Nurs 322 Quiz 4

Front 1

What does vulnerability mean?

What does it result from?

Back 1

Susceptibility to actual or potential stressors that may lead to an adverse effect

Results from the interaction of internal and external factors that cause a person to be susceptible to poor health

Front 2

What are vulnerable populations?

Back 2

Those groups with increased risk for adverse health outcomes that are more likely than the general population to suffer from health disparities

Front 3

What does the term risk mean?

Back 3

Is an epidemiologic term that means some people have a higher probability than others

Front 4

What are healthy disparities?

Back 4

The wide variations in health services and health status among certain population groups

Front 5

Why are vulnerable populations more sensitive to risk factors?

Back 5

Because they are often exposed to cumulative risk factors

Front 6

Vulnerability results from the combined effects of:

Back 6

physical, environmental, personal resources, and biopsychosocial resources

Front 7

What race/ethnic groups and residence have the highest rates of poverty?

Back 7

Nonmetro greater than metro

Blacks highest rates, then Hispanics

Front 8

What are the vulnerable population groups of special concern to nurses?

Back 8

Poor and homeless persons, pregnant adolescents, migrant workers and immigrants, severely mentally ill individuals, substance abusers, abused individuals and victims of violence, persons with communicable disease and those at risk, persons who are human immunideficiency virus positive, have hepatitis B virus, or have an STI

Front 9

Cost of health disparities

Back 9

30% of direct medical costs for Blacks, Hispanics, and Asian Americans are excess costs due to health inequities

Economy loses an estimated $309 billion per year due to the direct and indirect costs of disparities

Front 10

What are social determinants of health?

Back 10

Factors such as economic status, education, environmental factors, nutrition, stress, prejudice, and age that lead to resource constraints, poor health, and health risk.

Front 11

Outcomes of vulnerability

Back 11

Can be negative (such as lower health status) or positive (with effective interventions)

Front 12

What is the cycle to vulnerability?

Back 12

Sometimes when one problem is solved, another quickly emerges, leads to feelings of hopelessness

Front 13

How did the social security act of 1935 affect vulnerable populations?

Back 13

Created largest federal support program for elderly and poor Americans

Front 14

How did the social security act amendments of 1965, medicare, and medicaid affect vulnerable populations?

Back 14

Provided for health care needs of elderly, poor, and disabled people

Front 15

How did Title XXI of the social security act of 1997 affect vulnerable populations?

Back 15

Provided for the State Children's Health Insurance Program (SCHIP) to provide funds to uninsured children

Front 16

How did Health insurance portability and accountability act of 1996 affect vulnerable populations?

Back 16

Intended to help people keep their health insurance when moving from one place to another

Front 17

How did the balanced budget act of 1995 affect vulnerable populations?

Back 17

Influenced the use of resources for providing health services

Front 18

How did the patient protection and affordable care act of 2010 affect vulnerable populations?

Back 18

Has provisions for reducing the growth of future Medicaid expenditures

Front 19

What is Human Health Services (HHS) Disparities Action Plan?

Back 19

Builds on existing HHS initiatives (such as HP) to reduce health disparities (racial and ethnic)

Front 20

How does the Affordable Care Act impact health and health care disparities?

Back 20

•TheAffordable Care Act (ACA) advances efforts to reduce disparities and to improvehealth and health care for vulnerable populations.•TheACA health coverage expansions will significantly increase coverage options forlow- and moderate-income populations and particularly benefit vulnerablepopulations. -TheACA also includes provisions to strengthen the safety-net delivery system,improve access to providers, promote greater workforce diversity and increasecultural competence, strengthen data collection and research efforts, andimplement an array of prevention and public health initiatives

Front 21

Life expectancy disparities in vulnerable populations?

Back 21

•Whilethe average life expectancy has increased since 1970, these gains have not beenevenly distributed. Infant mortality rates are significantly higher for Blackand American Indian and Alaska Native babies compared to other groups. Blackmales of all ages have the shortest life expectancy compared to all othergroups.

Front 22

Disparities in self-reported health status in men ages 18 to 64?

