N415 Exam #1

Aids in the management of self- car, needs vary based on the individual

Main concepts of Nursing
Meta- Paradigm of Nursing:
Health, Person, Nursing, Environment

Health is
a dynamic state of complete physical, mental, spiritual, and social well- being not merely the absence of disease or infirmity.

Public Health is
what we do as a society collectively to assure the conditions in which people can be healthy. The health of a geographic area or a specific population (age, ethnicity, etc)

What does medicine do?
Saves one life at a time

What does public health do?
Saves millions of lives at a time

Life Expectancy 2000-08

Life Expectancy 1800

Which factors contribute to the increased life expectancy?
Public health efforts are responsible for 25 of the nearly 30 years of improved life expectancy.

10 Great US PH Achievements (1900-1999)
-Safer workplace
-Safer and healthier food
-Motor vehicle safety
-Control of infectious diseases
-Decline in deaths from coronary heart disease and stroke
-Family planning
-Recognition of tobacco use as a health hazard
-Healthier mothers and babies
-Fluoridation of drinking water

Challenges for the 21st Century
-Emergence of new and old communicable and infectious diseases, larger food-borne disease outbreaks, acts of terrorism
-Chronic disease prevention programs
-Infrastructure to support more complex technologies
-Hospital “intensivists”
-More care provided in the home
-Doctorate of Nursing Practice
-Emphasis on prevention and wellness

2009 Nation Health Expenditures
$2.5 trillion

Predicted total US spending in 2019
$4.5 trillion

Health Spending
Spending out pacing gross domestic product. 17% of our spending is on health care.

Where is the most money spent in the US health system?
-Hospital care
-Physician services
-95% of all health care expenditures is for medical treatment
*** Only a small fraction spent on home health, public health, research, and construction

Building Cost per Hospital Bed
It costs approx $1 million

Nursing and Physician Density per 1000 Population
Nurses: 9.82
Physicians: 2.41

Populations as a Focus for Care
-Residents of a specific geographic area or specific targeted groups of people who may be at risk for, experience, a disproportionate burden of poor health outcomes (ANA, 2013, p. 3)

WHO Definition of Health Outcomes
A measure a resource of the health status of a given population and for everybody life, not the object of living (1984).

IOM Definition of Health Outcomes
The health outcomes of a group of individuals, including the distribution of such outcomes within the group (1998, 2003).

What is Public Health?
-Science and art of preventing disease
-Prolonging life
-Promotion of health
-Environmental safety and improvement
-Improvement of the standard of living
-Maintenance of health
-Improving health for all citizens, regardless of ethnicity, age, socioeconomic status, and gender bias

Public Health in America
Vision: Healthy People in Healthy Communities
Mission: Promote physical and mental health. Prevent disease, injury, and disability.
-Prevents epidemics and the spread of disease
-Protects against environmental hazards
-Prevents injuries
-Promotes and encourages healthy behaviors
-Responds to disasters and assists communities in recovery
-Assures the quality and accessibility of health services

Three Core Functions of Public Health
Defined by the IOM:
-Policy Development

Core Public Health Functions: Assessment
Refers to systematically collecting data on the population, monitoring the population’s health status, and making information available about the health of the community.

Core Public Health Functions: Policy Development
Refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.

Core Public Health Functions: Assurance

10 Essential Public Health Services by Core Function, Assessment
1. Monitor health status to identify community health problems.
2. Diagnose and investigate health problems in the community

10 Essential Public Health Services by Core Function, Policy Development
3. Inform, educate and empower people about health issues
4. Develop policies and plans that support individual and community health efforts
5. Enforce laws and regulation that protect health and safety

10 Essential Public Health Services by Core Function, Assurance
6. Mobilize community partnerships to identify and solve health problems
7. Link people to personal health services
8. Ensure a competent public health & personal health care workforce
9. Evaluate effectiveness, accessibility and quality of health services
10. Research for new insights and innovations to health problems

Public Health Frameworks: Ecological Model (Upstream Approach)
-Multiple determinants of health
-Population and environmental approach are critical
-Links and relationships between levels are crucial
-Multiple strategies by many sectors are needed to achieve desired outcomes
-Includes physical environmental factors
-Includes social environmental factors
-Encompasses neighborhoods, communities, institutions, and policies

Emerging Public Health Frameworks: Conventional Model
The conventional model uses a downstream approach.
Only addresses biological and behavioral bases for disease.

