Community 315 - Exam 2

olanjones's version from 2016-10-20 23:39

Healthy People 2020 - School Nursing (pg 751-2)

Increase to 28.2% the proportion of schools that provide comprehensive health education to prevent health problems in all areas
Increase the proportion of schools that have full-time registered school nurse to student ratio of at least 1:750
Increase the proportion of schools that have official policies/engage in practices that promote a health & safe environment (indoor air & water quality, hazardous waste disposal plan, mold plans, reduced pesticide exposure)
Reduce to 399.6/100,000 rate of minor/young adult perpetration arrests for violent crimes
Increase the proportion of school-based health centers with oral health components
Increase the proportion of schools that require daily physical education
Increase to 17 the number of states that require regularly scheduled elementary school recess
Reduce proportion of children who miss school due to asthma; Increase number of people with asthma who receive education about appropriate response, s/s, peak flow
Increase to 100% tobacco-free environments in schools (facilities, properties, vehicles, events); Reduce use of tobacco by adolescents

School Nurse Role (pg 750)

Question Answer
Coordinated School Health ModelHealth education, Physical education, Health services, Mental health & social services, Nutrition services, Healthy & safe environment, Family & Community involvement, Staff wellness
No Child Left BehindUses standardized academic testing to determine funding distribution for schools - has resulted in less support for health services (which promote student retention/learning readiness/academic performance)
Where did school nursing begin historically?England & France in the mid-nineteenth century
Who started school nursing in the US; for what purpose?Lina Rogers Struthers (placed by Lillian Wald); To reduce absences d/t communicable disease
School nursing initially emphasized personal hygiene, what did it expand to include?prevention, examination, treatment, & advocacy
Nat'l Assoc of School Nurses minimum requirements for entry-level school nurses?4-year baccalaureate degree and licensure as an RN
School nurses have an obligation to providesafe, consistent, quality care in accordance with "School Nursing: Scope & Standards of Practice" (ANA & NASN)
School health programs are under the jurisdiction ofstate mandates & laws
Focus of school nurse interventionsreduction of high-risk behavior & promotion of healthy lifestyles
Health-enhancing behaviorsrefusal skills, problem solving, decision making, media analysis, assertiveness skills, communication, coping strategies for stress, behavioral contracting

Adolescent & Teen Concerns

Question Answer
Two levels of assessment for school-age childrenIndividualized (ht/wt, immunization status, etc) or Population-based (measuring attributes in a classroom of children, i.e. 40% of the class has BMI >30)
Leading cause of morbidity & mortality in school-aged childrenUnintentional injury
Injury hazards for school-agedMotor vehicle/pedestrian/biking crashes, Firearms, Burns, Assault
Denali Kid Care is an example ofCHIPs (state Children's Health Insurance Program), school nurses may facilitate student/family access to these types of programs (also to Medicaid)
Common health concerns of school-aged childrenDrug/Alcohol use, Cigarette use, STDs & Communicable disease, Teen pregnancy, Violence, Mental health, Skin disorders (infection/allergy/cancer), Respiratory conditions, Nutritional concerns (obesity/anorexia), Dental health
Though the rate is decreasing (as of 2009) how to US teen pregnancy rates compare globally?US is 9 times higher than other developed countries
Physical effects of pregnancy on teen Momshypertension, toxemia, anemia, nutritional deficiencies, UTIs, premature delivery, rapid or prolonged labor, eclampsia, infections
Consequences for children of teen momsstillbirth is twice as common, mortality rate in 1st year is 2-4 times higher, greater risk of health problems/hospitalization, increased incidence of child abuse/neglect, low birth weight, decreased cognitive development, daughters are more likely to become teen moms (33%), sons are 2.2 times more likely to become incarcerated
Nurses role in sex ed/teen pregnancy* Primary: education, risk behavior screening, provide access to contraception
* Secondary: early detection, resolutions strategies (abortion, adoption, raising), prenatal/postpartum & newborn care
* Tertiary: access to birth control, parenting skills, Nurse Home Visiting Program (birth to 2 years old)
Abstinence-only teaching is not as effective as comprehensive sex ed, what other factors help?- Program lasts a sufficient amount of time
- Addresses peer pressure
- Teaches communication skills
- Reflects the age/sexual experience/culture norms of the students
What is the Personal Responsibility Education Program?Part of the Affordable Care Act; funds education programs on sex (pregnancy, STD prevention), healthy relationships, communication with parents, & financial literacy
Bandura's Social cognitive theorySelf-efficacy (the person's belief in the ability to perform a behavior)
Self-outcome expectancy (what the person expects to get from performing a certain behavior)
Modeling (imitating the behavior of someone else)