Back 22

Nationally just one in ten (11%) men 18-64 rated their health as fair or poor, but Hispanic 22.3%, AI/AN men 18.8%, black men 13.3%, white men 8.5%, asian men 8.3%

Front 23

Health disparities in diabetes

Back 23

•Diabetesis a growing health burden on men in the U.S. On average 4.2% of men ages 18 to64 reported having been diagnosed with diabetes, but this range was also large,topping out at 10.1% of AI/AN men in Oklahoma and 9.0% of black men in Michiganto 1.7% of white men in DC and 1.8% in Hawaii.

Front 24

Health disparities in cardiovascular disease

Back 24

•Amongmen 18 to 64 years, the prevalence rate of cardiovascular disease was 3.5%nationwide , and ranged from 11.7% of Hispanic men in Louisiana and 11.6% ofAI/AN men in Wisconsin to 1.3% of white men in DC and 1.5% of black men inRhode Island

Front 25

Health disparities in obesity

Back 25

•Nationally,one in four men ages 18 to 64 (25.2%) were obese (Body Mass Index (BMI) of 30or higher). This ranged from highs of 50.1% of AI/AN men in North Dakota and44.0% of Black men in Kansas to lows of 3.4% of Asian/NHPI men in Massachusettsand 5.0% in New York

Front 26

Health disparities in smoking

Back 26

•Onein four men ages 18 to 64 was a current smoker in 2006 . Among men, the highestsmoking rate was among AI/AN (43.2%). The range on this indicator was quitelarge, with the highest rates among of AI/AN men in Wyoming (60.2%) andWisconsin 57.2%) and the lowest rates among Asian/NHPI men in Maryland(8.3%)and white men in Utah(11.9%)

Front 27

Health disparities in education

Back 27

•Education:Among racial and ethnic groups, the Asian or Pacific Islander, non-Hispanicpopulation had the highest (best) rate of on-time high school graduation, 91.8%for the 2008–2009 school year. •Ratesfor other subgroups were: White, non-Hispanic: 82.0%, American Indian or AlaskaNative, non-Hispanic: 64.8%, Hispanic 65.9%, Black, non-Hispanic: 63.5%

Front 28

Health disparities in cancer?

Back 28

Cancer:Black women have the highest breast cancer death rates of all racial and ethnicgroups and are 40% more likely to die of breast cancer than white women.

Front 29

What factors contribute to the health disparity of black women having highest rates of breast cancer death?

Back 29

Blackwomen often have cancers that grow faster and are harder to treat.Blackwomen often have fewersocial and economic resources thanother women.Blackwomen are less likely to get prompt follow-up care when their mammogram showssomething that is not normal.Blackwomen are less likely to get high-quality treatment if they have cancer.

Front 30

What type of care is proposed to help vulnerable populations?

Back 30

Trend towards providing more comprehensive, family-centered services when treating vulnerable population groups; family-centered "one-stop" services

-Wrap-around services and comprehensive services

Front 31

What are wrap-around services?

Back 31

available comprehensive health services,and social and economic services also provided, either directly or throughreferrals; in this way, social and economic services that will help ensureeffectiveness of health services are “wrapped around” health services

Front 32

What are comprehensive services?

Back 32

are health services that focus on morethan one health problem or concern

Front 33

Health People 2020 connection to health disparities

Back 33

The objectives emphasize improving health by modifying individual, social, and environmental determinants of health

Front 34

Interventions for planning and implementing care for vulnerable populations

Back 34

•Createa trusting environment.•Showrespect, compassion, and concern.•Donot make assumptions.•Coordinateservices and providers.•Advocatefor accessible health care services.•Focuson prevention.•Knowwhen to “walk beside” the client and when to encourage the client to “walkahead.”•Knowwhat resources are available.•Developyour own support network.

Front 35

The federal government defines poverty on the basis of:

Back 35

income, family size, age of the head of household, and number of children younger than 18 years

Front 36

What is persistent poverty?

Back 36

Refers to individuals and families who remain poor for long periods and who pass poverty onto their descendents

Front 37

What is neighborhood poverty?

