Jennifer : Red Crystal : Yellow Ch.

5 (5 questions) Definition of primary health care Primary care includes services directed at reducing the potential for a disease through continuous, coordinated, and comprehensive care. Takes place in a primary care providers office. P. 126 Ideal primary health care Preventive, primary care and secondary care usually take place in the primary care providers office. Ideal would be to focus more on preventive (health promotion). Historically the focus has been on tertiary care that is provided in large medical facilities. P. 126-127 Traditional systems are being redesigned into multilevel integrated systems. P. 133 Uses of the ER (and non urgent care) p. 135 describes the advent of ambulatory care centers which are referred to as urgent care, urgicare, minute clinics or walk-ins. They try to enhance consumer satisfaction by being convenient, cost effective and caring. Good for minor illnesses. Distribution of responsibility Dispute with health care systems Improving health care in the community Primary care model (community oriented) What Is Community-Oriented Primary Care? Community-oriented primary care (COPC) is a systematic approach to health care based upon principles derived from epidemiology, primary care, preventive medicine, and health promotion (Longlett et al. 2001). In 1982, the Institute of Medicine advocated increased COPC training among health professionals (Connor and Mullan 1983). A conference sponsored by the Institute of Medicine (IOM) resulted in an operational definition that included three requirements for implementing COPC. Definition of community-oriented primary care: A primary care practice providing accessible, comprehensive, coordinated, continuousovertime, and accountable health care services. A defined community for whose health the practice has assumed responsibility. In this context, community refers to geographic or social communities; groups that form within the workplace, church, or schools; or persons enrolled in a common health plan. Specifically excluded are communities consisting of the active patients in a practice. A process including the following steps: (1) defining and characterizing the community, (2) conducting a community diagnosis, (3) developing and implementing an intervention,

and (4) monitoring the impact of intervention. An additional step added to this list includes (5) involving the community to carry out the preceding four steps (Rhyne et al. 1998). The fundamental basis of COPC is the community and the ethic of service to drive community health improvement (Gardner et al. 2000). The level of community engagement, however, can often be in question in a COPC context. For example, the community's and the health organizations needs may differ, or a relationship may not have been established between the health service organizations and their surrounding communities. It is essential that the community be involved in designing and implementing the COPC experience. [Link] Ch. 7 (6 questions) Cost effective ways to allocate health care resources Greatest influence in health care spending Competition in the market is the mechanism for setting price and quality. Efficiency and satisfied customers is important. P. 159 No single factor explains why health spending has grown at the rate it has. There was an economic effect of increased demand as a result of increased sources of funds from government. Other influences are: inflation, increased drug costs, expensive advanced technology, change in population demographics, excess in the system, administrative excess, and emphasis on cure over prevention of illness. P. 167-168 Medicare/Medicaid Medicare p. 170-171. Title XVIII of the Social Security Act, called health insurance for the aged and disabled. Health insurance for everyone over age 65 years, persons entitled to social security or railroad disability benefits for at least 24 months, people with ESRD with dialysis or kidney transplant. Administered by HCFAHealth Care Financing Administration. Hospital insurance is part A, supplemental medical insurance is part B, Medicare+Choice is part Cwhich is managed care organizations/HMO. Medigap is private insurance that can be purchased that pays most of the health care services that are not covered by Medicare. P. 172 Medicare is considered an entitlement program because people have contributed to Medicare through their taxes and it is due to them regardless of wealth.

Medicaid is a welfare program, representing funds transferred from more economically affluent individuals to those in need. Title XIX of the Social Security Act is a federal-state matching funds program to provide basic health care to indigent. Funds are matched based on per capita income of each state. Each state establishes is own Medicaid eligibility standards, determines the type, amount, duration and scope of services, sets the rate of payment for services and administers its own program. P. 172-173. Nursing interventions Collaboration? P. 177

p. 180 Community health nurses can optimize patient care by using economic information in coalition building, research, lobbying, negotiation with insurers, and influencing policy on health care allocation. Improving health outcomes Primary prevention and economics This is basically about how if we prevent illnesses, it is cheaper than trying to treat chronic illnesses. Ch. 8 & 9 (6 questions) Nursing and the political process p. 137 (ch.5) talks about the ANAs efforts to develop a special interest group. The ANA is involved in legislation that ensures basic health care services for everyone.

