Академический Документы
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Historical Perspective
First written reference to care of the ill at home is found in the New Testament Florence Nightingale, 1860s Opened the Nightingale School of Nursing in 1860 where she stressed good
workhouses
Origin of the concept of visiting nurse District public health nursing. Each nurse was assigned a specific geographic
area of London William Rathbone: Promoted the establishment of district nursing Modern concept of visiting nurse
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Historical Perspective
Lillian Wald
Founder of Public Health Nursing The number of poor immigrants who had come to
America from Europe with little resources Lived in communities on the lower east side of Manhattan Resided in tenements Developed many illnesses
.
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Historical Perspective
Lillian Wald continued:
Visiting Nurse Service founded by Lillian Wald and Mary
Brewster in 1893. Venture was funded entirely through private donations Started with a focus on MCH
Henry Street Settlement House, 1895 Founded by Lillian Wald; help by Mary Brewster Nurses lived in the neighborhoods where they worked Coined the term Public Health Nurse Lillian Wald defined public health nursing as seeking to
cure the sick patients as well as trying to alleviate the underlying cause of disease by improving health education and public health standards.
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Historical Perspective
1910: approx. 90% of all nursing care was provided in the home Shift to the Hospital after World War I Technology and complexity Increased Access to Health Insurance An Aging Population and Increased health care needs Injuries from war Development of private insurance & Medicare & Medicaid
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Historical Perspective
Shift Back to the Community in the 1980s
Escalating Health Care Costs
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Historical Perspective
Rising Health Care Costs in the 1980s
Overuse of expensive care & procedures
Failure to promote preventive services Increased number of uninsured people Higher insurance rates for those that can pay Increased Health Care Salaries
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Historical Perspective
Rising Health Care Costs in the 1980s continued:
Aging Population Survival of patients with complex problems Expensive, sometimes, unnecessary tests covered by
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(TEFRA) in 1982
1983 Social Security Amendments Prospective Payment System (PPS) Diagnosis Related Groups (DRGs) for
reimbursement
Development of PPOs, HMOs, and managed MRosa
Managed Care
Through the use of responsible, effective, and cost-efficient care, Managed care refers to a system that for a set fee, assumes responsibility and accountability for the health of a population
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Community
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between health care settings The individual & family have primary responsibility for decisions The patient is viewed within the family and social systems Illness is a part of life Purpose of care is to limit disability, improve functional capacity and QOL Treatment effectiveness drives decisions
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health
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NLN
NLN recommends that all nursing education prepare nurses to function in community based settings.
To also understand the business of health care
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Prevention
Consideration of family, culture, and
community
Continuity of care through Collaboration Essential for quality care
Continuity of Care
Coordination of activities involving clients, providers,
Collaboration
Commits two or more persons or
organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health
Question
Which of the following is an example of how an individuals perceptions of his or her health may improve the way he or she manages self-care? A. Maria believes that illness comes from God as punishment for sin. B. Juan thinks that if he takes his medication and stops smoking, his asthma will improve. C. Kristin states that there is nothing she can do to alter her labile blood sugars.
Levels of Prevention
Primary Prevention
prevention of initial occurrence of disease or injury Includes Health Promotion & Health Protection
Secondary Prevention
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Immunizations Physical assessment HTN screening Teaching re: lifestyle changes such as diet Smoking cessation Mammography Support groups for caregiver Meals on Wheels for homebound Seat belts Pregnancy testing Alcohol & drug prevention PT after stroke Mental health counseling for rape victims Home management after chronic illness Hygiene teaching
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diabetes about diet Teaching to a family member about how to follow procedure for a dressing change Support group for children with asthma Shelters for victims of natural disasters
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Goals of Prevention
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Screening
Identifies individuals with unrecognized health
Outreach
Locates populations of interest or populations
at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained
Question
Which public health nursing intervention is seen in the following example? Student nurses go into a neighborhood door-todoor. They identify individuals who have not had flu shots and direct them to the local community centers flu clinics. A. Screening B. Outreach C. Health teaching
Question
Which public health nursing intervention is seen in the following example? A group of student nurses takes blood pressures at a senior center in the community and provides information about hypertension, what follow-up those with high blood pressure require, and how they may secure health care. A. Screening B. Health education C. Outreach
Question
Which public health nursing intervention is seen in the following example? A nurse and a physical therapist meet to plan the care of an elderly woman who is hospitalized with a broken hip and will be discharged from the hospital today. A. B. C. Collaboration Consultation Care management
Question
Which public health nursing intervention is seen in the following example? A nurse meets with Edna, an elderly woman who has been hospitalized with a broken hip, and her family. They discuss what self-care Edna can manage on her own and how the family may be able to assist her once she goes home, and determine the community resources available to assist with her care.
