Community Health

NR 442
Test Matrix Exam 1
Chp.'s 1, 2, 5, 6, 7, 26

Test Matrix

● Define Community, population, key terms

o Community​: a group or collection of individuals interacting in social units and
sharing common interests, characteristics, values, and goals.
o Population​: a group of people with common personal or environmental
characteristics.
▪ It can also refer to all the people in a defined community.
o Public Health:​ the art and science of preventing disease, prolonging life and
promoting health through organized community efforts to benefit each citizen.
▪ The mission of public health is social justice, which entitles all people to
basic necessities such as adequate income and health protection and
accepts collective burdens to make it possible.
o Public health nursing​ Community/public health nursing is the synthesis of
nursing practice and public health practice.
o Health:​ a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.
o Aggregates:​ Subgroups or subpopulations that have some common
characteristics or concerns (pregnant teenages in the same school district)
o Community Health​ extends the realm of public health to include organized
health efforts at the community level through both government and private
efforts. Participants include privately funded agencies such as the American
Heart Association and the American Red Cross. A variety of private and public
structures serves community health efforts.
o Health-related quality-of-life (HRQOL):​ ​is a multi-dimensional concept that
includes domains related to physical, mental, emotional, and social functioning.
It goes beyond direct measures of population health, life expectancy, and causes
of death, and focuses on the impact health status has on quality of life
o Population-focused nursing ​concentrates on specific groups of people and
focuses on health promotion and disease prevention, regardless of geographic
location.
● Know Public Health Assumptions
o Mission: is social justice, which entitles all people of basic necessities such as
adequate income and health protection and accepts collective burdens to make
it all possible.
o Assumption: Society’s responsibility to meet the basic needs of the people, thus
a greater need for public funding of prevention efforts to enhance the health of
our population.
 o Current U.S health policies advocate changes in personal behaviors that may
predispose individuals to chronic disease or accidents.

● Know core Public Health Functions

o Assessment
▪ regular collection, analysis, and information sharing about health
conditions, risks, and resources in a community
o Policy
▪ use of information gathered during assessment to develop local and state
health policies and to direct resources toward those policies
o Assurance
▪ focuses on the availability of necessary health services throughout the
community. It includes maintaining the ability of both public health
agencies and private providers to manage day-to-day operations and the
capacity to respond to critical situations and emergencies.
● Identify types of risk factors and modifiable risk factors
o Risk factors: variables that increase the rate of disease in people who have them
(such as genetic disposition) or in people exposed to them (an infectious agent
or a diet high in saturated fat).
▪ Types of risk factors include:
o Modifiable risk factors: aspects of a person’s health risk over which he or she has
control. Examples include smoking, leading a sedentary or active lifestyle, type
and amount of food eaten, and the type of activities in which he or she engages
(skydiving is riskier than bowling).
● Recognize examples of the 3 levels of prevention
o Primary Prevention​: activities directed at preventing a problem before it occurs
by altering susceptibility or reducing exposure for susceptible individuals. It
consists of two elements
▪ General health promotion
▪ Specific population
▪ Ex. Immunization, seat belt use, water purification
o Secondary Prevention​: early detection and prompt intervention during the
period of early disease pathogenesis. It is implemented after a problem has
begun, but before s/s appear, and targets those populations that have risk
factors.
▪ Ex. Mammography, blood pressure screening, scoliosis
screening,papanicolaou tests, screenings in general
o Tertiary Prevention​: targets populations that have experienced disease or injury
and focuses on limitation of disability and rehabilitation. Aims of tertiary
prevention are to keep health problems from getting worse, to reduce the
effects of disease and injury, and to restore individuals to their optimal level of
functioning.
▪ Ex. Teaching how to self administer insulin, referral of patients with
spinal Cord Injury for occupational and physical therapy, leading a
support group for grieving patients.
● Community Assessment
o Community as Partner Model-
o Areas to assess

o Parts of a needs assessment

 ▪ Data collected directly from an aggregate may be more insightful and
accurate; therefore community health nurses sometimes conduct
community needs assessments. The strategy chosen for collecting needs
assessment data depends on the size and nature of the aggregate, the
purpose for collecting information, and the resources available to the
nurse.
BOX 6.4  Steps in the Needs Assessment Process
1. Identify aggregate for assessment.
2. Engage community in planning the assessment.
3. Identify required information.
4. Select method of data gathering.
5. Develop questionnaire or interview questions.
6. Develop procedures for data collection.
7. Train data collectors.
8. Arrange for a sample representative of the aggregate.
9. Conduct needs assessment.
10. Tabulate and analyze data.
11. Identify needs suggested by data.
12. Develop an action plan.