Malpractice p. 204 Malpractice is a more specific term that considers a professional standard of care as well as the professional status of the health care provider. To be liable for malpractice, the person committing the misconduct must be a professional acting in a professional role. Professional misconduct includes either doing something that should not be cone (commission) or not doing something that should be done (omission). Scope of practice is guided by? p. 204 Nursing practice in each state is governed by a nurse practice act which includes the laws and regulations that control the requirements for entry into practice, the standards for acceptable practice, the standards for continuing competence and the disciplinary actions taken for misconduct. The state nurse practice act is the most important piece of legislature for nurses because it governs every facet of nursing practice. Definition of constitutional law Derived from federal and state constitutions and is the supreme law of the land. The US Constitution is the highest legal authority that exists and no other law, state or federal may overrule it. P. 197 How do bills passed in congress apply to nurses (not sure what she wants with thisobviously have to obey laws) regulation? p. 203 Regulatory processregulation is the act of controlling, directing or governing according to a rule, principle or system. Once bills are passed into law by the legislative branch of government, they must be implemented by the administratie agencies of the executie branch. Regulation is used to clarify and interpret existing policy and laws and decide what methods will be used to enforce them. p. 200 How Nurses can get involved in political process: be an informed voter, be aware of what the candidates stand for on national, state and local levels and where they stand on issues that are important to nursing. Can contact nursing organizations for info. Once legislators are in office, nurses should get to know them and make themselves and their views known to

them. To have an idea introduced as a bill, find a sponsor in the house and senate. Approach sponsors early. Ch. 17 (12 questions) International agencies for global health: pg 384 United Nations: Came together after WW II to establish a commitment to world peace and security through international cooperation. It has a membership of 192 nations, the UN represents the interests of almost all countries of the world. The UN does not make laws but provides the means to help resolve global conflicts and formulate policies that affect all nations. All members have equal vote regardless of size or wealth pg 384. United Nations International Childrens Emergency Fund (UNICEF): created in 1964 to assist millions of sick and hungry children in war-torn Europe and China. It soon became apparent that children all over the world needed help. Now the primary objective is to provide economic and humanitarian relief for the worlds more disadvantaged children without discrimination. The programs are aimed at ending hunger and malnutrition, helping refugees, promoting education of girls, controlling diseases, saving the environment, and securing human rights pg 387. World Health Organization: A partner in the UN system is responsible for directing and coordinating international health. WHO helps countries address public health issues and supporting research. The primary objective is for all people to attain the highest level of health pg 387. World Bank: Has attempted to meet the needs of a changing economy. The World Banks priorities have evolved from rebuilding war damaged European nations to alleviating poverty in developing countries. Over the past few decades the World Bank has become increasing instrumental in reducing poverty and raising the standard of living in many developing countries. Table 17-1: World Bank Development Projects pg 389 Education, HIV/AIDS, Health, Debt Relief, Biodiversity, Fight against corruption, War/conflict Carter Center: Is a non-profit, non-governmental organization (NGO) located in Atlanta. It is associated with Emory University and has been instrumental in alleviating global health problems through its commitment to promoting peace and fighting disease. Carter Center has three main objectives 1. Prevent and resolve conflicts 2. Enhance freedom and democracy, and 3. Improve health. Bill and Melinda Gates Foundation: A nonprofit NGO that focus on reducing extreme poverty, improving health, and increasing access to public libraries Definition of global health: Is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized. It has been defined as 'the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide' Thus, global health is about worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. Pg 364 Issues of global health pg 391 - 395

Disease Burdens (Infectious Disease): In the low and middle-income countriesd three infectious disease are among the top causes of death for adults ages 15 to 59. HIV/AIDS, TB, and lower respiratory infections. Chronic Disease: Because of changes in diet and lifestyle and increases in life expectancy, many developing countries are seeing increases in the incidence of chronic disease such as cardiovascular diseases, cancers, diabetes, and chronic respiratory disease. Obesity is also fastly becoming one of the worlds leading risk factors for premature death. One in four people are too fat. Cardiovascular disease is not the number one cause of death worldwide. With 80% of the worlds 13 million cardiovascular diseases occur in low- middle income countries. Levels of violence: WHO defines violence as the intentional use of force or power, threatened or actual, against oneself or another person; Who defines violence on 4 levels: individuals, relationship, community and societal. Box 17-5 The Consequences of Collective Violence: Increased civilian death rates during violent conflicts are usually due to the following causes: Injuries Decreased access to food Increased risk of communicable disease Decreased access to health services Decreased public health programs Poor environmental conditions Psychological distress

