Community Study Guide for the HESI

Population Groups across the Lifespan

Health Risks

Infants
# 1 cause of injury or death is suffocation followed by Motor Vehicle Accidents then
Homicide.
Sudden Infant Death Syndrome (SIDS)
Infection is the most significant cause of illness in infants and children.

Children
Obesity – Healthy people objectives have addressed youth fitness and obesity. Obesity is
defined by using BMI which is a ratio of weight to height.

Risks for childhood obesity were related to obesity in the parents.

Obesity rates are higher in populations such as Native Americans, Hispanics, and African
Americans. Lower socioeconomic groups in urban settings have been associated with
higher rates as well.

Injuries and Accidents - Number one cause of death in ages 1 – 24 yrs.

Motor vehicle accidents are the leading cause of death among children and teenagers.

Toddlers experience a large number of falls, poisonings, and motor vehicle accidents.

School age children - have the lowest injury death rate; however, this group has
difficulty judging speed and distance, placing them at risk for pedestrian and bicycle
accidents.

Screening/Preventive Measures
 Height/weight
 Vision and hearing
 At birth: hemoglobinopathy, phenylalanine level, T4, and TSH
 Immunization status: check the Centers for Disease Control and Prevention
(CDC), www.cdc.gov, for current administration schedules
 Lead exposure
 Cholesterol and triglyceride levels
 Dental health

Community Education
 Anticipatory guidance
 Breastfeeding
  Sleeping positions
 Nutrition
 Physical activity
 Substance use disorders
 Dental hygiene/health
 Skin protection
 Injury prevention including car, fire, and water safety; helmet use; poison
control; and CPR training

Adolescents - injury accounts for 75% of all deaths and risk-taking becomes more
conscious at this time especially among males.

Screening/Preventive Measures
 Height/weight
 Vision and hearing
 Dental health
 Mental health screenings
 Immunization status (www.cdc.gov)
 Cholesterol and triglyceride levels
 Substance use disorders, including tobacco
 Substance use disorders, including tobacco
 Rubella serology/immunization history (females)

Community Education
 Anticipatory guidance
 Substance use disorders
 Sexual behavior
 Nutrition, especially calcium intake for females
 Physical activity
 Skin protection
 Injury prevention including car, fire, and firearm safety

Suicide is the second leading cause of death among youths between the ages of 15 and
24. Suicide is the third leading cause of death among youth between the ages of 10
and 24 years.

Acute Illness - is also a significant cause of illness in children.

Chronic Health Problems- improved medical technology has increased the number of
children surviving with chronic health problems. Examples: Down Syndrome, spina
bifida, cerebral palsy, asthma, diabetes, congenital heart disease, cancer, hemophilia,
bronchopulmonary dysplasia, and AIDS

Routine immunizations have been very successful in preventing selected diseases.

Good nutrition is essential for healthy growth and development and influences disease
prevention in later life.

Women
The women’s health movement was pivotal in bringing national recognition to women’s
health issues.
Women have a longer life expectancy than men
Women are more likely to have acute and chronic conditions that require them to use
more services than men.
Women of color are more statistically more likely to have poor health outcomes because
of poor understanding of health, lack of access to health care, and lifestyle practices.
Heart disease leading cause of death in women
Lung Cancer leading cause of cancer in women and 2nd leading cause of death

Health Concerns/Leading cause of death

 Reproductive health
 Childbearing
 Menopause
 Osteoporosis
 Heart disease
 Diabetes mellitus
 Malignant neoplasm (breast, cervical, ovarian, colorectal)

Community Education
 Nutrition
 STI prevention
 Substance use disorders
 Breast self-examination
 Skin protection
 HIV prevention
 Injury prevention including car, fire safety, and violence

Men
Men are physiologically the more vulnerable gender, shorter life span and higher infant
mortality rate
Life expectancy of men in the US is one of the lowest in the developed countries
Men engage in more risk-taking behaviors than women
Men tend to avoid diagnosis and treatment of illnesses that may result in serious health
problems
Health Concerns/Leading cause of death
 Heart disease
 Malignant neoplasm (prostate, testicular, skin, colorectal)
 Unintentional injuries
 Lung disease
 Liver disease
Community Education
 Nutrition
 Testicular self-examination
 Substance use disorders
 Skin protection
 HIV prevention
 Injury prevention including car, fire safety, firearm safety, and violence

Elderly
Steadily growing population
Increase in chronic conditions, demand for services, and strained health care budgets
More older adults live in the community

Nurses address the chronic health concerns of elders with a focus on maintaining or
improving self-care and preventing complications to maintain the highest possible
quality of life.