● Community Based vs. Community Oriented

o Community Based: works with individuals and families to bring about change.
looking at all factors within the community that affects them. The nurse focuses
on "illness care" of individuals and families across the lifespan. While providing
care to individuals and families, the RN maintains an appreciation for the values
of the community.
▪ Focused on illness care, taking care of individuals and families, and caring
for acute and chronic illness.
▪ Ex. Home health nurse doing wound care, school nurse caring for children
by administering epipen for allergies.
o ​Community Oriented: Has as its primary focus the health care either of the
community or populations as in public health nursing or of individuals, families,
and groups in a community.
▪ Focused on population and community as a whole. Health promotion and
disease prevention activities to improve health of the population.
▪ Same as public health nursing.
o The difference: Community based nurses deal primarily with illness oriented care
whereas community oriented nurses provide health care to promote quality of
life.
● Reporting diseases (pg. 525)
o Local health department: They are required to report notifiable communicable
diseases to the state department of health.
 o State department of health: They are required to report notifiable
communicable diseases to the CDC.
● Know key Public health figures
o John Snow
▪ Demonstrated the transmission of cholera via the public water source
o Florence Nightingale/District nursing (Did nursing in England,
▪ The pioneer of modern nursing/advocated for education reform for
nurses
▪ Focused on sanitation when taking care of patients on the battlefield
▪ Believed in keeping records of all that she did (Statistical information on
the death rates of soldiers)
▪ Importance of systematic observation, data collection, & statistical
analysis in relation to nursing care.
▪ Heavily involved in the Crimea War
o Lillian Wald (New York)
▪ Played an important role in establishing public health nursing in the
United States—later called “Visiting Nurses Association of NYC”
▪ Established Henry Street Settlement in 1893 (along with Mary Brewster)
▪ Role of Henry Street Settlement was “one of helping people to help
themselves” (Wald, 1871)
▪ She coined the term ​Public Health Nursing
▪ Practice family-focused nursing, nurse the whole person
o Linda Rogers
▪ First school nurse (1902)
● Role of government agencies in Public Health
o Cabinet-level Department of Homeland Security created in 2003. Absence of
consistent federal strategy, plans and systems from the Department of
Homeland Security leaves 3,000 public health agencies in 50 states without clear
guidance for coordinating disaster response.
o Federal role: Monitors health needs, sets policies & standards, supports
research; supports state & local initiatives. Finances through: Medicare,
Medicaid, Veterans' & Community Health Centers
o State role: Support Medicaid, medical education, state & local health care
initiatives. Enforces codes, licensing; coordinates health with social service, aging
& other services; provides mental health services & facilities.
o Local role: Health departments. Public hospitals and health systems' "safety
nets". Crisis response for public health emergencies. Serve medically needy &
low income populations.
● Know Epidemiologic models
o Epidemiologic Triangle: Their interaction determines the development and
cessation of communicable diseases, as they form a web of causality, which
increases or decreases the risk for disease.
▪ The ​agent ​is the physical, infectious, or chemical factor that causes the
disease
▪ The ​host ​is the living being that an agent or the environment influences
 ▪ The ​environment ​is the setting or surrounding that sustains the host.

o Wheel Model of Epidemiology

o Chain of Transmission
▪ Infectious Agents: An organism capable of producing infection or
infectious disease
▪ Reservoirs: The environment in which a pathogen lives and multiplies
▪ Portal of Exit: Means by which an infectious agent is transported from the
host.
▪ Modes of transmission: Method whereby the infectious agent is
transmitted from one host (or reservoir) to another host.
● Direct: Person to person
● Indirect: Implies a vehicle of transmission (biological or
mechanical vector, common vehicles or fomites - inanimate
objects, airborne droplets).
▪ Host susceptibility: The presence or absence of resistance to an infectious
agent.