Emerging Public Health Frameworks: Socioecological Model
Uses an upstream approach. Upstream determinants of health. Social relations, neighborhoods and communities, institutions’ social and economic policies.

Community Partnerships: IOM
Wants active participation in health programs for communities.
-Increase effectiveness
-Increase productivity
-Empower participants
-Strengthen social engagement
-Ensure accountability

Public Health Nursing
Defined as:
“Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (APHA, Public Health Nursing Section, 2013).

It is population-focused practice that emphasizes the promotion of health, the prevention of disease and disability, and the creation of conditions in which all people can be healthy.

PHN as a Nursing Specialty
-community oriented (Community-based and Community-driven care)
-Health and prevention focus
-Interventions are made at the community or population level

Population- focused Practice VS Individual- Focused Practice
Population-Focused Practice:
-Diagnoses, interventions, and treatments are carried out for population or subpopulation. Levels of prevention (primary, secondary, tertiary)
-Population-level decision making is different
-Concerned with more than one subpopulation

Individual-Focused Practice:
-Diagnoses, interventions, and treatments are carried out at individual client level

PHN Specialists and Core PH Functions: Assessment
Participate in and provide leadership for:
-Assessing community needs, health status of populations within the community, and environmental and behavioral risks
-Look at trends in the health determinants
-Identify priority health needs
-Determine the adequacy of existing resources within the community
-Engage in policy-development efforts

PHN Specialists and Core PH Functions: Policy Development
Core function and core intervention strategy.
Seeks to build constituencies that can help bring about change in public policy.

-Development of Healthy People 2020 state objectives
-National effort to control acquired immunodeficiency syndrome (AIDS)
-Anti-smoking ordinances

PHN Specialists and Core PH Functions: Assurance
-Focuses on the responsibility of public health agencies to make certain that activities have been appropriately carried out to meet public health goals and plans
-Includes the development of partnerships between public and private agencies

Public Health Nursing VS Community Health Nursing
Public health nursing:
-Community-oriented, population-focused strategies
-Community-based combination of population-focused, community-oriented strategies and direct-care clinical strategies
-Focus is the community as a whole and the effect of the community’s health.
-Care is provided within the context of preventing disease and disability, and promoting and protecting the health of the community as a whole

Community health nursing
-Applies to all nurses practicing in the community including individuals, families, and groups
-Delivery of personal health care services.

Community- Oriented VS Community- Based Nursing Practice
Community-Oriented Nursing Practice:
-A philosophy of nursing service delivery.
-The nurse provides health care to achieve the purpose of PH through PH core functions

Community-Based Nursing Practice:
-A setting-specific practice where care is provided (e.g. school, working place, etc.)

PHN Education
-BSN graduate has basic preparation to function as a staff PHN
-Master’s degree required for specialization in PHN
-Then eligible to sit for certification exam.
-BSN graduate has basic preparation to function as a staff PHN
-Doctor of Nursing Practice (DNP) will likely be required for specialization in PHN
-Then eligible to sit for certification exam

Health Disparity
Health care in the United States:
-The most costly
-Poorer outcomes than other industrialized countries
Health outcomes are worse for:
-Lower income individuals/families.
-Racial and ethnic minorities.
-Those lacking health insurance.