Armed Conflict and War: Violent conflicts between nations and groups, acts of terrorism, rape, as a weapon of war, and gang warfare occur daily in certain parts of the world. Box 17-5 outlines some of the causes of death for civilians during violent conflict or war. Poverty: Means powerlessness, lack of representation, and freedom, Almost half of the worlds 6 billion are poor. According to the World bank there are three levels of poverty: extreme, moderate, and relative. Extreme poverty: Also known as absolute or abject poverty is defined as living on less than $1 per day. At this level members of the household are not able to meet the basic needs of survival. 1. Moderate poverty: Defined as living on less than $2 per day. At the level the basic survival needs are being met. 2. Relative poverty: Defined as a household income below a given proportion of the national average. It means not having things that the middle class in countries take for granted. Womens Rights: Everyday all of the world, girls are kept out of school, beaten, forced to marry and have sex. One woman dies from complications of pregnancy and childbirth every minute accounting for more than one million deaths world-wide each year.

Issues of WHO: Helps to direct and coordinate international health. The focus of WHOs work is producing and disseminating global health standard and guidelines, helping countries to address public health issues, and supporting health research Definition of global nurse migration: the worldwide shortage of nurses, which results from a Global undersupply and high attrition rates, affects developed countries in the West the same way as it affects developing countries in Asia, Africa and Latin America. Many developed nations are recruiting workers from less developed nations to alleviate staffing shortages. This practice has resulted in a global distribution of healthcare workers and has left the countries with the greatest needs with the greatest shortage. Thus, the ongoing nursing shortage in developing countries is worsened by a loss of thousands of trained nurses every year to emigration. Global nursing: To ensure quality nursing care for all, sound global health policies, the advancement of nursing knowledge, and the presence of a satisfied global nursing workforce. Pg 396 Emphasis of global health: The nations of the world came together to recognize the concept of primary health care as a strategy to reach the goal of Health for All by the Year 2000 The Declaration of Alma Ata defined primary health care as essential health care based on practical scientifically sound, and socially acceptable methods.

Impact of global health: Direct impact reasons: In an increasingly connected world, diseases can move as freely as people and products. Infectious diseases can easily cross national borders and pose immediate threats in the U.S. diseases such as SARS, avian flu, and drug resistant TB. Working to solve global health problems includes addressing diseases that people in this country dont usually think of as posing an immediate threat on our soil. Indirect impact reasons: Global health matters to Americans for reasons that may not be immediately clear, but that are nevertheless very real. For example, rising incidences of diseases like HIV/AIDS, malaria, and TB are increasing poverty and political instability in many countries. That in turn has political and economic consequences worldwide. Working to address global health problems can help prevent civil strife in other countries. It can support economic stability and improve the quality of peoples lives. That can be good for U.S. security, our economy, and the way our country is perceived throughout the world. The U.S. has the research capacity to take a leadership role in the effort to improve global healthand to have a positive impact on the lives of billions of people worldwide. Functions of global nursing: The possibilities are endless for nurses in global health. They range from providing an educational role to doing research in a focused way. The common thread among nurses is that nurses bring a patient-centered focus to the global health team. How travel affects global health: International travel has been identified as one of the major factors associated with the global spread of infectious diseases. Millennium Developmental Goals : The UN adopted the Millennium Declaration, which recognized that all governments not only have a responsibility to their own citizens, but also a collective responsibility to

uphold the principals of human dignity, equality and equity for all the worlds people. The UN Millennium Developmental Goals were developed to coordinate and strengthen unprecedented global efforts to meet the needs of the worlds poorest people pg 396. Box 17-6: United Nations Millennium Developmental Goals: pg 397 1. 2. 3. 4. 5. 6. 7. 8. Eradicate extreme hunger and poverty Achieve universal primary education Promote gender equality and empower woman Reduce child mortality Improve maternal health Combat HIV/AIDS malaria, and other infectious diseases Ensure environmental sustainability Develop a global partnership for development

Ch. 24 (11 questions) Types of Disasters: Emergency: any hurricane, tornado storm, flood, high water, wind-driven water, tidal wavem earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, fire explosion or other catastrophe in any part of the US that required federal emergency assistance to supplement state and local efforts in order to save lives. Pg 576 Major disaster: Any events listed in emergency in any part of the US, in determination by the US president causes damages of sufficient severity above and beyond emergency services by the federal government to supplement efforts and available relief organization in alleviating the damage loss hardship, or suffering caused Reactions of a disaster both physical and emotional: Box 24-5 pg 582 Health Effects of Disasters