Back 37

Refers to geographically defined areas of high poverty, characterized by dilapidated housing and high levels of unemployment

Front 38

Factors affecting the growing number of poor persons:

Back 38

•Decreasedearnings•Increasedunemployment rates•Changesin the labor force•Increasein female-headed households•Inadequateeducation and job skills•Inadequateantipoverty programs and welfare benefits•Weakenforcement of child support statutes•DwindlingSocial Security payments to children•Increasednumbers of children born to single women

Front 39

Effects of poverty on health across the lifespan

Back 39

•Higherrates of chronic illness•Higherinfant morbidity and mortality•Shorterlife expectancy•Morecomplex health problems•Moresignificant complications and physical limitations resulting from chronicdisease•Hospitalizationrates three times more than for persons with higher incomes

Front 40

Who does poverty have an especially negative effect on?

Back 40

Women of childbearing age, adolescent women, children, older adults, both urban and rural communities

Front 41

Two common ways to determine the number of people who are homeless:

Back 41

1) Point-in-time-counts counting thenumber of persons who are homeless on a given day or during a given week or2) period prevalence counts, whichexamines the number of people who are homeless over a given period of time

Front 42

What are the effects of homelessness on health?

Back 42

•Hypothermiaand heat-related illnesses•Infestationsand poor skin integrity•Peripheralvascular disease and hypertension•Diabetesand nutritional deficits•Respiratoryinfection and chronic obstructive pulmonary diseases•Tuberculosis(TB)•HIV/AIDS•Trauma•Mentalillness •Useand abuse of tobacco, alcohol, and illicit drugs

Front 43

What is deinstitutionalization?

Back 43

Involved moving many people from state psychiatric hospitals to communities with the goal of improving the quality of life for those persons; however, the community based services were often not in place and continuity of care became a problem

Front 44

Who are the most at-risk poulations for mental illness? Why?

Back 44

Low income and minority groups are often at increased risk for mental illness because they lack access to services

Front 45

Primary prevention for poverty and homelessness

Back 45

•affordablehousing, housing subsidies, effective job-training programs, employerincentives, preventive health care services, multisystem case management, birthcontrol services, safe-sex education, needle-exchange programs, parenteducation, and counseling programs

Front 46

Secondary prevention for poverty and homelessness

Back 46

•aimedat reducing the prevalence of pathologic nature of a condition (i.e.,supportive and emergency housing, soup kitchens, screening for depression)

Front 47

Tertiary prevention for poverty and homelessness

Back 47

•attemptsto restore and enhance functioning (i.e., support of affordable housing,promotion of psychosocial rehabilitation programs)

Front 48

How does US compare in terms of poverty rates?

Back 48

US has some of the highest relative poverty rates among industrialized countries, reflecting the high inequality of incomes

Front 49

What is poverty?

Back 49

The condition of lacking basic human needs such as nutrition, clean water, health care, clothing, and shelter because of the inability to afford them.

Also known as absolute poverty or destitution

Front 50

What is relative poverty?

Back 50

The condition of having fewer resources or less income than others within a society or country

Front 51

How have poverty levels in the US changed over time?

Back 51

Cyclical in nature: 13-17% live below poverty line at any given point in time; 40% falling below poverty line at some point within a 10 year time span; 58.5% will spend at least one year below the poverty line at some point between ages 25 and 75

Front 52

How is poverty measure set?

Back 52

Current measure established in 1960; based on research indicating that families spend about 1/3 of their incomes on food so official poverty line was set by multiplying food costs by three; since then, the figures have been updated annually for inflation but have otherwise remained unchanged

Front 53

food now comprises what percentage of average family expenses?

Back 53

one-seventh

Front 54

How has family expenditures changed in past years?

Back 54

Food decreased from 1/3 of spending to 1/7 of spending, while costs of housing, child care, health care, and transportation have grown disproportionately

Front 55

The poverty measures includes incomes sources including:

Back 55

earnings, interest, dividends, Social Security, and cash assistance (income is counted before subtracting payroll, income, and other taxes, overstating income for some families)

Front 56

Issue with poverty measure and geographical location

Back 56

Current poverty measure is a national standard that does not adjust for the substantial variation in the cost of living from state to state and between urban and rural areas

Front 57

What does the term low socioeconomic status mean?