Assessing the elderly incorporates physical, psychological, social, and spiritual domains.
Individual and community focused interventions involve all three levels of prevention
through collaborative practice.

Health Concerns/Leading cause of death

 Heart disease
 Malignant neoplasm
 Cerebrovascular disease
 Chronic Obstructive Pulmonary Disease
 Pneumonia and Influenza
 Substance use disorders

Community Education
 Substance use disorders
 Nutrition
 Exercise
 Dental health
 Sexual Behavior
 Injury prevention
 Car and fire safety
 Fall prevention
 Violence

U.S. Healthcare problems

More than 43 million people in the United States are uninsured, and many more simply
lack access to adequate health care.
Health care reform measures seek to make changes in the cost, quality, and access of the
present system.

The integration of primary care and public health is necessary for the future health of the
nation

To achieve the specific health goals of programs such as healthy People 2010, primary
care and public health must work within the community for community-based care.

The most sustainable individual and system changes come when people who live n the
community have actively participated.

Nurses are more than able to fill the gap between personal care and public health because
they have skills in assessment, health promotion, and disease and injury prevention;
knowledge of community resources; and the ability to develop relationships with
community members and leaders.

Home Visits - give a more accurate assessment of the following than do clinical visits
regarding:
- the family structure
- the natural or home environment
- behavior in that environment

Home visits provide opportunities to identify both barriers and supports for reaching
family health promotion goals.

Home visits afford the opportunity to gain a more accurate assessment of the family
structure and behavior in the natural environment.
Home visits also provide opportunities to observe the home environment and to identify
both barriers and supports to reducing health risks and reaching family health goals.

The home health nurse must evaluate the living environment for safety, paying close
attention to non-secure rugs, electrical outlets, and extension cords; the use of oxygen;
low lighting; the need for safety devices in the bathroom; and other potential
environmental hazards.

Faith Community

Parish nurses: nurses who respond to health and wellness needs within the faith context
of population of faith communities and are partners with the church in fulfilling the
mission of health ministry.

Parish nursing: a community-based and population-focused professional nursing

practice with faith communities to promote whole person health to its parishioners
usually focused on primary prevention.
Parish nurse coordinator: a parish nurse who has completed a certificate program
designed to develop the nurse as a coordinator of a parish nursing service.

Parish nurse services respond to health, healing, and wholeness within the context of the
church. Although the emphasis is on health promotion and disease prevention throughout
the life span, the spiritual dimension of nursing is central to the practice.

The parish nurse partners with the wellness committee and volunteers to plan programs
and consider health-related concerns within faith communities

To promote a caring faith community, usual functions of the parish nurse include
personal health counseling, health teaching, facilitating linkages and referrals to
congregation and community resources, advocating and encouraging support resources,
and providing pastoral care.

Parish nurses collaborate to plan, implement, and evaluate health promotion activities
considering the faith community’s beliefs, rituals, and polity. Healthy People 2010
guidelines are basic to the partnering for the programs.

Nurses working in the parish nursing specialty must seek to attain adequate educational
and skill preparation for the accountability to those served and to those who have
entrusted the nurse to serve

Nurses are encouraged to consider innovative approaches to creating caring communities.

These may be in congregations as parish nurses, among several faith communities in a
single locale, or regionally; or in partnership with other community agencies or models
such as block nursing.

To sustain oneself as a parish nurse healer, the nurse takes heed to heal and nurture self
while supporting individuals, families, and congregation communities in their healing
process.

Hospice

Hospice care focuses on enhancing the quality of life through the provision of palliative
care, supporting the client and family through the dying process, and providing
bereavement support to the family following the client’s death.

Clients can receive hospice care in a variety of settings, including the home, hospice
centers, hospitals, and long-term care settings.
 Hospice care is a comprehensive care delivery system for clients who are
terminally ill. Further medical care aimed toward a cure is stopped. The focus
becomes relief of pain and suffering, as well as enhancing quality of life.
 The hospice nurse provides care for the client and the client’s entire family.
Hospice care includes skilled, direct services and indirect care coordination.
 Hospice care uses an interprofessional approach.
  Controlling manifestations of the medical problem and dying process is a priority.
 The provider directs hospice care services which are then managed by the nurse.
 Helping the family transition from an expectation of recovery to acceptance of
death is an important aspect of providing hospice care. The hospice nurse can
continue to work with the family for up to 1 year following the death of the client.
 Postmortem bereavement services are offered for the family.

