Exam III

Please focus on concepts related to the following items in chapters assigned for this
portion of the course. If you have questions, please write them down—send to
faculty so that they may be addressed during the group study session.

Chapter 7 Epidemiology in Community Health Care

• Explain the host, agent, and environmental model.

• Host, Agent, & Environmental model: interactions among these three

elements explaining infectious and other disease patterns

• Host: a susceptible human or animal who harbors and nourishes a disease-

causing agent; Factors: age, sex, race, genetics, response to stress, diet,
exercise, sleep patterns, health habits

o Inherent resistance: having an ability to resist pathogens

• Agent: a factor that causes or contributes to a health problem or condition;

caused by factors that are present or lacking ; infectious (communicable
diseases) or noninfectious

• Environment: all the external factors surrounding the host that might
influence vulnerability or resistance; geography, climate, weather, safety,
water and food supply, presence of animals, insects, plants

• Describe theories of causality in health and wellness.

Causality: the relationship between a cause and its effect

• Chain of Causation: identifying the reservoir (where the causal agent can live
and multiply; human with malaria), portal of exit (mosquito bites Malaria
infected human), mode of transmission (mosquito), portal of entry (mosquito
bites uninfected human), host (human becomes infected with Malaria),
environment (can have a profound influence at any point along chain)

• Causation in Noninfectious Disease: nine elements to evaluate the

relationship between environmental exposure and potential health outcomes
(noninfectious): strength of association (ratio of disease in those with or
without suspected causal factor), consistency, specificity ( a cause leads to
one effect), temporality (time order or time sequence), biological gradient
(dose response relationship), plausibility (it is possible), coherence of
explanation (scientific knowledge), experiment, analogy (similarities between
the associate of interest and others)

• Multiple Causation: causation is viewed as multifactorial; multiple

opportunities to find solutions
• Web of Causation: intervention could profoundly impact the development of
that disease; multiple factors was the deciding factor in the development of
poor outcomes; provides opportunities for health care interventions at a
variety of levels

• Discuss the types of epidemiologic studies that are useful for researching
aggregate health.

• Descriptive Epidemiology: investigations that seek to observe and describe

patterns of health-related conditions that occur naturally in a population

o Counts

o Rates: statistical measures expressing the proportion of people with a

given health problem among a population at risk

• Analytic Epidemiology: seeks to identify associations between a particular

human disease or health problem and its possible causes; more specific than
descriptive studies

o Prevalance studies: patterns of occurrence

o Case control studies: compares people who have a health condition

with those who lack this condition

o Cohort studies: group of people who share a common experience in a

specific time period

• Experimental Epidemiology: builds on the information from descriptive and

analytic approaches; the investigator actually controls or changes the factors
suspected of causing the health condition under study, then observes what
happens to the health state; carried out under carefully controlled conditions

• Explain a web of causation matrix that assists you with recognizing multi-
causal factors in disease or injury occurrences.

• Data from birth and death certificates are used to identify complex
interactions among multiple causal factors that produce’s a negative health
condition leading to the issue

• Define immunity and compare passive immunity, active immunity, cross

immunity, and herd immunity.

• Immunity: a host’s ability to resist a particular infectious disease causing

agent; the body forms antibodies and lymphocytes that react with foreign
molecules and render them harmless
• Passive Immunity: short term resistance that is acquired either naturally or
artificially (newborns through maternal antibody & inoculation with antibody
products to provide temporary resistance)

• Active Immunity: long term/lifelong resistance that is acquired either

naturally (thru host infection) or artificially (vaccinations)

• Cross Immunity: a situation in which person’s immunity to one agent provides

immunity to a related agent (passive or active); BCG vaccine helps prevent
TB to people who have been exposed to leprosy

• Herd Immunity: the immunity level present in a population group (mandatory

preschool immunizations and required travel vaccinations)

• Identify the four stages of disease or health conditions.

• Susceptibility Stage: the disease is not present and individuals have not been
exposed

• Subclinical Disease Stage: begins when individuals have been exposed to a

disease but are asymptomatic

• Clinical Disease Stage: signs and symptoms of the disease or condition

develop (lab tests, acute symptoms)

• Resolution Stage: the disease or health condition causes sufficient anatomic

or functional changes to produce recognizable signs and symptoms

• List the major sources of epidemiologic information.