Office of Minority Health created in 1986
-Extensive health data
-Cultural competency
-Minority population profile data base

Disadvantaged Minority Health Act of 1990
-Improve the health status of underserved populations, including racial and ethnic minorities
-Remains an overarching goal of Healthy People 2020

Determinants of Health Disparity
1. Natural biological variation
2. Health-damaging behavior
a. Freely chosen (playing football, bungee jumping)
b. Limited selection of life-style
3. Exposure to unhealthy working environment
4. Accessibility to health services
5. Health-related social system: No job, no health insurance

Healthy People 2020
-Committed to the achievement of optimal health for all people in the United States
-Social Determinants impact health outcomes

Components of the US Health- Care Delivery System that foster health disparity
-A lack of diversity in the workforce.
-A lack of low health literacy.
-A lack of Primary care and specialist providers in some areas of the country.

Social Determinants of Health
The circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics (WHO).

Social determinants of health are more important than or equal to individual behavioral choices such as:
-Tobacco, high-fat and high-calorie diets, and a sedentary lifestyle.
-Socio-economic circumstances during early childhood are a better predictor of cardiovascular disease and diabetes than behavioral choices.

Health Disparity: Role of Race
-Race is a social construct with no biological foundation
-Complicated causation between race and poor health outcomes
-Segregation in jobs, environment, education impact, health and outcomes
-Limited access to quality resources to maintain health
-Lack of space for physical activity
-Poor sources of nutritious food
-Limited social interactions/networks

Health Disparity: Role of Income and Education
-Within the same racial group, social class determines the rate of health disparity.
-Middle and upper class minority groups generally have better health and outcomes than those living in poverty.
-The more years of education the better the health.

Paradigm Shift
-Moving from detection and correlation to causation and intervention
-More translational research
-Increase engagement of communities as full partners

RWJ Commission to Build a Healthier America
-All children receive early developmental intervention
-WIC and Food Stamps
-Public/private partnerships for full service grocery stores where there are none with nutritious foods
-Healthy school lunches
-Require PE in all schools every day
-Smoke-free nation
-Create healthy community demonstrations for health promotions
-Healthy homes/housing
-Safety and wellness in every aspect of daily life
-Provide accurate data for policy makers

Population- Based Health
-Health Promotion
-Health Protection
-Risk Reduction
-Health Prevention

Health Promotion
Goal is to change behaviors, promote healthy lifestyles, reduce morbidity, mortality.
-Upstream approach
-Environmental factors
-Policy, law

Health Protection

Health Prevention

Risk Reduction

CDC Health Protection Goals
-Protection the population from evolving threats
-Promote health in the workplace and at home
-Promote health across the lifespan
-Promote global health

How is health prevention accomplished by?
-Health policies
-Health programs
-Health practices

Ecological Approach
Environment, Social Spheres, Economy.
-Used globally with much success. Individual health is dependent on population health.

Intervention Wheel
Illustrates how public health nurses improve the health of individuals, families, communities, and systems
-Population basis of interventions
-Levels of care

Primary Prevention
-prevent development of disease
-Goal: reduce risk factor, incidence rate. Central part of nursing practice

Secondary Prevention
-early detection and treatment of disease
-Goal: reduce prevalence and size of incidence rate

Tertiary Prevention
-Prevention of disability and premature death
-Prevention of adverse health consequences r/t chronic disease
-Case management
-Chronic disease management

Total number of cases out of the total population

New number of cases out of 100,000 population

Prevalence Pot
-Total number of disease cases
-Issues related to duration of disease

What is Healthy People 2020?
-A national agenda that communicates a vision for improving health and achieving health equity.
-A set of specific, measurable objectives with targets to be achieved over the decade.
-These objectives are organized within distinct Topic Areas.

Key Features of Healthy People
-Creates a comprehensive, strategic framework that unites health promotion and disease prevention issues under a single umbrella.
-Requires tracking of data-driven outcomes to monitor progress and to motivate, guide, and focus action.
-Engages a network of multidisciplinary, multisectoral stakeholders at all levels.
-Guides national research, program planning, and policy efforts to promote health and prevent disease.
-Establishes accountability requiring all PHS grants to demonstrate support of Healthy People objectives.

