulted, three times more likely to be beaten by prison guards, and 50%
more likely to be assaulted with a weapon or to threaten suicide when
compared with adolescents in a juvenile center
o Juveniles in detention and correctional facilities are 4 times more likely than
youths in the general public to commit suicide and 50-75% have diagnosed
mental illnesses
o To ensure the safety of adolescents in an adult facility, the nurse must be
aware of their individual vulnerability
o A mechanism for adolescents to access medical and mental health care is
o The services provided must also be in the context of the developmental
stage and experience of adolescence- so placing a adolescent in an adult
prison setting is something that should never happen

The correctional health nurse was completing an admission physical for a newly
incarcerated prisoner. The nurse realized the prisoner was talking to someone other
than the nurse. What does the nurse need to remember
o Prisons and jails have become the residence of a very large number of
persons who have mental illness

Respect the inmates right to refuse medication- even if the result is an adverse outcome

Education and forensic nursing

Require in depth knowledge and skills acquired through specialized programs of study
Colleges and universities have begun to offer these specialized programs to educate
forensic practitioners
They may obtain a certificate in forensic nursing, a minor or concentration, or a
graduate degree
The specialized curriculum includes: nursing fundamentals such as evidence collection,
documentation, and testifying, along with forensic law and science. Plus the nurse must
complete supervised clinical hours or a clinical internship
Chapter 32: Faith Community Nursing
The national health interview survey found that people who attended religious services
weekly or more often had a life expectancy nearly 5 years greater than those people who
never attended an organized religious meeting, these persons experience decreased anxiety,
depression, and stress
Throughout hx, churches have provided care for the indigent and disenfranchised, meeting
basic needs and basic health care
Westberg envisioned a partnership between the hospital and all church congregations
in the hospitals community and proposed in 1984 that participating churches would

make contributions to fund a nurses salary. His plan was implemented in 1985 as a
joint venture with Lutheran general hospital & 6 congregations in Chicago area, thus
was born modern parish nursing
1997 parish nursing recognized as nursing specialty by ana
2005 (spring) the scope and standards for faith community nursing
o ana revised the standards providing a clearer definition of the practice and
changing the name of the specialty from parish nurse to faith community
nurse. While acknowledging the importance of the Judeo-Christian basis of
the practice, the authors believed the change better reflected the diversity
now found in the specialty.

What is Faith Community nursing?

Faith community nursing is the specialized practice of professional nursing that
focuses on the intentional care of the spirit as part of the process of promoting holistic
health and preventing or minimizing illness in a faith community
a focus on spiritual dimension is central to the practice of a Faith Community Nurse
Key Features of a FCN:
Integration of faith and health
Holistic approach
Focus on health promotion (primary level prevention)
Focus on community
a rn with at least a bsn, several years of experience in clinical practice, plus formal
education as a fcn
Plus taken the basic parish nurse course (most of these nurses have worked >20 yrs)
Works with ministerial team and health committee of his/her parish
Seeks to creatively bridge the gaps ided in health education and health care delivery
*usually does not do hands on care and tries not to duplicate other available health
it is crucial fcn have at least a bacc degree as well as several years of experience because
they need to be autonomous with self direction and an independent decision maker
facilitation/networking- a fcn often finds the communities needs overwhelming, a good way
to manage the overwhelming needs involves recruiting, training, and directing volunteers
needed to implement needed programs
Spirituality- an individuals essence as a person; the human desire for a sense of meaning,
purpose, connecting, and fulfillment through intimate relationships and life experiences.
Spirituality is seen as being intertwined with mind, body, and emotions
Spiritual distress: a disruption in the life principle that pervades a persons entire being
and that integrates and transcends ones theological and psychosocial nature a disruption
of ones belief system

Symptoms of spiritual distress- loneliness, isolation, and hopefulessness

Circle model of spiritual care

1. Caring
2. Intuition (Acting on instinct- intuitive abilities as responses that expert nurses have
after several years of experience and these abilities enable the nurse to read
between the lines
3. Respect (Understanding the importance of religious beliefs and practices)
4. Caution (avoiding proselytizing or preaching religion to clients
5. Listening (allows an understanding of spoken and unspoken words and feelings,
encourages open communication, and supports and empowers patients to
communicate needs and desires)
6. Emotional support (the link between the physical and spiritually; includes working
with feelings, showing love, and using appropriate touch and empathy)
What can you do to provide spiritual support
Dying patient asks you to pray outloud
o Use a traditional prayer you have memorized from the dying persons faith.
If you do not have that knowledge, then use a prayer book from that
individuals faith and find suitable prayer. A guideline to follow is to keep
the prayer simple and offer the request to the clients higher power
What might cause ethical conflict for a fcn?
o Policies, values, & beliefs
o The nurse must understand the policies, values and beliefs of the
congregation related to specific health issues
Sharing methods dealing with infertility
o Nurse must understand his or her own beliefs and values that are in conflict
with the faith communities beliefs. She must ask to be excused from the
station if a couple wants to obtain information inconsistent with the churchs




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