Palliative system of health care for terminally ill people; takes place in the home with
family involvement under the direction and supervision of health professionals,
especially the visiting nurse. Hospice care takes place in the hospital when severe
complications of terminal illness occur or when family becomes exhausted or does not
fulfill commitments.
DISASTERS

A disaster is an event that causes human suffering and demands more resources than are
available in the community. A disaster can be naturally occurring, man-made, or a
combination of both. For example, a hurricane (natural disaster) causing power outages.

Disaster preparedness is seen at the national, state and local levels.

Professional Preparedness

 Requires nurses and other personnel to be aware of and understand the disaster plans
at their workplace and community- participate in mock drills
 Adequately prepared nurses will function in leadership capacity and assist towards
smoother recovery phase
 Fieldwork, shelter management requires creativeness and willingness
 American Red Cross provides training for health professionals to adapt existing skills
to disaster setting

Role of Community Health Nurse

 Can initiate or update disaster plans at workplace and community and ensure
education, drill participation
 Knowledge of vulnerable populations, available community resources
 Assessing and reporting of environmental hazards, unsafe equipment, faulty
structures, disease outbreaks, e.g., measles, flu

Before anything happens prepare for Safety in a Disaster

Utilize the following 4 steps:

1. Find out what could happen to you:

a. Determine what types of disasters are most likely to happen
b. Learn about warning signals in community
c. Ask about care for pets
d. Review the disaster plans at workplace, and other places where families
spend time together
e. Determine how to help the elderly or disabled

2. Create a disaster plan

a. Discuss types of disasters that are likely to happen and review what to do
b. Pick 2 types of places to meet
c. Choose an out-of-state friend to contact
d. Review evac. Plans

3. Complete this checklist

a. Post emergency numbers next to phone
 b. Teach how to call 911
c. Determine when and how to turn of water, gas, and electricity
d. Check adequacy of insurance coverage
e. Locate and review use of fire extinguishers
f. Install and maintain smoke detectors
g. Conduct a home hazard hunt
h. Stock emergency supplies
i. CPR certification
j. Locate all escape routes
k. Find safe spots

4. Practice and maintain your plan

a. Review every 6 mos.
b. Conduct drills
c. Replace stored water every 3 mos. and stored food every 6 mos.
d. Test and recharge fire extinguisher
e. Test smoke detectors

Personal Preparedness
Nurses who are disaster victims themselves and provide care to others will experience
considerable stress.

American Red Cross and Federal Emergency Management Agency (FEMA) are two
well known authorities on disaster preparedness, response, and recovery. Additional
agencies are the CDC, Department of Homeland Security (DOH), Office of Emergency
Management (OEM), and the public health system.

Three levels of Preparedness

1st level – Personal Preparedness

2nd level- Professional Preparedness
3rd level- Community Preparedness

**Most states and counties have an Office of Emergency Management (OEM) that is
responsible for developing and coordinating emergency response plans within their
defined area. The state office supports local OEMs and other state agencies that
participate in disaster response. It provides planning and training services to local
governments, including financial and technical assistance. During an actual emergency
or disaster, the state OEM coordinates a state response and recovery program if
necessary. County OEMs are in charge of creating a comprehensive, all-hazard plan that
should address realistic dangers to the community and list available resources.

**Nurses need to review the disaster history of community, including how past disasters
have affected the health care delivery system, how their particular organizations fit into
the plan, and what role they and their organizations are expected to play in a disaster.
Stages

Preparedness: Know who is at risk, Personal, Professional and Community

Preparedness

Personal Preparedness
 Entails plan for keeping oneself ready for disaster, both mentally and physically
 Individuals not personally prepared will have less to give to family, community, job,
and other disaster victims
 Nurses can be disaster victims- personal preparation needed to attend to patients
 Checklist helpful to prepare

