Core Components of School Health

Health Services

Healthy School Env't

Health Instruction

Physical: safety

Psychosocial: bullying

Cultural: tolerance and diversity

Educate

Role Model

Resource person

Clinician

Counselor

Educator

Case Manager 

Advocate

Health Services

Basic First Aid

Acute/Chronic Illness

Immunizations

Screenings

Specialized Care (Special Needs)

Healthy School Env't

Physical: safety

Psychosocial: bullying

Cultural: tolerance & diversity

Health Instruction

Teach

Educate

Role Model

Resource

School Nurse Health Roles

Clinician

Counselor

Educator

Case Manager

Advocate

Indicators of School Health

Absenteesim

Case Finding ("at-risk" students)

- absent > 10%

- disciplinary issues

- frequent nurse visits

- disability

- recent trauma

What contributes to most homelessness?

1. Limited $ management experience

2. Lack of motivation for employment

3. Persistent probs (substance/alcohol abuse)

4. Not willing to seek medical attn

When presenting STD prevention program to community leaders, what should be addressed first?

1. How they can help

2. ID high risk ppl

3. Services offered by existing programs

4. STD prevalence in community

What is most important when planning a program to reduce lead exposure with children?

1. Gender-specific behaviors

2. Env'tl risk factors

3. Family health practices

4. SES

What is the major difference between acute care and home health care?

HH is in the client's home env't

Why does HH assessment take longer?

It includes supplies/resources and the family

Why does client teaching sometimes need to be repeated in the home?

Clients sometimes don't remember hospital teaching d/t incr'd stress

What type of care would a client need if he was D/C'd from the hospital, but wasn't ready to go home?

Transitional care

How/when did HH come about?

During the time of the Henry Street Settlement in NYC when there was a need for care in schools and homes

Why is there not a nurse in every school?

Low budget (in most school districts)

If a school nurse provides a health fair in the community, what role is she mainly doing?

Community outreach

If a school nurse feels uncomfortable with an issue a student has, what should she do?

Call another nurse to work with the student

When a school nurse begins an anti-drug teaching presentation, what level of prevention is this?

Primary

Who is considered the founder of public health nursing?

Lillian Wald

Why is public health nursing considered so appealing?

Autonomy and independence

Why were nurses so unprepared for public health nursing?

Nurses were trained in hospitals (diploma schools)

What was the major obstacle for public health nursing at the turn of the century?

Lack of adequate funds

What is a shoe-leather survey?

A walk through the community

What is a windshield survey?

Drive through community in the car

Who are the most rapidly growing group of homeless?

Families w/ children

What services does the Topeka Rescue Mission provide?

Clothing, food bank (every other month), furniture, health care, job training, etc.

Why is HC for the homeless so expensive in the community?

Frequent use of the emergency room as opposed to a PCP or walk-in clinic

Does the TRM have curfew and strict rules and guidelines?

Yes, in by 7pm. 

Separated by the single and families with children.

Why apply as a volunteer at a rescue mission?

What can you do there?

A good opportunity and experience working w/ vulnerable/diverse populations.

Serve meals, nurse clinic, holiday events.

What is a key way to be involved as a political advocate?

Join your state Nurses Association

What is the case management client for in 4th level?

To provide comprehensive care to a complex client and pull everything learned over training.  Also participate in teaching and providing community resources.

Sam Spady DVD was about...?

Alcohol poisoning on college campuses

A community nurse wants to teach her clients how to keep their env't healthy.  What is the best advice she can give?

Reduce, reuse, recycle

What is community assmt?

Process of critically examining the characteristics, resources, assets, and needs of a community, in order to develop strategies to improve the health and quality of life of the community.

The V/S of the community is...

Epidemiologic Data:

who is affected?

to what extent?

why?

Physical assmt of a community...

Observe

Auscultate

Palpate

...learn thru direct experience

The structure of a community includes...

Physical env't

Socioeconomic composition

Facilites and services

A community's CAPACITY...

Strengths, weaknesses, and problem solving skills of the community

A community's competence is...

How effectively the community works

together to meet needs

Who are key informants in a community?

Community leaders or experts that can provide a

broad range of information

Community assessment + change project =

Nursing process applied at the community level

Health promo and disease prevention

interventions can be applied to...

Individual, family or community level probs

Primary Prevention

Prevention BEFORE a problem or

disease occurs

Secondary Prevention...

Screening

Early Dx

Referral and Tx in early stages of present

disease but not previously detected

Tertiary Prevention

Interventions to tx an identified disease

state (often chronic)

Goal: restoration of helath or rehab

What is a policy?

Guideline that determines how something is done

- gives purpose and direction for activities and interventions

- determines what choices to make regarding use of resources

What is politics?

Processing of influence the decisions of others

- shapes public policy

Rural health population

Rural Hospitals

Lower occupancy and swing beds

- Pt's triaged to urban centers

Limitations in rural services...

Distance (EMS volunteers)

Less use of mental health and rehab

Access issues in rural health...