o Web of Causation
● Know Incidence Rate/ Prevalence Rate
o Incidence rate: the number of new cases of disease or injury within a population
during a specified amount of time
▪ Incidence Rate: Number of new cases in the population at a specific time
= population total x 1000 = _______ per 1000
o Prevalence rate: The number of all cases of a disease or injury within a
population during a specified amount of time.
▪ Prevalence Rank: Number of existing cases in the population at a specific
time + population total x 1000 = _______ per 1000
● Differentiate Descriptive and Analytic Epidemiology
o Know types of studies
▪ Descriptive Epidemiology: focuses on the amount and distribution of
health and health problems within a population. Its purpose is to
describe the characteristics of both people who are protected from
disease and those who have a disease.
▪ Analytic Epidemiology: investigates the causes of disease by determining
why a disease rate is lower in one population group than in another.
● Know stages of infection/Spectrum of disease occurrence
o Latent Period: period of replication before shedding
o Communicable Period: shedding of the agent
o Incubation Period: time from invasion to the time when disease symptoms first
appear.
 o Spectrum of Disease Occurrence:
▪ Incidence: new cases in a population
▪ Endemic: occurs at a consistent, expected level in a geographic area.
▪ Outbreak: an unexpected occurrence of an infectious disease in a limited
geographic area during a limited period.
▪ Epidemic: an unexpected increase in occurrence of an infectious disease
in a geographic area over an extended period.
▪ Pandemic:a steady occurrence of a disease, or an epidemic, that covers a
large geographic area or is evident worldwide.
● Know vaccine storage, transport, & handling: ​Transport & Handling (pg. 21-26)
o Vaccine storage: A cold chain is a system used to ensure that vaccines are kept at
a designated temperature from the time they are manufactured until they are
used for vaccination. Vaccines may be stored in liquid crystal thermometers, dial
thermometers, recording thermometers, ice pack indicators, shipping indicators
that change color if the temperature exceeds or falls below the recommended
level, freeze-watch indicators, and cold chain monitors.
o Transport: Vaccines should only be transported using appropriate packing. The
total time for transport alone or transport plus clinic workday should be a
maximum of 8 hours (e.g., if transport to an off-site clinic is 1 hour each way, the
clinic may run for up to 6 hours). Transport diluents with their corresponding
vaccines to ensure there are always equal amounts of vaccines and diluents for
reconstitution. Your facility should have a sufficient supply of materials needed
for vaccine transport of your largest annual inventory. Appropriate materials
include:
▪ Portable vaccine refrigerator/freezer units (preferred option)
▪ Qualified containers and packouts
▪ Hard-sided insulated containers or Styrofoam™ (Use in conjunction with
the Packing Vaccines for Transport during Emergencies tool. This system
is only to be used in an emergency.)
▪ Coolant materials such as phase change materials (PCMs) or frozen water
bottles that can be conditioned to 4° C to 5° C
▪ Insulating materials such as bubble wrap and corrugated
cardboard—enough to form two layers per container
▪ TMDs for each container
o Handling:
● Know all types of immunity
o Herd Immunity: Protection due to the immunity of most community members
exposure unlikely
o Natural Immunity: Natural defense mechanisms of the body to resist specific
antigens or toxins
o Acquired Immunity: Develops through actual exposure to the infectious agent
o Active: Production of antibodies by the body in response to infection or
immunization with a specific antigen
 o Passive: Transfer of antibodies to the host either transplacentally from mother to
newborn or through transfusions of immunoglobulins, plasma proteins,
antitoxins.
● Differentiate disease prevention, health promotion, health improvement
o Disease Prevention: activities that protect people from disease and the effects of
disease.
o Health Promotion: (Green and Kreuter) any combination of health education and
related organizational, economic, and environmental supports for behavior of
individuals, groups, or communities conducive to health. (Parse) states health
promotion is motivated by the desire to increase well-being and to reach the
best possible health potential.
o Health improvement: the work to improve the health and wellbeing of
individuals or communities through enabling and encouraging healthy lifestyle
choices as well as addressing underlying issues such as poverty, lack of
educational opportunities and other such areas
● Hill-Burton Act
o In 1946, Congress passed a law that gave hospitals, nursing homes and other
health facilities grants and loans for construction and modernization.