Professional Preparedness
 Requires nurses and other personnel to be aware of and understand the disaster plans
at their workplace and community- participate in mock drills
 Adequately prepared nurses will function in leadership capacity and assist towards
smoother recovery phase
 Fieldwork, shelter management requires creativeness and willingness
 American Red Cross provides training for health professionals to adapt existing skills
to disaster setting

Community Preparedness
 Level of preparedness only as high as people/ organizations in the community make it
 Well-prepared communities have written disaster plans, conduct drills, have adequate
warning system, and backup evacuation plan
 Office of Emergency Management- state/ county office coordinating regional plans
 Understanding past disasters can influence planning for future, liabilities in resources

Response

The primary objective of disaster response is to minimize morbidity and mortality. The
level of disaster determines FEMA’s response. Levels are not determined by the number
of casualties but by the amount of resources needed.
FEMA Levels of Disaster Response

 Level III- a minor disaster, involves a minimal level of damage but could result in the
president declaring an emergency. A minimal request for federal help
 Level II- moderate disaster- likely to result in major disaster being declared. Regional
federal resources engaged, other outside area may be called on
 Level I- massive disaster, severe damage or multistate scope. Full engagement of
federal regional and national resources
 Citizens and health professionals must be attached to official agencies with disaster
management responsibilities to avoid further risk

American Red Cross

3 ways to classify a disaster:

 Type- agent that caused the event, such as hurricane, hazmat, transportation

 Level- anticipated or actual Red Cross response and relief costs

Level I. costs less than $10,000

Level II costs $10,000 or more, but less than $50,000
Level III costs $50,000 or more, but less than $250,000
Level IV costs $250,000 or more but less than $2.5 million
Level V costs $2.5 million or more

 Scope- magnitude of the event, units affected and responding

(ex. - a single-family, local, state, major, federally declared)

Single family – affects an individual or single family- occurs within the

jurisdiction of a single Red Cross chapter
Local Disaster- Affects more than one family, occurs within the jurisdiction of a
single Red Cross chapter
State Disaster- Affects multiple families, occurs within the jurisdiction of one or
more Red Cross chapters within a single state
Major Disaster- has one or more of the following characteristics
-coordinated response of multiple Red Cross units
- affects more than a single state
- creates national news
- result in emergency or disaster declaration by the President etc.

Presidentially Declared Disaster- requires full or partial implementation of the

National Response Plan
National Response Plan
Once a federal emergency has been declared, the National Response Plan may take
effect, depending on specific needs arising from the disaster. The NRP is a concerted
effort to prevent terrorist attacks within the US; reduce American’s vulnerability to
terrorism, major disasters, and other emergencies; and minimize the damage and recover
from attacks, major disasters, and other emergencies that occur.

Role of the Nurse

 Role in disaster response depends on nurse’s past experience, role in community
disaster preparedness, specialized training, special interest

 Community health nurses valued for skills in community assessment, case finding,
prevention, education, surveillance, working with aggregates

 Plans for triage must begin as soon as rescue workers arrive- highest priority given to
life-threatening injuries with high probability of survival- nurse’s accurate assessment
info will help match available resources to population’s emergency needs
Recovery
The recovery stage of disaster occurs as all involved agencies pull together to restore the
economic and civic life of the community. For example: the government takes the lead
in rebuilding efforts whereas the business community tries to provide economic support.

Nurse’s Role in Recovery

 Multifaceted responsibilities- flexibility required to assist in successful recovery
 Teaching health promotion, disease prevention, assessment of physical, psychological
problems incurred in cleanup efforts, as well as threat of communicable disease
 Case finding, referral for mental distress
 Assessment and reporting of environmental health hazards resulting from event

Get community back to normal, deal with emotional matters and after effects.
Assess what might be going on in community using primary, secondary and tertiary care

Levels of prevention related to Disaster Management

Primary Prevention- Participate in developing a disaster management plan for the

community

Secondary Prevention- Assess disaster victims and triage for care

Tertiary Prevention- Participate in home visits to uncover dangers that may cause
additional injury to victim or cause other problems (e.g. house fires from faulty wiring).