Cost

Distance

Acceptability

Env'tl Issues in Rural Health

Workplace is usually outdoors

Distance

Communication

Farm Work in Rural Communities

Dangerous occupation

Morbidities:

- trauma

- noise-induced hearing loss

- skin disease/cxr

- exposure to chemicals/pesticides

Community Health Nurse Role in Rural Health

Expert generalist

Independent

Close ties

Social & Professional roles intertwined

Community visibility

Migrant Workers

Seasonal employment w/ temporary residence

- Racially and culturally diverse

- 75% earn < $10k/yr

- Few or no benefits

Migrant Lifestyle

Housing often subsidized

- variable

- proximity to hazards

Limited medical care

Interrupted education for children

Migrant Women

Employed as workers

Household mgmt

Risk for physical abuse

Migrant Children

Work age 14 (12-13 w/ consent)

Changing schools

Dual cultures

Care of other children

Migrant Health

Higher rates of TB & other illnesses

Dental disease

Occupational injury and exposure

What is vulnerability?

Applies to a person/group at risk for

adverse health outcomes d/t circumstances

over which they have little or no control

Factors of Vulnerability...

The physical env't

Biological, psychological or social factors

Personal resources

What is poverty?

Lack of financial resources to meet basic needs

Who is considered a vulnerable population?

Poor/homeless

Migrant workers, esp if poor and transient

Disable

Substance abusers

Victims of violence or disaster

HIV+

Very old/young

Pregnant teens

Refugees and immigrants

Mentally ill

What is acute poverty?

Situational (job loss)

What is chronic poverty?

Persists for year or generations (cycle of poverty)

What are health problems r/to poverty?

More chronic illness and complex health probs

Higher infant mortality rate/LBW babies

Developmental delays in children

Nutritional inadequacies

Higher accidnet and homicide rates

What are social and env'tl problems with poverty?

Poor academic achievement

Inadequate housing

Partial employment or unemployment

Limited job skills

High risk/dangerous jobs

Poverty can L/to Homelessness

What is homelessness?

An individual who lacks a fixed, regular, and adequate night-time residence

OR

An individual who has a primary night-time residence that is:

-a supervised shelter

- a temp residence for instituational care

- a public/private place not ordinarily used as a sleeping place

- Economic

- Social influences

- Personal influences

- Political

Community level - ASSESS

Population focus

- support

- educate

-eliminate poverty

What are secondary preventions of homelessness?

Community level - plan and develop programs

Population focus -

- case find and screen

-offer health services

Community level - support existing programs/services

Population focus -

- minimize disability by effective tx of chr disease, mental and dental care, and substance abuse (case mgmt)

ADVOCATE for policies to address unmet

needs of homeless persons

Medicare "certified" agency

Pt needs intermittent skilled services

Homebound

POC authorized by MD

D/C planning

Case Mgmt

Coordination of community resources

Interdisciplinary collaboration

Provision of skilled nursing care

Infusion therapy

Enteral nutrition

Wound/skin Mgmt

Vent dependent pts

Perinatal home care

Hospice/palliative care

What did Florence Nightingale implement?

The first nurse training program

- William Rathbone founded the first district nursing association in England

Why was there an incr'd need for trained nurses in

public and community health?

urbanization, industrialization and immigration

The 1st trained nurse in the U.S. who was salaried as a visiting nurse

What did Lillian Wald establish?

Henry Street Settlement

1. Population focused home care

2. Transitional care in the home

3. Home-based primary care

4. Home health

5. Hospice

- ethical issues (reimbursement and access to care)

- role development (high-technology and hospice)

- opportunities for research

(quality of care, cost-effective, pt safety)

- Problem classification Scheme

- Intervention Scheme

- Problem Rating Scale for Outcomes

What 3 principle benefits does the Omaha System offer?

Parish nurses respond to health, healing and wholeness w/in the context of the church.

- Emphasis of health promo and disease prevention throughout the lifespan,

but with a spiritual dimension

Promote a caring faith community through

- personal health couseling

-health teaching

- facilitating links and referrals to coungregation

and community resources

- advocate and encourage support resources

- provide pastoral care

Be informed consumers and be

advocates for citizens in their communities

education

waste minimizing

land use planning

envn'tl permitting

entn'tl standards

monitoring

compliance and enforcement

clean-up and remediation

questions and observations about intended

and unintended envn'tl exposures

What are important skills for nurses in

envn'tl health practice?

an important skill that acknowledges the

outrage factor experienced by

communities w/ envn'tl hazards

What is included in env'tl health practice?

principles of health promo

disease prevention

health protection

- Assessment: monitor, assess and surveilance of local health probs and needs; dx and investigate

- Policy Development: foster local involvement and sense of ownership that emphasizes needs and advocates for resources.

- Assurance: enforce laws/regulations that protect health and ensure safety; link ppl to services eval effectiveness

educate on safe sex, smoking cessation,

Drug/ETOH dangers, seat belt use,

pregnancy, STDs, and proper nutrition

What are some crucial health

concerns of the Native American population?

Diabetes management

HTN

Why is it important to volunteer

in the global health setting?

To incr awareness, educate, and incr

an appreciation of the resources in the U.S.

A common group, connected, with

meaningful interactions

Define a Population/aggregate...

- Informant reviews

- Community forum

- Secondary data

- Windshield survey

- Focus group

- Surveys

- Participant observation