• Existing Data:

o vital statistics (information gathered from ongoing registration of

births, deaths, adoptions, divorces, and marriages)

o census data (data from population census taken every 10 years)

o morbidity statistics;

o local health agencies could be helpful; local health departments can

provide this information on request,

o reportable diseases (varicella, rabies, AIDS, meningitis, syphilis, and

TSS & diseases subject to international quarantine regulations),

o disease registries (conditions with major public health impact- TB,

cancer)
 o Environmental monitoring (pesticides, industrial wastes,
radioactive/nuclear materials, chemical additives to food, pollutants)

o Informed Observational Studies: informal observation and description;

any client group encountered by the CHN can trigger this study

o Scientific Studies: carefully designed scientific studies

Chapter 13:

• Types of Health policy

o Health policy: specific policies involving health care

o Distributive Health policy: promotes nongovernmental activities that

are thought to be beneficial to society as a whole

o Redistributive Health policy: changes the allocation of resources from

one group to another, usually to a broader or different group
(Medicare)

o Regulatory Health policy: one that attempts to control the allocation of

resources by directing those agencies or persons who offer resources
or provide public services (certain government regulations set
standards for the licensure of health care organizations- hospitals and
health care providers)

• foundation of public health nursing=social justice (both a process and a goal

which includes a vision of society that is equitable and all members are safe
and secure)

• professional advocacy-membership is professional organizations is important

for nurses to advocate change; to build a collective voice for nurses

o polarization: the process by which a group is severely split into two or

more factions over a political issue (Democrats & Conservative Parties)

• influencing policy/ talking w/ your legislators managed care

o Honesty is the best policy: don’t promise what you can’t deliver, never
mislead a legislator

o Start early

o Know what you want: know pros and cons, be clear about what you are
asking
 o KISS (Keep It Simple, Stupid!)

o No permanent enemies, no permanent friends

o Know your opponents

o Compromise

o There is strength in numbers

o Work at the local level

o Thank you

Chapter 16 Global Health and International Community Health Nursing

• Universal Imperatives of Care: this paradigm underscores the notion of first

things first

o Mortality: keep population alive and free from illness; CHN might get
frustrated that disabled are going without resources; when mortality is
a priority, physician will be the valued HCP

o Morbidity: the conditions that make people sick

o Daily Functioning: must focus on the necessities first

o Decision-Making: in order to choose you need options; privatization &

internet access

o Cost: health costs are burden of the community; nations are forced to
weigh the cost of managing some health conditions over others & most
of the time they opt out

• Classification of Environmental Hazard: OECD, WHO have classified the

environmental hazards affecting the communities that include the impact of
local climate changes on weather patterns and agriculture

o Infectious agents- bacteria & viruses

o Respiratory fibrotic agents- coal dust

o Asphyxiates- carbon monoxide

o Poison- pestacides

o Psychological agents

o Physical agents
 o Teratogens

o carcinogens

• Era of Infectious Diseases: have killed people, made them sick, altered their
daily functioning, influenced their decision making, and affected the cost of
care; factors include the climate, geography and other conditions infectious
organisms need to survive and thrive

• Era of Infectious Diseases and the Universal Imperatives of Care

• Nongovernment organizations:

o Global Health Council: world’s largest membership alliance dedicated

to saving lives by improving health throughout the world; advocates
for needed policies and resources & share ideas

o Center for International Health & Cooperation: promotes healing and

peace in countries shattered by war, regional conflicts, and ethnic
violence

o CARE: American rush life-saving care packages from citizens, churches,

clubs to survivors of WWII; responds to famines, worldwide disasters;
delivers programs in education, health, water sanitation, community
building

o The Carter Center: intervenes in disease prevention and agriculture

throughout the world; Guinea Worm, River blindness, Health training
initiative

o International Council of Nurses: represents the global interests and

concerns of the nursing profession

• Declaration of Alma-Ata: 134 countries implemented primary health care

(worldwide)