Population at Greatest Risk for Disruption after a Disaster:

Persons with disabilities

Persons living on a low income, including the homeless
Non-English speaking persons and refugees
Persons living alone
Single-parent families
Persons new to the area
Institutionalized persons or those with chronic mental illness
Previous disaster victims or victims of traumatic events
People who are not citizens or legally documented immigrants
Substance abusers

Terrorism/Bioterrorism
Role of the Nurse:

 Help people cope with the aftermath of terrorism

 Allay public concerns and fears of bioterrorism
 Identify the feelings that you and others may be experiencing
 Assist victims to think positively and move to the future
 Prepare nursing personnel to be effective in a crisis situation

Nurses are concerned with anthrax and small pox and should have awareness of these
diseases

Need to have vaccine for small pox

BIOTERRORISM AGENTS

CATEGORY A
Highest priority agents, are easily transmitted, high mortality rates, and pose threat to
national security.

Examples: smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (e.g., Ebola),
and plague.

CATEGORY B
Second priority since they are reasonably easy to spread. Low mortality rate, but
increased morbidity rates.

Examples: typhus fever, ricin toxin, diarrheagenic E. coli, and West Nile virus.

CATEGORY C
Third priority, are emerging pathogens which may be engineered for mass distribution
due ease of production, have the potential for high morbidity and mortality rates, or both.

Examples include Hantavirus, Influenza virus, tuberculosis, and rabies virus.

The five components to a comprehensive public health response to outbreaks of illness

are the following:

- Detecting the outbreak

- Determining the cause
- Identifying factors that place people at risk
- Implementing measures to control the outbreak
- Informing the medical and public communities about treatments, health
consequences, and preventative measures

Triage: the process of separating casualties and allocating treatment on the basis of the
victims’ potentials for survival.

- Highest priority is always given to victims who have life threatening injuries but
who have a high probability of survival once stabilized
- Second priority is given to victims with injures that have systemic complications
that are not yet life threatening and could wait 45 – 60 minutes for treatment
- Last priority is given to those victims with local injuries without immediate
complications and who can wait several hours for medical attention.

Rationale from Saunders

In an emergency department, triage is classifying clients according to their need for care
and includes establishing priorities of care. The kind of illness, the severity of the
problem, and the resources available govern the process.

Clients with trauma, chest pain, severe respiratory distress or cardiac arrest, limb
amputation, acute neurological deficits, and those who sustained chemical splashes to the
eyes are classified as emergent and are the number 1 priority.

Clients with conditions such as a simple fracture, asthma without respiratory distress,
fever, hypertension, abdominal pain, or the client with a renal stone have urgent needs
and are classified as number 2 priorities.

Clients with conditions such as a minor laceration, sprain, or cold symptoms are
classified as nonurgent and are the number 3 priority.

Review of Disaster Nursing

1. List the three levels of disaster management.

Disaster preparedness, disaster response, disaster recovery

2. List examples of the three levels of prevention in disaster management.

Primary: Develop plan, train and educate personnel and public; secondary: Triage,
treatment-shelter supervision; tertiary: Follow-up, recovery assistance, prevention
of future disasters

3. Define triage.
To sort or categorize

4. Identify three bioterrorism agents.

Anthrax, pneumonic plague, botulism, smallpox, inhalation tularemia, viral
hemorrhagic fever, ricin, sarin, radiation

5. Identify three infection control measures for Ebola.

Three infection control measures for Ebola include the following:
A. Place the client in a single-patient room with a private bathroom.
B. Wear full PPE.
C. When there are copious amounts of blood and other body fluids, caregivers
should wear additional PPE, including double gloves, disposable shoe covers, and
leg coverings.

6. Identify the agency to notify when providing care for a client with a suspected
diagnosis of Ebola virus.
Notify appropriate health care providers, supervisors, and the CDC of clients with
a suspected diagnosis of Ebola virus.
7. Describe the delayed triage category.
Delayed triage category indicates that the status of a client who has a serious life-
threatening injury is not expected to deteriorate significantly in a few hours.

8. Describe travel recommendations for a couple preparing for in vitro fertilization.

Inform couple that the Zika virus is probably transmitted via sexual contact and
provide information regarding the possible transmission of the Zika virus
resulting in the congenital defect to the fetus. Recommend obtaining information
regarding travel from CDC travel line.

Older adult health risks

Nutrition, safety, social isolation, and depression

The following are ways to help prevent or decrease the occurrence of falls:

 Install adequate lighting

 Wear proper footwear that supports the foot and contributes to balance; shoes
should be made of non-slip materials.
 Place a bell on any resident cats; cats move quickly and can get underfoot.
 Paint the edges of stairs a bright color.