History of Healthy People
1979—ASH/SG Julius Richmond establishes first national prevention agenda: Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention

HP 1990—Promoting Health/Preventing Disease: Objectives for the Nation

HP 2000—Healthy People 2000: National Health Promotion and Disease Prevention Objectives

HP 2010—Healthy People 2010: Objectives for Improving Health

Healthy People 2020 – Launched December 2010

Healthy People 2020: Stakeholder Input
-Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020
-Public Meetings
-Public Comment Web Site
-Healthy People Consortium
-Federal Interagency
Workgroup (FIW)

Healthy People 2020…
-Builds on a foundation of three decades of work in health promotion and disease prevention objectives aimed at improving the health of all Americans.
-Is grounded in science, guided by public input, and designed to measure progress.
-Seeks to improve health outcomes through prevention strategies that address “ecological contexts” and determinants of health.

Healthy People 2020 Mission
-Identify nationwide health improvement priorities.
-Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
-Provide measurable objectives and goals that are applicable at the national, State, and local levels.
-Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
-Identify critical research, evaluation, and data collection needs.

Healthy People 2020 Objectives
-Represent quantitative values to be achieved over the decade.
-Organized within the Topic Areas.
-Managed by lead Federal agencies.
-Supported by scientific evidence.
-Address population disparities.
-Data driven and prevention oriented.

Healthy People Consortium
A diverse and dedicated group of organizations committed to achieving Healthy People 2020’s health goals and objectives.

Community Health Assessment Purpose
-Gather information to determine needs, prioritize problems, and plan interventions
-Identification of areas in need of improvement

Community Health Assessment Goal
-To improve the health status of the community
-First step of health planning
-Provides baseline data
-Logical systematic approach
-Ideally involves a partnership with community members

Types of Communities
-Community of place
-Community of interest
-Community of common characteristics

What is each community defined by?

Community Definitions: Palce
-Physical environment
-Main transportation arteries

Community Definitions: People
-Age breakdown

Effective Community Functioning
Select measures of community competence include:
-Commitment to the community,
-Conflict containment and accommodation (working together),
-Participant interaction,
-Decision making,
-Management of the relationships with society,
-Participation (use of local services),
-Self-/other awareness, and
-Effective communication.

Components of a Community Assessment
-Other indicators of health

Structure of the Community:

Services and resources available


Steps to Assessing Community Health
-Gathering relevant existing data and generating missing data
-Developing a composite database
-Interpreting the composite database to identify community problems and strengths
-Analyzing the problem

Concepts of Community Assessments
Needs versus Assets

Community-based participatory research initiative

Maximize on strengths

Asset mapping:
-People, places, and systems
-Focuses on effectiveness not deficiencies
-Empowers people
-Builds working together and relying on one another
-Uses everyone’s talents

Concepts of Community Assessments: Community- Based Participatory Research (CBPR)
Engagement of community members as full partners in an assessment


Achieves change

CBPR benefits:
-Equal contribution
-Balance between research and action
-Culturally competent care in a community
-Engages community in the process of change

Community Health Assessment and Group Evaluation (CHANGE) Model
Helps communities build action plans based on:
-Areas of improvement.

Provides program evaluation in communities:
-Action plan

Steps in the CHANGE Model
Action Step 1: Assemble the community.
Action Step 2: Develop a team.
Action Step 3: Review community sectors.
Action Step 4: Gather data from each sector.
Action Step 5: Review data and reach consensus.
Action Step 6: Enter data.
Action Step 7: Analyze data and assign ratings to each sector.
Action Step 8: Build an action plan.

Community- Focused Nursing Process
-Community Assessment
-Community Nursing Diagnosis
-Planning for Community Health
-Implementing in the Community
-Evaluating Community Health Interventions

SOAPE Framework Individual
S= Subjective; Pt feelings and beliefs
O= Objective; Pt data
A= Assessment; Identified problems
P= Plan; Begin metformin and refer to nutritionist and trainer
E= Evaluation; Blood sugar level, calories consumed, minutes of exercise

SOAPE Framework Community
S= Subjective; Residents opinion of community health problems and causes
O= Objective; Statistics on demographics and health status
A= Assessment; Above average incidence of diabetes, lack of health clubs, lack of walking or cycling paths, only grocery store nearby is a convenience store
P= Plan; Organize a farmers market
E= Evaluation; Number of residents purchasing food at the market, residents opinion of market

