Publiccommunity Health and Nursing Practice Caring for Populations by Christine L. Savage
Savage, Christine;
SECOND EDITION
Questions & Answers from this book
Questions and answers are connected to the referenced book and its available source material.
Chapter 1: Public Health and Nursing Practice
How does the Intervention Wheel define 'advocacy'?
The Intervention Wheel defines advocacy as pleading someone's cause or acting on someone's behalf, while focusing on developing the capacity of the community, system, individual, or family to plead their own cause or act on their own behalf.
How does the Health and Medicine Division (HMD) of the National Academies define health literacy, and what factors does it emphasize?
The Health and Medicine Division of the National Academies defines health literacy as something that emerges when the expectations, preferences, and skills of individuals seeking health information and services meet the expectations, preferences, and skills of those providing information and services. It emphasizes that health literacy arises from a convergence of education, health services, and social and cultural factors.
Chapter 2: Optimizing Population Health
What are the four assessments that form the core of the MAPP process?
The four assessments at the core of the MAPP process are the Community Themes and Strengths Assessment, the Local Public Health System Assessment (LPHSA), the Community Health Status Assessment, and the Forces of Change Assessment. Together they combine qualitative and quantitative methods to build a comprehensive picture of the community.
How does the chapter define a community in contrast to aggregates and populations?
The chapter defines a community as a group of individuals living in the same geographical area or sharing a common denominator, such as ethnicity or religion, who recognize their membership through social interaction, ties to other members, and often collective decision making. In contrast, aggregates and populations are larger groups who share at least one characteristic, such as age or a health issue, but whose members may not interact with one another or recognize themselves as part of the group. The text notes that the terms aggregate and population are frequently used interchangeably.
What are the core assumptions underlying screening programs, and how do they relate to the criteria for implementing a screening program?
The core assumptions are that screening will reduce disease-associated morbidity and mortality through early identification and treatment, and that all who screen positive have access to appropriate assessment and treatment services. These assumptions underpin the screening criteria: valid tests, practical tests, serious disease, effective early treatment, high prevalence, and available referral resources. Each criterion helps ensure the assumptions can actually be met in practice.
Chapter 4: Introduction to Community Assessment
What is the Behavioral Risk Factor Surveillance System (BRFSS) and what type of data does it provide for community assessments?
The Behavioral Risk Factor Surveillance System (BRFSS) is a data source available for communities that, since 1984, has tracked health conditions and risk behaviors. It provides secondary data on behavioral risk factors such as tobacco use, alcohol use, exercise, and nutritional patterns, with findings like current smoking, binge drinking, overweight, and leisure-time activity. This information helps community assessment teams examine lifestyle factors contributing to health problems such as premature mortality.
What demographic indicators did the team use to assess Small Town's population, and what data sources did they rely on?
They used gender, age, race, home ownership, and income as demographic indicators, and later also looked at poverty level, crime, and fire safety. Their data sources were U.S. Census Bureau data: the 2010 decennial census and the 2016 American Community Survey estimates, accessed through the American FactFinder Web site.
Chapter 5: Health Program Planning
How does the MAPP framework differ from the CHANGE tool in community health planning?
In the CHANGE model, program planning is only the final phase; the model has eight phases and only its last phase, developing the community action plan, concerns program planning. In MAPP, by contrast, the action cycle itself is the program planning phase.
What are the five components of a logic model in health program planning, and how do they relate to each other?
The five components are resources (inputs), activities, outputs, outcomes, and impact. The model reads from left to right like a chain of reasoning: the first two components are the planned work, and the last three are the intended results. Resources and activities combine to produce outputs, which lead to outcomes and eventually to the program's long-term impact.
Chapter 6: Environmental Health
In the case study of Libby, Montana, what was the source of asbestos exposure for the townspeople, and what actions did the EPA take in response?
The townspeople were exposed to asbestos through contaminated soil around town, where asbestos from vermiculite mining settled near homes, schools, athletic fields, and other public places and was tracked indoors. In 2002, the EPA placed Libby on its National Priority List, which led to testing and inspection of nearly 5,000 residential and commercial properties and cleanup operations; in 2009, the EPA declared a public health emergency, mobilizing funds for further home-to-home cleanup and health-care resources.
What was the change in the blood lead level (BLL) trigger for intervention in children, and what was the rationale for this change?
The blood lead level (BLL) trigger for intervention in children was changed in 2012 from 10 to 14.9 μg/dL to a BLL of 5 μg/dL. The rationale was evidence that even lower levels of lead exposure increase the risk for adverse health outcomes in children.
Chapter 8: Communicable Diseases
In the context of the case study, explain how the issue of rheumatic heart disease in Rwanda exemplifies the upstream, midstream, and downstream approach to addressing health at the population level.
In this case, upstream means the underlying poverty and lack of financial resources in Rwanda that keep a low-income country from providing basic medical care. Midstream means the missed opportunity to treat strep throat with throat cultures and antibiotics before it becomes rheumatic fever. Downstream means Team Heart's yearly surgery to repair heart valve damage in people who already have rheumatic heart disease. The case indicates that limited resources should be directed to the midstream step, treating strep throat early, rather than letting the disease progress to the point where surgery is needed.