• Eradication: interruption of person-to-person transmission and limitation of

the reservoir of infection so that no further preventive efforts are required

• Elimination: a disease that has been interrupted in a defined geographic area

• Control: indicates that a specific disease has ceased to be a public health

threat; aimed at reducing

• Chapter 17 Being Prepared: Disasters and Terrorism

• Describe a variety of characteristics of disasters, including causation, number
of casualities, scope, and intensity

o Natural Disaster: caused by natural events (floods, earthquakes)

o Man-Made Disaster: caused by human activity (bombings)

o Casualty: a human being who is injured or killed by or as a direct result

of an accident

o Multiple casuality incident: more than two people but less than 100

o Mass casualty incident: involving 100 or more casualities

o Scope: the range of its effect, either geographically or in terms of the

number of victims

o Intensity: the level of destruction and devastation it causes

• Agencies and organizations for disaster management :

o Red Cross: founded by Clara Barton and charted by U.S. Congress;

provides disaster assistance free of charge across the country through
volunteers; not supported by government but relies on donations;
sheltering, food, basic health and mental health services, and
distribution of emergency supplies

o The Federal Emergency Management Agency FEMA: federal agency

responsible for assessing and responding to disaster events in the U.S;
provides training and guidance in all phases of disaster management;
is a part of Homeland Security

o WHO: provides disaster assistance internationally

• Responding to disasters:

o Rescue: firefighters & special trained personnel; protective gear might

be required; greatest need is at hospitals

o Triage: the process of sorting multiple casualties in the event of a war

or major disaster; required when the number of casualties exceeds
immediate treatment resources; goal= to effect the greatest amount
of good for the greatest number of people

 Red: urgent=if not treated immediately will lead to death

(unconscious with internal bleeding)
  Yellow: delayed= injuries that require medical attention but not
critical (conscious victim with a fractured femur)

 Green: minor/walking wounded=minor injury (conscious victim

with superficial cuts, bruises)

 Black: dead/non-salvageable

• Psychological consequences of disasters:

o Acute Distress Disorder: (occurs within 1 month of disaster and

resolving within 4 weeks) numb, absence of emotion, being in a daze,
derealization, depersonalization, dissociative amnesia

o Post-Traumatic Stress Disorder: (acute reaction lasting longer than 4

weeks) recurrent recollections of the event (images, thoughts,
perceptions), recurrent distressing dreams of the event, acting or
feeling as if the traumatic event were reoccurring (illusions,
hallucinations, flashbacks), efforts of avoid activities, places & people,
feelings of detachment, sense of a foreshortened future, difficulty
going to sleep, exaggerated startle response

• Role of the CHN in disasters:

o Primary Prevention: look and listen (surveillance), be alert to signs of

possible terrorist activity; dead or dying animals, unexpected illnesses,
unusual odor, low lying clouds unrelated to weather, swarm of insects

o Secondary & Tertiary Prevention: must be prepared to act safely,

access information rapidly, and use resources effectively; may be
called to provide direct care to victims, set up, mass immunizations,
make home visits

o Fight anxiety:

 Be a little afraid

 Keep a courage journal

 Reassure your children

 Cook something hearty, healthy, and large

 Give kindness to others

 Get spiritual

 Laugh
  Get back to nature

 Find reasons to believe the sky is not falling

• Chapter 25:

• Factors associated w/ vulnerable populations

o Poverty: having less money means being loss able to afford adequate
housing in a safe neighborhood; fewer opportunities for exercise due to
violence; less education; exposed to higher risk at job; less likely to
shop for healthy foods; chronic stress; high pollution in low income
neighborhoods

o Uninsured & Underinsured: majority are working adults and not eligible
for Medicaid or Medicare; living in poverty called working poor;
disparities are found in uninsured populations; few resources do not
utilize screenings and preventive measures & delay treatment due to
money; only receive care for problem at hand and no community care;
regular examinations are delayed and earlier death may result

o Race & Ethnicity: 1/3 of the population belongs to a racial or ethnic

group and it continues to rise; Hispanics are the fasting growing group
(high fertile rates); Hispanics, Blacks, and Native Americans are more
likely to be in poor health than Whites; Southeast Asians have poor
morbidity and mortality; Blacks-AIDS & pulm embolism; Hispanics-
obese=diabetes; attributed to cultural barriers, discrimination, and
lack of access to appropriate health care; recent immigrants have
healthier exercise and dietary patterns than those born in U.S.; low
educational attainment; racial predisposition for disease development
by environmental triggers

• How does the CHN empower clients in vulnerable populations?

o Empowerment: an active, internal process of growth that is reached by

actualizing the full potential inherent within each client and occurring
within the context of a nurturing nurse-client relationship

o Two way street: clients gain knowledge and skills and act on informed
choices, but also empowers the nurse to continue to empower

o Have a client-centered approach (flexibility in dealing with the client)

o Develop a trusting relationship based on respect and dignity

(nonjudgmental, empathy)
 o Employing advocacy (individual level and politically)

o Being a teacher and role model (use variety of strategies)

o Capacity building through encouraging and supporting of clients’ work

toward health goal (reflective listening)

o Outcomes: increased self-esteem, confidence, improved self-efficacy,

ability to reframe situations in positive way, see community & want to
make things better