CA: Subjective Data
-Key informants
-Opinion survey:Systematic collection of opinion data from interviews of community members. Number of interviews depends on resources and health topic being investigated

CA: Objective Data
Observational Data: Obtained from visual examination of the community. Provides contextual information

Secondary Data: Data already collected that provides information on the population or community subsystems

Primary Community Assessment
-Windshield Survey (driving): Primary data collection. Gives the “pulse of the community”
-Shoe leather survey (walking)
-Kinship/Economics/Education/Political/Religious/Associations (KEEPRA): Family life, Stable economy, Schools and other educational, Evidence of political activity, Places of worship, Neighborhood associations

Secondary Community Health Data
Secondary data not specific to individuals.

-Age, gender, marital status
-Occupation, Income
-Education, Race/ethnicity
-Numbers in household
-Census tract
-Census block
-National health survey
-Morbidity, Mortality
-Crime reports
-Communicable/noncommunicable diseases
-Motor vehicle crashes
-Leading causes of
-Deaths, Births
-Marriages, Divorces

Planning and Implementation
After selecting a priority issue.
-Identify the resources required
-Identify participant responsibilities
-The activities required to accomplish the goal
-Typically involves coordination and organization

People- Centered Care
Universal Health Care

US Healthcare System
Personal health care sector:
-Focus on care of individuals
->90% of all expenditures

Public health care sector:
-Focus on care of populations
-Medicare and MediCaid

Primary Care
-Care provided by health care professional
-Care provided at the individual level

Primary Health Care
-Broad range of services
-Emphasis is on prevention
-Care provided at the community level

Public Health Revolutions
1800’s- concern about epidemics

1900’s-concern about chronic illness

2000-concern about social justice

1978: Declaration of Alma ATA, Article 25 at the Int’l conference on Primary care
-Healthy People (1979), Healthy people 1990, 2000, 2010, & 2020
-2010 – The Patient Protection and Affordable Care Act

History of Social Security and Health Policy
1935: The Social Security Act- Health care was on a fee-for-service basis

1965: Amendment to the Social Security Act- Medicare, Medicaid, and Supplemental Security Income (SSI)

2010: Health Care Reform Bill: The Affordable Care Act- Expand care coverage to all Americans

-A federal health insurance program for older adults and those with permanent disabilities.
-Administered by the Centers for Medicare and Medicaid Services (CMS)
-Medicare covered nearly 55 million Americans in 2015 (vs. 47.6 million 2011). 83% of beneficiaries are seniors, 17% are under age 65, 5.6 million in CA
-Medicare spending accounts for 15% of total federal spending in 2015 and 23% of total national health spending in 2014.

Eligibility of Medicare
-Those who are qualified for the SS retirement benefit. Full retirement age* for SS: 65~ 66 yrs
-Those who have disabilities
-Those who need hemodialysis (ESRD)

Social Security Retirement Benefits
Those who worked for more than 10 years and paid taxes (40 credits)
-Goss annual income between $15,720 ~ $118,500 in 2015 & 2016
{SS tax: 6.2%x2} + {Medicare tax:1.45% x2} = 15.3%
-From 2013, additional 0.9% in Medicare tax for those income >200,000 ($250,000 couple)
-Retirement benefits start from 62 years 2 months.
93.3% at age 65, 86.6% at age 64; 75% at 62
-Benefit: Average $1,263/month (Old-Age & Survivors Insurance) in 20161

Supplemental Security Income (SSI)
-Average monthly payment: $433.59/mo in 20161
-Maximum $889.4/individual; $1,496.2/couple if eligible in 20162