According to the chapter, what are the key components of the epidemiological triangle and how do they relate to the transmission of communicable diseases?
The epidemiological triangle has three key components: the agent (the infectious organism causing the disease), the environment (including the reservoir and mode of transmission), and the host (the susceptible human). They relate to transmission because the agent must leave a reservoir, travel through a mode of transmission, and enter a susceptible host through a portal of entry, completing the cycle of infection.
What factors contributed to the delayed diagnosis and high case fatality rate in the MDRTB outbreaks in hospitals between 1988 and 1992?
The delayed diagnosis was caused by the fact that most patients were also infected with HIV, so TB did not present in a classic manner. Recognition of drug resistance was also delayed because drug susceptibility testing took too long, and this contributed to the high case fatality rate.
Chapter 9: Noncommunicable Diseases
How does the chronic care model differ from the acute care model in the management of noncommunicable diseases?
The chronic care model differs from the acute care model by managing noncommunicable diseases over time through an integrated care delivery model, rather than treating only acute phases in an acute care setting. It shifts the focus to long-term management in the community, with the goal of decreasing morbidity and mortality. The model also relies on an informed, activated patient interacting with a prepared, proactive practice team, supported by community resources, self-management support, decision support, and clinical information systems.
What is the leading risk factor for cancer, and what percentage of lung cancers are attributed to it?
Tobacco use is the leading risk factor for cancer. The source states that 80% of all lung cancers result from smoking or exposure to secondhand smoke.
Chapter 10: Mental Health
What disparities in mental health care access and use exist among African American and Hispanic populations compared to non-Hispanic whites, as described in the chapter?
The chapter states that although African Americans and Hispanics are more than 20% more likely than non-Hispanic whites to report psychological distress, African Americans are 15% less likely and Hispanics are half as likely as non-Hispanic whites to receive mental health care. These groups also have the highest numbers of people who lack insurance coverage. Possible explanations include variations in symptom expression, provider bias, experiences of mistreatment, difficulty accessing treatment, and stigma.
What are the two main reasons why persons with serious mental illness (SMI) die 10 to 20 years earlier than the general population, as described in the chapter?
The text lists two main reasons: part of the earlier death is attributed to suicide and injury, and the other contributing factor is the strong association among serious mental illness, chronic disease, and substance use.
Chapter 11: Substance Use and the Health of Communities
What is the harm reduction model in the context of substance use, and what are its guiding principles?
The harm reduction model is an approach used in substance use prevention that seeks to reduce harm associated with alcohol and drug use or other high-risk behaviors, rather than focusing only on achieving abstinence. It spans interventions from safer use, such as needle exchange programs, to abstinence, offering options to individuals who are unwilling or unable to pursue abstinence-based treatment. The guiding principle of harm reduction is that these interventions should be free of judgment or blame.
According to the chapter, what are the key components of Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a public health approach to managing substance abuse?
SBIRT stands for screening, brief intervention, and referral to treatment. Screening uses validated tools to identify patients at risk for substance-related harm. Brief intervention is a short, practical conversation, often using motivational interviewing, to encourage cutting back. Referral to treatment is used when patients need more intensive help, such as those at risk for withdrawal or with daily illicit drug use.
What is the controversy surrounding medication-assisted treatment (MAT) for opioid use disorder, and what does evidence suggest about its effectiveness compared to abstinence-based approaches?
The controversy centers on using opioid agonist medications such as buprenorphine and methadone for long-term maintenance rather than requiring complete abstinence. Evidence indicates that medication-assisted treatment is more effective than an abstinence-based approach in reducing relapse, overdose deaths, and other harms associated with opioid use disorder.
Chapter 12: Injury and Violence
How did nurses at Cincinnati Children's Hospital Medical Center apply the upstream approach to injury prevention?
The nurses at CCHMC applied the upstream approach by initiating community-based prevention programs instead of only treating injuries after they occurred. They developed a child passenger safety program at 46 community fitting stations to help low-income families with car seat installation, initiated a bike safety program, held community health fairs, and led the Safe Kids Coalition. Their work was collaborative, involving public health, fire, and police departments in community settings.
What is the Haddon Matrix and how is it used in injury prevention?
The Haddon Matrix is a tool for analyzing injury risk based on the epidemiological triangle, with rows for the pre-event, event, and post-event phases and columns for host, agent, and environment. It is used to identify contributing factors at each phase and to plan injury prevention and mitigation strategies, such as preventing the event, reducing impact during the event, and improving outcomes afterward.
Chapter 14: Health Planning for Acute Care Settings
Chapter 15: Health Planning for Primary Care Settings
Chapter 16: Health Planning with Rural and Urban Communities
Chapter 17: Health Planning for Maternal-Infant and Child Health Settings
Chapter 20: Health Planning for Occupational and Environmental Health
Chapter 21: Health Planning, Public Health Policy, and Finance
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