• Resiliency: the ability to bounce back or recover from life’s stressors without
permanent injury; dealt with life outcomes not health; external support and
the individual’s temperament can help; PHN can provide support at both the
individual and population levels

• ways to decrease health disparities

o Health Disparity: chain of events signified by a difference in

environment, access to/use of/quality of care, health status, or
particular health outcome that deserves scrutiny

o Improve quality of health care, increase access to care, eliminate

discrimination, education about HIV/homelessness/drug use/race &
ethnicity to care givers to help promote better care

• participatory action research: community based participatory research; used

among vulnerable populations around the world because it calls upon the
expertise and perspectives of the community in identifying needs and
developing appropriate interventions; process of problem identification and
problem solving using reflection and analysis

o investigator posing a research question to a group from a selected

community. Feedback in given and more information is gathered and
analyzed; community members viewed as co-researchers and invested
in the outcomes and results

o PAR: Problem inquiry, organization of participants, awareness and

action

• definition of a vulnerable population: groups who have a heightened risk of

adverse health outcomes; often have higher mortality rates, less access to
health care, uninsured or underinsured, lower life expectancy, and overall
diminished quality of life
Chapter 26--Clients w/ Disabilities

• % of population w/ disabilities: 20% population with disabilities

• American's w/ Disabilities Act of 1990:

o To protect the civil liberties of the many Americans living with

disabilities ; broad spectrum of protections for disabled persons;
prohibits discrimination on the basis of disability in employment, state,
and local government

o Must have a disability or some type of relationship or association with

an individual who has a disability

o Public accommodation providing access for individuals with disability

• Concept/ definition of a disability:

o A person who has a physical or mental impairment that substantially

limits one or more major life activities, a person who has a history or
record of such an impairment, or a person who is perceived by others
as having such an impairment

• respite care:

o a service that is receiving increasing attention; provides time off for

caregivers, including family members, who care for someone who is ill,
injured or frail

o adult day center, in the home, or in a residential setting (assisted living

facility or nursing home)

• International classification of Functioning, Disabilities and Health

o Functioning: encompasses all body functions, activities, and

participation

o Disability: Impairments, activity limitations, or participation restrictions

o Health: emphasizing the observation that no 2 people with the same

disease or disability have the same level of functioning

• Health People 2000 and 2010 re : disabilities and chronic disease

o 2010: ½ of goals are related to disability; people with disability are

identified as having an activity limitation or who use assistance or who
perceive themselves as having a disability
 o 2000: only covered 1 area

Chapter 28 Working with the Homeless

• Define the concept of homelessness

o Examine the factors contributing to homelessness, analyze the major

issues confronting the homeless, and examine the role of the
community health nurse in addressing the needs of the homeless

• Describe the demographic characteristics of the homeless living in the USA

o Age: 39% under 18—42% of that was under 5

o Gender: single-men; families- women

o Ethnicity: urban- African American men; rural- White, Native American,

migrant workers

o Families: families with children

• Homeless subpopulations

o Homeless Men: single male adults; employed but usually hold

temporary low wage jobs with little security; uncontrolled substance
abuse; chronically homeless: have significant health problems due to
chronic substance abuse, lack of shelter, and poor access to health
services

o Homeless Women: majority female families; family violence; history of

physical or sexual assault; emotional disturbances; STDs, injuries

o Homeless Children: homeless families are fastest growing population;

live in shelters, live with friends or relatives, or live in motels or camp
grounds; evicted from housing; emotional and behavioral problems;
anxiety, depression, withdrawal, aggressive; other things take priority
over education- more likely to repeat grades & have learning
disabilities; go hungry; experience physical or sexual abuse; more
likely to get sick

o Homeless Youth: persons under 18 who lack parental, foster, or

institutional care; “unaccompanied youth”; urban population; survival
sex=HIV, Hepatitis, STDS; anxiety, conduct disorders, malnutrition

o Homeless Families: lack of affordable housing; uninsured; child at

greater risk if father becomes injured or ill, job loss, substance abuse,
or incarcerated
 o Homeless Veterans: Black men over white men and women; Vet
programs provide case management, residential treatment, and other
services

o Rural Homeless: White, female, married, working, homeless for the first
time, homeless for a shorter length of time; needs to be expanded to
people who live in temporary or standard housing

o Older Homeless: poverty and lack of affordable housing; live on fixed

income; isolation is a factor; difficulties applying for benefits ; prone to
criminal victimization and duffer from health conditions