Medicare Part A
-Hospital insurance program
-Funded by a dedicated Medicare tax (2.9 % of earnings) of current workers and by the co-payments of the beneficiaries.
-No premium. If not qualified, $411/mo in 2016 <-- $426, $ 407 in 2014, 2015 /mo (CMS, 2016) Enrollment: -Enrolled a few months before age 65. -Recipients receive Medicare Card two months before age 65. -If the person is not retired yet and still working, the person has to report to the SS office and enroll for Medicare insurance. After age 65, the group health plan is the primary payer* Scope of Coverage: -In-patient hospitalization:Benefit period=60 days You pay (in 2016) -$1,288 for the first 60 days of hospitalization -$322 per day for days 61-90 of a hospital stay -$644 per day for days 91-150 of a hospital stay -All costs for each day beyond 150 days Short-term rehabilitative care: Skilled nursing facility -None for the first 20 days -$161 per days for days 21-100 in 2016 -Home health care, PT, OT, Speech Tx, medical social services, durable medical equipment, medical supplies -Hospice care

Medicare Part B
-Supplementary Medical Insurance
-Funded by general revenue and beneficiary premiums
Premium: Standard $104.90 in 2016 (Income <$85,000/p ) Deductible: $166 in 2016 up to $335.70/mo Coinsurance: 20% -Requires a personal decision -Co-payment for out-patient services -For the poor who cannot pay the monthly payment, federal programs are operated to support part or full payment. Requirement: Limited income per month and assets < $4,000/person or $6,000/couple Coverage: -Physician visits (in- and out-patient) -Certain home health services -Durable medical equipment and devices -Medical services Lab, X-ray, ambulance, physical therapy -Preventive services Mammography, flu vaccination, DM lab, bone mass measurements, cholesterol, glaucoma test, education, etc.

Not covered by Part A and B
-Dental care and dentures
-Hearing aid and hearing exam
-Routine eye exam and most eye glasses
-Long-term care
-Prescription drugs

Medicare Part C
-Medicare Advantage Plans or “Medicare + Choice”
-A plan offered by a private company that contracts with Medicare to provide client with all Medicare Part A and B benefits
-Funded through beneficiary premiums and general revenues
-Variety of plans: Medicare HMO, PPO
-Average premium $32.6 (2016) in addition to the Part B premium ($0 to $200 in 2016)1
-16.8 million (31%) of beneficiaries are enrolled in Medicare Advantage Plans in 2015 and the numbers are increased.

Medicare Part D
Medicare Prescription Drug Plans:
-Out-patient prescription drug coverage
-Financing for Part D comes from general revenues (74%), beneficiary premiums (15%), and state contributions (11%).
-Began in 2006
-Eligibility: Anyone who has Medicare Part A and B or C
-Joining is voluntary.
-In 2015, 39 million enrolled in Medicare Part D
-In 2015, premium surcharges from $12.30 to $70.80/Mo for higher income (> $85K, individual) beneficiaries.

-A joint federal and state medical assistance program for the poor
-Medi-Cal in CA
-The program is financed jointly by states and the federal government.


-Those who receive SSI.
-Medicare beneficiaries with income less than 133% of Federal Poverty Level.
-Those who are beneficiaries of disabilities for 2 yrs before 65 years old.
-Illegal immigrants are not eligible by Health Care Reform
-Nearly 70 million enrolled in Jan 20151
-Covers 1 in 5 Americans under age 652
Under the Affordable Care Act (ACA), nearly everyone under age 65 with income below a national “floor” (100-150% of poverty level) is eligible for Medicaid in 2014
About half of all Medicaid enrollees are children, 25% non-elderly adults, and 25% were elderly.
-1 in 3 of the state’s children
-Expenditure: In FY2012-13.
46% of all births in the state
2/3 of all nursing home residents
60% of all net patient revenues in California’s public hospitals
-Annual recertification is required to maintain eligibility.

Medi- Cal/ Medicaid: Coverage
-The coverage varies according to the state.
-If the one has both, Medicare will be applied first.