Need to assess the health literacy of the client first

Program outcomes: smoking cessation, weight management, diabetic management

- look at the evaluation of the specific outcome

- Identifying changes in the client’s health status that result from nursing care
provides nursing data that demonstrate the contribution of nursing to the health
care delivery system.

Research studies using the tracer or sentinel method to identify clients’ outcomes and
client satisfaction surveys can be used to measure outcome standards.

From data, strengths and weaknesses in nursing care delivery can be determined.

The most common measurement methods are direct physical observations and
interviews.

Primary Care - refers to organized community efforts designed to prevent disease and
promote health (education).

Secondary Care – is an intermediate level of health care that includes diagnosis and
treatment. Screening

Tertiary Care - rehabilitation and return of a patient to a status of maximum usefulness

and a minimum risk of recurrence of a physical or mental disorder
Levels of Prevention

Primary Prevention - Counsel clients in health behaviors related to lifestyle

Secondary Prevention - Implement a family-planning program to prevent unintended

pregnancies or young couples who attend the primary clinic

Tertiary Prevention - Provide a self-management asthma program for children with

chronic asthma to reduce their need for hospitalization (prevent from getting worse)
Federal Agencies

Many federal agencies are involved in government health care functions. The agency
most directly involved with the health and welfare of Americans is the U.S. Department
of Health and Human Services

U.S. Department of Health and Human Services (USDHHS)

Largest health program in the world, its mission is to enhance the health and well-being
of the American people through the following:

- Alcohol, drug abuse, and mental health programs

- Disease tracking and identification
- Health care access for all and integrity of the nation’s health entitlement and
safety net programs
- Identification and correction of health hazards
- Medical assistance after disasters
- Medical research
- Promotion of exercise and healthy habits
- Protection of the nation’s food and drug supply

The Health Resources and Services Administration of the USDHHS contains the Bureau
of Health Professions, this bureau includes separate divisions for nursing, medicine,
dentistry, public health, and allied health professions
The Division of Nursing administers nurse education legislation, interprets trends and
nursing needs of the nation’s health care delivery system, and serves as a liaison with the
nursing community and with international, state, regional, and local health interests

Two other agencies with the DHHS:

The National Institute for Nursing Research (NINR)

Healthcare Research and Quality (AHRQ)

This institution is the focal point of the nation’s nursing research activities. It promotes
the growth and quality of research in nursing and patient care, provides important
leadership, expands the pool of experienced nurse researchers, and serves as a point of
interaction with other bases of health care research

Nurses can apply for support for research, projects, or training from a variety of agencies
within the federal government besides the NINR of the Division of Nursing.

Other federal agencies: Dept. of Commerce, Dept. of Defense, Dept. of Labor (includes
OSHA), Dept. of Agriculture (includes WIC), Dept. of Justice, Food and Drug
Administration.
Voluntary and Private Nonprofit Agencies

Voluntary and private agencies are grouped together as nonprofit home health agencies,
voluntary agencies are supported by charities such as United Way, Medicare, Medicaid,
other third-party payers, and client payment.

The amount of financial assistance the voluntary agency receives depends on the
community it serves. With Medicare, the private nonprofit agency emerged as an
alternative agency to the public-supported program. These agencies included
rehabilitation agencies, based in either rehabilitation facilities or skilled facilities.

Nurses use assessment skills to detect potential and actual exposure pathways and
outcomes for clients cared for in the acute, chronic, and healthy communities of practice.

Risk communication is an important skill and must acknowledge the outrage factor
experienced by communities with environmental hazards.

Vulnerable populations- are those groups who have an increased risk to develop adverse
health outcomes, vulnerable populations often experience multiple cumulative risks and
they are particularly sensitive to the effects of those risks.

Vulnerable populations often are more likely than the general populations to suffer from
health disparities.

Examples of areas that show health disparities across populations groups are infant
mortality, childhood immunization rates, and disease-specific mortality rates.

Vulnerable Population Groups of Special Concern to Nurses

- Poor and homeless people

- Pregnant adolescents
- Migrant workers and immigrants
- Severely mentally ill individuals
- Substance abusers
- Abused individuals and victims of violence
- Persons with communicable disease and those at risk
- Persons who are human immunodeficiency virus (HIV positive) or have Hep B or
sexually transmitted disease.