Physical: Sleep disturbances, poor concentration, back pain, tachycardia, poor diet Psychological: Loss of self and relationships, emotional pain, brooding, aggressive thoughts, depression Sociocultural: loss of intimacy, loss of sense of belonging to once-claimed culture

Disaster management plan: 1. Local government agencies, such as the mayor and civil defense must respond 2. If the local government becomes overwhelmed, the state responds at the governor request through states agencies and the national guard 3. Local, state, federal and volunteer organizations make an assessment of damage 4. When state resources have been exhausted the governor of the state make a request to the president for a declaration of a major disaster. 5. FEMA evaluated the request and recommends action to the White House 6. The president gives the executive order for the declaration or FEMA informs the governor that the request has been denied

Stages of disaster planning: pg 583 Disasters can be divided into five chronological stages that require specific levels of prevention and levels of response at various points during each stage. Pg 583 7. Nondisaster, or interdisaster stage: Planning and preparation for a disaster include the two critical elements of disaster preparedness. 1) Disaster training, and educational programs for the community and 2) the development of a disaster plan for all involved in the mitigation of a potential disaster. Included in this stage are primary prevention: Such as assessment of hazards and risks, vulnerability analysis, inventory of existing resources for coping with disaster 8. Predisaster, or warning stage: The disaster plan when available is implemented, which included early warnings based on predictions of impending disasters and mobilization as well as implementation of protective measures. Primary prevention is the focus and is attained by the emergency personnel providing information, advisories, and warnings issues. Mobilization can occur in the form of evacuation to shelters 9. Impact stage: Involves holding on and enduring the impact of the disaster [Link] stage: the community assesses the consequences of the disaster impact. This stage begins during the actual impact and continues until the immediate threat of additional hazards have passed [Link] or rehabilitation stage: Begins when communities start the healing process When does disaster management begin : Disaster planning should begin before the disaster event preferably the non-disaster stage pg 583 Nursing interventions: Disaster health care is very different from daily nursing practice; it is not routine and the philosophy of care is based on providing the greatest good for the greatest number. Pg 587 Community health nurses are integral in planning for and responding to disasters. Nurse should be disaster prepared and disaster aware, maintain own emergency equipment and skills, be certain that your family knows what to do in the event of an emergency, provide education. Become trained and certified in professional disaster nursing by the local American Red Cross chapter pg 597. Primary prevention: Aimed at reducing the probability of disease, death, and disability resulting from a disaster pg 576 Purpose of disaster planning: A planned response to disasters must occur to lessen the terror of a disaster, to cushion the impact by providing care for the greatest number of potential survivors and to increase societys ability to survive disasters and grow more self-sufficient and self-reliant in the process. pg 586 The purpose of disaster planning is to reduce a communitys vulnerability to the tremendous consequences of disasters and to prevent or minimize problems resulting from system damage associated with the disasters pg 587 Greatest burden of disasters: the inability to evacuate vulnerable populations pg 593 Also the search and rescue missions are the most challenging pg 595 (????) s/s of bioterrorism attack (?????) Not in chapter but if you can find it let me know states of disaster planning (????) I think I addressed this earlier

characteristics of disaster plans: pg 588 1. The disaster plan is based on realistic assessment of potential problems that could happen, such as destruction to property, material, and utilities; impairment of communication 2. Estimates of types of injuries that would result from the disasters most likely to occur in the area 3. The plan is brief, concise and inclusive of all who can provide disaster aid 4. The plan is organized by a timeline; it details the stages of disasters, who must be involved, what should occur, and how each stage should unfold 5. The plan is approved by all agencies that provide authority endorsement 6. The plan is regularly tested through mock drills 7. The plan is always considered a work in progress Common Elements of a Disaster Plan Box 24-8 pg 589 natural disasters: Box 24-2 pg 576 HP 2010 (????) Not in chapter Philosophy of care during a disaster: Disaster health care is very different from daily nursing practice; it is not routine and the philosophy of care is based on providing the greatest good for the greatest number. Pg 587 Community health nurses are integral in planning for and responding to disasters. Disaster triage allows healthcare personnel to identify the most salvageable patients so that treatment can be initiated immediately. Colored tags with symbols are attached to disaster victims so healthcare personnel can readily see level of triage. Pg 595