Mandatory services:
-In-patient and out-patient hospital care
-Physician and other medical provider services
-Skilled nursing facility care
-Laboratory and X-ray services

Optional services:
-Dental and vision care
-Hospice care
-In-patient psychiatric care
-Rehabilitation and therapy services
-Prescription drugs

Affordable Care Act
-First step in Nation’s effort to reform the health-care delivery system
-Background: * Watch 3 videos listed in weekly reading
-Goal: improve access to affordable coverage for everyone, reduce healthcare costs, improve quality of care by improving health outcomes
-Main focus: No denial of coverage for preexisting conditions, include children <= age 26 on their parents health insurance, expansion of Medicaid eligibility. -Managed by USDHHS

Official Public Health Agencies
-Supported by taxes
-Accountable to citizens
-Many functions are mandated by law

Public Health Agency Obligations
-Prevent spread of disease
-Protect public from environmental hazards
-Prevent injury
-Promote healthy behavior
-Respond to disasters
-Assuring accessibility of services

Voluntary Public Health Agencies
-Funded by donations
-Responsible to the Board of Directors
-Often disease specific
-Were initiated because of the lack of an adequate public health system
-National Tuberculosis Association
-American Public Health Association
-Am Heart Association

Levels of the Public Health System
-State (most activity occurs at the state level)

PHC Workforce
-Multidisciplinary team of health care providers.

Team members include:
-Primary care generalists and public health physicians
-Community outreach workers
-Mental health counselors
-Other allied health professionals
-Community members also important to the team

PHC Initiative
-Declaration of Alma Ata (1978): Goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives

Healthy People 2020 /w 4 main goals:
-Healthy People (1979)
-Healthy People 1990
-Healthy People 2000
-Healthy People 2010

What is primary care?
-First level of the private health care system
-Delivered in a variety of community settings
-Americans access it through insurance programs
-Managed care:
Managed Care Act of 1973
HMOs, PPOs, and POS
Medicare Advantage Program

Primary Care Workforce
-Primary care developed in the 1960s: Needed to reexamine role of general practitioner

Primary care generalists include:
-Family physicians
-General internists
-General pediatricians
-Nurse practitioners (NPs)
-Clinical nurse specialists (CNSs)
-Physician assistants (PAs)
-Certified nurse-midwives (CNMs)
-Doctorate in Nursing Practice (DNP)

Public Health System
-Mandated through laws that are developed at the national, state, or local level
-Organized into many levels in the federal, state, and local systems
-At the local level, health departments provide care that is mandated by state and federal regulations.

Federal System
-U.S. Department of Health and Human Services (HHS= manages ACA)
-Office of Global Health Affairs
U.S. Public Health Service (PHS)
-Health Resources and Services Administration (HRSA= set education policies including nursing school)
-National Institutes of Health (NIH)
-Agency for Health Care Research and Quality (AHRQ)
-Food and Drug Administration (FDA)
-Centers for Disease Control and Prevention (CDC)
-Centers for Medicare and Medicaid Services (CMS)
-Department of Homeland Security (DHS= Bioterrorism and drugs)

State Health Department
-Stand ready for disaster prevention or response
-Health care financing and administration
-Direct assistance to local health departments
-Ongoing assessment of health needs
-Board of examiners of nurses

Local Health Department
-Direct responsibility to the citizens on its community or jurisdictions
-Variety of services and programs offered depending on the state and local health codes that must be followed, the needs of the community, and available funding and other resources

Indicators in the US health care system that continue to cause disparities:

2008 “Great Recession”
Weakening of national and global economy
Loss of 7 million jobs in the United States
National health spending expected to grow 6.1% per year, reaching $4.5 trillion by 2019
Per capita spending increasing from $8046 in 2009 to $13,387 in 2018
Increases in public spending
Decreases in private spending
By 2012, expect public payment for health care services will account for more than 50% of total health care purchases in the U.S.
Aging Baby Boomer population
Will increase Medicare expenditures
Medicaid recipients can be expected to decline as jobs are added to the economy.
Percentage of workers covered by employer-sponsored insurance should rise.
Premiums increase
Higher co-pay and deductible expenses
Costs will rise
Rise in percentage of uninsured