Migrant workers tend to have high occupational mobility; many are poor and have
limited formal education. They may seek health care only when they are ill and cannot
work. Whenever a nurse interacts with them, it is important to teach them about
prevention, health maintenance, environmental sanitation and pesticides, and nutrition
because it may be the only opportunity that the nurse will have to treat a particular
migrant worker. Nurses also should advocate for the rights of the migrant worker to
receive quality health care.
Behavioral (Lifestyle) Health Risk Assessment

Families are the major source of factors that can promote or inhibit positive lifestyles. It
is important to look at risks for the family as a unit.

Critical dimensions of lifestyle risks include the following:

- Value placed on behavior
- Knowledge of the behavior and its consequences
- Effect of the behavior on the family
- Effect of the behavior on the individual
- Barriers to performing the behavior
- Benefits of the behavior

It is important to assess the frequency, intensity, and regularity of specific behaviors. It

also is important to evaluate the resources available to the family for implementing the
behaviors.

Nurses should be aware that some Hispanic and Asian cultures place the needs of the
family above those of the individual. In the American Indian/Alaskan Native family,
members honor and respect their elders. Nurses should advocate for the individual, so
that when families make decisions, the individual’s needs are also considered. However,
members of the family may need to be included in the decision making.
Modifiable Risk and Unmodifiable Risks

Risk factors that are "unmodifiable," are things that neither you nor your patients can do
anything about. You need to know the "unmodifiable" risk factors, because they help you
to define high-risk individuals and groups for whom treating or controlling the
"modifiable" risk factors is a priority.

Modifiable risks can be changed such as smoking.

Epidemiology – how to calculate a rate

 The denominator includes the numerator

Example:

Crude birth rate Number of live births during 1 year X1000

Midyear population

Evaluating Outcomes

Outcomes can be measured by looking at changes from before and after the intervention
to solve the problems. Changes in the following can be used to see the outcomes of the
interventions:

- Demographics
- Socioeconomic factors
- Environmental factors
- Individual and community health status
- Use of health services

In the example of infant malnutrition, one would look for the number of cases of infant
malnutrition in the community before providing education to other health providers about
assessment of infant development. A time period for evaluation would be chosen and
perhaps 1 year later (the time frame). The number of cases of infant malnutrition would
be measured to see if a change had occurred and there were fewer cases.

Incidence rate- the frequency or rate of new cases of an outcome in a populations;

provides an estimate of the risk of disease in that population over the period of
observation

Prevalence: number of existing cases in a population at a given time

Nursing Process- Always assess before starting an intervention

Community assessment

Most nurses are familiar with the nursing process as it applies to an individual. Utilizing
the nursing process to promote community health now transitions the process to a
community focused nursing process.

Community assessment- the process of critically thinking about the community and
involves getting to know and understand the community as partner. The community
assessment phase involves a logical, systematic approach to the initial phase of the
nursing process. Community assessment helps as follows:

- To identify community needs

- To clarify problems
- To identify strengths and resources

Assessing the community health requires the following three steps:

- Gathering relevant existing data and generating missing data

- Developing a composite database
- Interpreting the composite database to identify community problems and strengths

Data Collection and Interpretation

The primary goal of data collection is to get usable information about the community and
its health. The systematic collection of data about community health requires the
following:

- Gathering or compiling existing data

- Generating missing data
- Interpretation of data
- Identifying community health problems and community abilities

Data gathering is the process of obtaining existing, readily available data. The following
data usually describe the demography of a community

- Age of residents
- Gender distribution of residents
- Socioeconomic characteristics
- Racial distributions
- Vital statistics, including selected mortality and morbidity data

Identify needs, problems, strengths, resources and apply what you know.
Windshield survey - is the motorized equivalent of simple observation. That is, it is a
descriptive approach which allows the assessment of components of a community by
simply driving through a community. However, this method may be time consuming,
requires a second person to drive while the nurse makes observations, and does not allow
for input from members of the community. The data collected “will help define the
community, the trends, stability, and changes that will affect the health of the
community”

School Nurse:

- Primary -The school nurse monitors the children for all of their state-mandated
immunizations for school entry.
- Secondary- School nurse is involved in screening children for illnesses and
providing direct nursing care (i.e., triage)
 - Tertiary – The school nurse cares for children with long-term health needs,
including asthma and disabling conditions

School nurses utilize their skills to perform catheterizations, suctioning, gastrostomy tube
feedings, insulin administration, glucose monitoring, and other skills while the children
attend school. (Tertiary)

The concern for health promotion of adolescents is safety because of their propensity to
take part in risky behaviors.