• Healthcare and the Homeless

o Chronic health conditions: TB, HIV/AIDS, diabetes, hypertension,

addictions and mental disorders

o Difficult to adhere to treatment regimens

o Health care takes a back seat to food, clothing, shelter

o High risk of trauma

o Tooth decay

o Homeless Health Care: address significant gaps in health care delivery

for this group

• Role of the CHN in providing care for the homeless

o Marginalized: persons excluded from mainstream society

o Disenfranchised: persons deprived of rights

o Setting up for care include shelters, clinics, soup kitchens, churches,

community centers

o Trust is essential

o Clarify one’s own beliefs and values about poverty, etc.

o Interview people who work with homeless

o Primary Prevention: advocating for affordable housing, employment

opportunities and better access to health care; financial counseling;
health education; addictions treatment
 o Secondary Prevention: early detection and treatment of adverse health
conditions; assessment of client needs; screening; barriers needs to be
assessed; consider faith-based communities for support

o Tertiary Prevention: limit disability and to restore maximum

functioning; provide rehab care and support to clients who are already
experiencing the consequences of homelessness

o Case Management: coordinate care and delivery of services

o Advocacy

Chapter 29 Issues with rural, migrant, and urban health care

• The role of the CHN in caring for a mobile workforce

o Provide much needed services using community resources, innovative

thinking, tenacity, and sensitivity

o Improving existing services

o Advocating and networking

o Practicing cultural sensitivity

o Using lay personnel for community outreach

o Utilizing unique methods of health care delivery

o Employing information tracking system

• Working in a rural community

o Nurses are more likely to work outside hospital settings that urban RNs
& commute outside their residential areas to work

o Advocate

o Coordinator/Case Manager

o Health Teacher

o Referral Agent

o Mentor

o Change agent/researcher

o Collaborator
 o Activist

o Use autonomy in daily practices; prioritize tasks quickly and work

efficiently with others; physical isolation; lower salary

• Social justice and the CHN

o Occurs when a society provides for the health needs and health care
issues of all people by treating people fairly, regardless of where they
live or who they are

o Emphasize social justice

o CHN have broad and holistic views of health; strong convictions about
health care being a basic human right

• Rural Health Issues

o Agriculture: pesticides and fertilizers; air & soil; bad well water;
farming accidents; need health care; air pollution; traffic accidents

o Built Environment: the development of housing, highways, shopping

areas, and other manmade features added to the natural environment;
stressors on water, supplies & air quality; urban sprawl is when people
move from urban areas to more suburban environments which can
increase air & water pollution, access to health care & heat islands-
occur when green areas are exchanged for asphalt which results in
temperature and ecosystem changes

• Health Risks of Migrant Workers and their families

o Occupational Hazards: agriculture then mining; long hours in wet

cloths, working with contaminated soil &water, climbing, exposure to
elements; injury; TB; parasitic infections

o Pesticide Exposure: working in sprayed fields; contaminated water

sources

o Substandard Housing & Poor Sanitation: move frequently; mobile

homes; dilapidated conditions; crowding

o Migrant Family Health: educationally, socially, and physically

disadvantaged children; psychiatric problems; children receive
fragmented health care; substance abuse & violence

o Infectious Diseases: TB; HIV

 o Economic Barriers & Limited Health Resources: unable to qualify for
basic health & disability benefits- Worker’s Compensation & SS &
Medicaid; many are eligible for public programs such as Medicaid, food
stamps

o Information Tracking System: collects and maintains health and

academic records for migrant children; able to track migratory
children’s lifestyle

• Migrant farm workers : Profile of a nomadic aggregate:

o Majority Mexico & Latin America

o Migrant farmworkers: move to find agricultural work throughout the

year

o Seasonal farmworkers: live in one geographic location & employed in

agriculture

o Migrant streams: predetermined routes

o Point to point migration: leaving a home base for part of the year to
travel to the same place along a route during agriculture season

o Nomadic migrant: travel away from home for several years, relying on
word of mouth job opportunities

o Restricted circuit: stay within small area throughout a season

o Migrant Hero: Cesar Chavez founded United Farm Workers- first union
in agricultural labor history to successfully organize migrant
farmworkers