A. B. C.
Infant Mortality
Death Rate of infants < 1 year per 1000 births An international measure of health status US Infant Mortality Rate = 6.9 International Ranking = 27
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The Community
Knowledge of the community increases quality care What makes a healthy community?
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Education
Religion Welfare
Recreation
Health Care Government
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Health
Defined by the World Health Organization as a state of physical, mental & social wellbeing and not merely absence of diseases Health Illness Continuum Continuum from optimal health to total disability
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What is Health?
Acute Care Nursing Focus
Fix the problem Eliminate disease
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for improving the health of all Americans; Framework for improving health of nation.
Road map to better health for all Can be used by many different people, communities,
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Determinants of Health
What makes some people healthy and others
unhealthy?
How can we create a society in which everyone
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Health Communication
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Arthritis, Osteoporosis, and Chronic Back Conditions Cancer Chronic Kidney Disease Diabetes Disability and Secondary Conditions Educational and Community-Based Programs Environmental Health Family Planning Food Safety Health Communication Heart Disease and Stroke Immunization and Infectious Diseases HIV
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Injury and Violence Prevention Maternal, Infant, and Child Health Medical Product Safety Mental Health and Mental Disorders Nutrition and Overweight Occupational Safety and Health Oral Health Physical Activity and Fitness Public Health Infrastructure Respiratory Diseases Sexually Transmitted Diseases Substance Abuse Tobacco Use Vision and Hearing MRosa
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Question
What can nurses do to address disparity in their own
community? A. B. C. Educate themselves regarding issues of disparity Use evidence-based decision making Identify vulnerable populations in their communities
D.
E.
National Center for Health Statistics, National Vital Statistics Reports, vol. 52, no. 3
Case Study 1
.
Harold is a 61-year-old bachelor who lives alone on a farm in a rural area. His diabetes has been well controlled for 40 years. Harold had lived with his mother, who cooked for him and administered his insulin. After his mothers death last year, he went to the clinic three times in 3 months for problems with his diabetes. Harold stated, Every time I went to the clinic I saw someone different. I would tell them the same story three times. Dont they ever talk to each other? He was admitted for a large ulcer on his ankle and uncontrolled diabetes last week.
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Case Study 1
a. What are the problems identified?
1. 2. 3. 4.
5.
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Case Study 1
b. How will you use the elements of community based nursing to plan for Harolds discharge?
self-care in the context of the family and community preventive focus continuity
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Case Study 1
c. List one goal for each problem identified.
1. 2. 3. 4.
5.
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Case Study 1
d. What nursing actions would you take to help achieve these goals?
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Case Study 2
Anna is 85 years old and suffers from congestive heart failure. She is not taking her medication. Her hemoglobin is 9.0 g/dL and she complains about constant fatigue. Her weight has remained constant, but she states my legs have gotten so swollen and I am so short of breath. a. Determine the primary nursing role.
b. State two likely basic or physical needs and psychosocial needs MRosa
Case Study 3
Mrs. Nguyen is a 45-year-old woman admitted to the hospital for spinal fusion of C5-6 & C6-7 vertebrae. She is from Vietnam & has lived in the U.S. for 15 years. She has been suffering from degenerative disk disease & osteoarthritis for the last 4 years & has lost some of the function in her right arm. Her plan of care was developed around the critical pathways for cervical fusion, with an expected length of stay in the hospital from 3 to 5 days. The surgical procedure was uneventful, but Mrs. Nguyen suffered from nausea & vomiting until the middle of postoperative day (POD) 1. Today is POD 2. She is able to get to the bathroom by herself but cannot dress herself, bathe herself, or pick up anything weighing over 3 or 4 lb. Her physician is recommending that she be discharged tomorrow, POD 3. She will be in a Philadelphia collar for 6 weeks, during which time she will be unable to drive. Mrs. Nguyen lives with her husband & 2 teenage sons, ages 14 & 16. Her husband owns a restaurant & works 12 to 14 hours a day. He will not be taking off any work time to care for her when she gets home.
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Case Study 3
a. List four reasons why the nurse is the best person on the interdisciplinary team to be involved in coordination of disciplines.
Question
Who said the nurse, through her peculiar introduction to the patient and her organic relationship with the neighborhood could be the starting point for wider service in the community? A. Mary Brewster B. William Rathbone C. Lillian Wald D. Florence Nightingale
Advocating self-care
Focusing on prevention Family, culture, and community Health and Social Systems are interactive Continuity of care Collaborative care