To effectively reach a population group you must connect with someone in the
community and establish trust.

Groups have role structures that define the expected ways in which members behave
toward one another.

Occupational Exposure

Work-related Diseases and

Job Categories Exposure
Conditions
Farm workers Pesticides, infectious agents, HTN, mood disorders,
gases, sunlight cardiovascular disease
Chemical workers Solvents, cleansers, etc. Cancer, etc.

For a complete list see textbook

Medicare
Provides hospital insurance and medical insurance to persons ages 65 years and older,
permanently disabled persons, and persons with end-stage renal failure
Part A – covers: hospital care and home care (home care or hospice – can’t have both),
skilled nursing care
Part B- covers: (non-institutional care insurance) Medical care, diagnostic services and
physiotherapy.

Medicaid
Provides financial assistance to states and counties to pay for medical services for poor
older adults, the blind, the disabled, and families with dependent children.

WIC a special supplemental food program administered by the Department of

Agriculture through the state health departments; provides nutritious foods that add to the
diets of pregnant and nursing women, infants, and children younger than 5 years.
Eligibility is based on income and nutritional risk as determined by a health professional

Outreach worker: a health worker who makes a special, focused effort to find people
with specific health problems for the purpose of increasing their access to health services
- evaluate effectiveness find out if successful and use ways to measure success
Epidemiologic triangle – agent, host, and environment – changes in one of the elements
of the triangle can influence the occurrence of disease by increasing or decreasing a
person’s risk for disease. Risk is the probability that an individual will experience an
event.

Agent- an animate or inanimate factor that must be present or lacking for a disease or
condition to develop
- Infectious agents (bacteria, viruses, fungi, parasites)
- Chemical agents (heavy metal, toxic chemicals, pesticides)
- Physical agents (radiation, heat, cold, machinery)

Host- a living species (human or animal) capable of being infected or affected by an

agent
- anything capable of being infected
- Genetic susceptibility
- Immutable characteristics (age, sex)
- Acquired characteristics (immunologic status)
- Lifestyle factors (diet, exercise)
Environment- all that is internal or external to a given host or agent and that is
influences the host and/or agent
- anything external
- climate (temperature, rainfall)
- Plant and animal life (agents or reservoirs or habitats for agents)
- Human population distribution (crowding, social support)
- Socioeconomic factors (education, resources, access to care)
- Working conditions (levels of stress, noise, satisfaction)

When there is a relationship between the host, agent and physical environment the
foundation for disease is present. Disrupting the connection will not permit the
disease to flourish.

Web of Causality - complex interrelations of factors interacting with each other to

influence the risk for or distribution outcomes.

- Recognizes the complex interrelationships of many factors interacting, sometimes

in subtle ways, to increase (or decrease) the risk of disease.
- Associations are sometimes mutual, with lines of causality going in both
directions

Family assessment

Ecomap- represents the family’s interactions with other groups and organizations,
accomplished by using a series of circles and lines.
- It is represented by a circle in the middle of the page
- Other groups and organizations are then indicated by circles
- Lines representing the flow of energy are drawn between the family circle and the
circles representing other groups and organizations
- An arrowhead at the end of each line indicates the direction of the flow of energy
(into or out of the family)
- The weight of the line indicates the intensity of the energy

Genogram- is a pictorial display of a person's family relationships and medical history. It

goes beyond a traditional family tree by allowing the user to visualize hereditary patterns
and psychological factors that punctuate relationships. It can be used to identify repetitive
patterns of behavior and to recognize hereditary tendencies.
Prevention Strategies for Violence

Individual and Family levels

- Assess during routine examination (secondary)
- Assess for marital discord (secondary)
- Educate on developmental stages and needs of children (primary)
- Counsel for at-risk parents (secondary)
- Teach parenting techniques (primary)
- Assist with controlling anger (secondary)
- Treat for substance abuse (tertiary)
- Teach stress-reduction techniques (primary)

Community Level
- Develop policy
- Conduct community resource mapping
- Collaborate with community to develop systematic response to violence
- Develop media campaign
- Develop resources such as transition housing and shelters

High school students and middle school students- steer away from violence and
teach to work on their own skills and build their self-esteem.