Rise in uninsured people to 46.3 million in 2008
Government programs play significant role in meeting the needs of the uninsured
Increasing demands leave some states struggling with budget
Strong relationship between health insurance coverage and access to health care services
Groups who face greatest barriers to access:
Minority group members
Non-English speakers
Medically underserved
56 million in the United States lack adequate access to primary health care (2007)
Safety net
Community health centers
Affordable Care Act (2010)

To Err is Human: Building a Safer Health System (IOM, 2000)
98,000 deaths a year attributed to preventable medical errors
7,000 of which are due to preventable medication errors
Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2003)
Long work hours pose most serious threat
Cultivating a culture of safety
Sentinel events reporting
Hospital Compare

National Health Policy
Federal Government and Medicare
-Not a care delivery system
-Social insurance system

State Health Policy
-Medicaid jointly financed by federal/state government
-States set own guidelines with mandated federal services
-Inpatient/outpatient care
-Early screenings
-Skilled care/long-term care
-Family planning
-Care for those less than 21 years of age

Local Health Policy
-State and local laws
-Infectious diseases
-Sanitary food and beverages
-Regulate/own health care facilities
-Nursing homes

Business/ Organizational Health Policy
Develop policies for employees/customers
Offer health insurance
Paid sick leave
Nutrition information provided by restaurants
Smoke-free campus
Not selling tobacco
Not selling inhalants to minors
****Smoke- free campus can be required by law (if state run) but may also be voluntary participation of private organizations.

Evaluation Criteria for Policy Planning
Likelihood of achieving goals/objectives
Achieving goals relative to cost
Fairness and justice in distribution of costs, benefits, and risks

Health Determinants
Health status is
-Interaction with the environment.
-Health service.

Upstream Thinking
Upstream thinking refers to influencing determinants of health prior to the development of poor health or even physiological changes that would lead to poor health.

Definition of a Disaster
Any natural or man-made incident that causes disruption, destruction, and/or devastation requiring external assistance
The disaster event type and timing predict subsequent injuries and illnesses.

Disaster Management Cycle
-Prevention (Mitigation)

WADEM Nursing Section
Define nursing issues for public health care and disaster health care.
Exchange scientific and professional information relevant to the practice of disaster nursing.
Encourage collaborative efforts enhancing and expanding the field of nursing disaster research.
Encourage collaboration with other nursing organizations.
Inform and advise WADEM of matters related to disaster nursing.

Role of the PHN in Prevention
-Organizing in mass prophylaxis and vaccination campaigns
-Should know the region’s local cache of pharmaceuticals and how to distribute
-Medicine delivery within 12 hours to any state
-State and local emergency planners ensure Points of Dispensing (POD) to provide prophylaxis to the entire population within 48 hours.
-Be aware of high-risk targets and current vulnerabilities such as public gathering, military, gov. facilities, water & food supplies, utilities, etc.

3 C’s of Disaster Response

Role of the PHN in Disaster Response
-First responder: Triage and public health triage
-Epidemiology and ongoing surveillance
-Rapid needs assessment
-Disaster communication
-Sheltering: Special needs shelters

What is the hardest part of a disaster?
The recovery phase

Aggregate A population group Assessment Systematic data collection about a population. includes monitoring the population’s health status and providing information about the health of the community WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR …

State the mission and core functions of public health. To promote physical, mental health and prevent disease, injury and disability. Assessment: 1)monitor health status to identify problems. 2)diagnose and investigate health problems and health hazards in the community. Policy Development: …

“what we, as society, do collectively to assure the conditions in which people can be heathy IOM definition of public health Assessment Policy Development Assurance Essential PH services WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR …

Population-Focused Practice emphasizes the promotion of health, the prevention of disease and disability, and the creation of conditions in which all people can be healthy Community Health Nurses focus on providing direct personal care services, including health education, to persons …

Public health What society collectively does to ensure that conditions exist in which people can be healthy Public health mission to generate organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent …

critical thinking “…the process of questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity [and]…underlies independent and interdependent decision making” (AACN, 2008, p. 36; as cited in EKU BSN Student Handbook). nursing process “…a problem solving …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out https://goo.gl/chNgQy