Question Answer
culturethe learned and shared beliefs, values, and life ways of a group that are generally transmitted from one generation to the next and influence people's thoughts and actions
ethnocentrismevaluation of other cultures according to preconceptions originating in the standards and customs of one's own culture
health care disparitiesinequalities that occur in the provision of healthcare and access to healthcare across different racial, ethnic and socioeconomic groups
prejudicepreconceived opinion that is not based on reason or actual experience
stereotypinga widely held but fixed and oversimplified image or idea of a particular type of person or thing
discriminationthe unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age, or sex
raceclassification of humans into groups based on physical traits, ancestry, genetics or social relations, or the relations between them
racismthe belief that all members of each race possess characteristics or abilities specific to that race, especially so as to distinguish it as inferior or superior to another race or races
ritea ceremony or act that often marks an important event of life transition
rituala prescribed series of actions or process closely related to a cultures ideology
Why is it important for a nurse to engage in cultural self-evaluation?it provides insights that can help them overcome ethnocentric tendencies & cultural stereotypes
The Process of Cultural Competence ModelCultural Awareness, Cultural Knowledge, Cultural Skill, Cultural Encounters, Cultural Desire
9 Key areas of cultural assessmentLifestyle patterns, Cultural values & norms, Cultural taboos & myths, The culture's world view & ethnocentric tendencies, The culture's perception of its similarities with & differences from other cultures, Health care rites & rituals, Degree of culture change, Caring behaviors, Folk & professional health-illness systems being used


Question Answer
Vulnerable populationgroup that is more likely to develop health-related problems, have more difficulty accessing health care to address those problems, and are more likely to experience a poor outcome or shorter life span because of those health conditions
Vulnerable groupsthose living in poverty, ethnic & racial minorities, the uninsured, the homeless, migrant/seasonal workers, prisoners
How can nurses advocate for vulnerable populations?by becoming involved in special interest groups, testifying before governmental agencies, advocating changes from within their current employing agencies, and providing information to other community groups and organizations
Povertythose who fall below the "adequate" federal living standard (a standard which is in dispute)
Poordifficulty providing the basic necessities of food, clothing, and shelter for themselves and their families (may not "qualify" as being in poverty)
Effects of socioeconomic status on healthpoor families may have to choose between medical care and basic needs, often delaying needed care or not pursuing it at all
Characteristics of HomelessRural areas: white, single or married women & their children are largest group; Urban areas: single men and single females with children are the two largest groups
Health Problems of the HomelessInfections, Trauma, Nutritional deficiencies, Chronic disorders (HTN, DM, PVD, HIV), Mental health disorders, Problems with pregnancy, Substance abuse
Housing First PhilosophyHousing is not contingent on compliance with services – instead, participants must comply with a standard lease agreement and are provided with the services and supports that are necessary to help them do so successfully
Strategies to eliminate health disparities• Promote the consistency and equity of care through the use of evidence-based guidelines
• Structure payment systems to ensure an adequate supply of services to patients from minority groups, and limit provider incentives that may promote disparities
• Enhance client–provider communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice
• Support the use of interpretation services when community need exists
• Support the use of community health care workers
• Implement multidisciplinary treatment and preventive care teams.



Question Answer
Common myths about older adultsthey are frail, senile, unhealthy, unhappy, set in their ways, irritable, not sexual, are ineffective/undependable workers
Erikson's stage for older adultsEgo integrity vs Despair = maintaining a sense of wholeness and purpose may represent a challenge in the midst of declining health & significant alterations in major life roles & relationships
Demographics of the agingMajority live independently, 42% are women >65 are widows, older adults consume 30% of all Rx meds & at least 25% of OTC meds, approx 10% of noninstitutionalized older adults receive help with 1 ADL compared with 91% of institutionalized
Support systems for aging familiesLong-term care, Home-care, Respite care, Community-based living, Nursing homes
In-home services for older adultsHome-delivered meals, Friendly visiting services, Emergency response systems, Telephone reassurance programs, Personal care services, Chore services

Home Care & Hospice

Question Answer
Medicare criteria for home health careHomebound status, Skilled services are needed, Skilled nursing service, Intermittent & part-time service is needed, Services are reasonable and necessary
Differences btwn HH nurse and Inpatient nurseInpt nurse often provide direct care, HHN primarily teach caregivers how to provide direct care; HHN documentation regulatory/reimbursement requirements but also conveys clincal course of client's care; HHN work as a case manager, determining client's needs; HHN must know who is going to pay & for what; HHN determines frequency/duration of care; HHN advocates for client by helping them negotiate the medical care system