Back 57

Social and economic deprivation including poor income, no accumulated assets, no access to power, poor education, low occupation

Front 58

What does indigent mean?

Back 58

People who are impoverished and deprived of basic comforts

Front 59

How have poverty rates changed between 2000 and 2012?

Back 59

Increased from 12.2% to 15.9%

Front 60

What are shared households?

Back 60

Defined as households that includes at least one "additional" adult: a person 18 or older who is not enrolled in school and is not the householder, spouse or cohabiting partner of the householder

Front 61

2013 HHS Poverty Guidelines

Back 61

Front 62

Unemployment's impact on uninsured and Medicaid?

Back 62

A 1% rise in the nation's unemployment rate is projected to increase the number of uninsured by 1.1 million and result in an additional 1 million enrolling in Medicaid

Front 63

What is a culture of poverty?

Back 63

Forms when families are struggling to meet basic needs, people begin to develop ingrained beliefs that limit their chances for future success: may include considering crime as an acceptable alternative to traditional employment or not believing children should strive for good grades in school.

Front 64

Who are the marginalized?

Back 64

Live on the edges of society rather in mainstream society

Front 65

What is disenfranchisement?

Back 65

Feeling of not having full privileges and rights as citizens

Front 66

Who are the politically invisible?

Back 66

Do not vote and do not own property

Front 67

Who are the invisible poor?

Back 67

-Marginalized: including the disenfranchised and politically invisible

-Low social status, little social support

Front 68

Health effects of poverty

Back 68

-Increase morbidity and mortality: lack of education, low occupational status, jobs with high demands and low control, social isolation, poor nutrition, poor housing

-Reduced access to health care

Front 69

Differences in education in children in poverty? Why?

Back 69

Once they reach elementary school, children who live in poverty often receive a substandard education

Forced to move frequently, attend under-funded schools

Front 70

What % of low-income families work?

Back 70

72%

Front 71

What is the definition of homelessness based on Stewart B. McKinney Act?

Back 71

Lack regular and adequate night time residence and has a primary night time residence that is:

-A supervised publicly or privately operated shelter designed to provide temporary living accommodation

-An institution that provides a temporary residence for individuals intended to be institutionalized

-A public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings

Front 72

Limitations of homelessness definition

Back 72

Difficult to assess homelessness in rural areas where there might not be any shelters (more likely to live with relatives in overcrowded, substandard housing)

Front 73

How is homelessness best measured?

Back 73

More appropriate to measure the number of people who experience homelessness over time, not the number of homeless people; because homelessness is usually a temporary circumstance, not a permanent condition

Front 74

Homelessness and (blank) are inextricably linked

Back 74

Poverty

Front 75

How are poverty and homelessness linked?

Back 75

–Poorpeople are frequently unable to pay for housing, food, childcare, health care,and education. –Difficultchoices must be made when limited resources cover only some of thesenecessities. –Oftenit is housing, which absorbs a high proportion of income that must be dropped. –Beingpoor means being an illness, an accident, or a paycheck away from living on thestreets

Front 76

Who are the hidden homeless?

Back 76

Many people cannot be counted in statistics for homelessness because the researchers cannot find them (many live in automobiles or in makeshift housing)

Front 77

Surveys in past years have yielded the percentage of homeless workers to be as high as:

Back 77

26%

Front 78

Why are people homeless?

Back 78

Poverty, housing, lack of affordable healthcare, domestic violence, mental illness, addiction disorders

Front 79

How did income opportunities change with legislation?

Back 79

Welfare to work reform (1996) replaced AFDC (federal program) with TANF, a block grant program

Front 80

How do foreclosures correlate with homelessness?

Back 80

Foreclosures have increased the number of people who experience homelessness; 32% jump in number of foreclosures between April 2008-April 2009

Front 81

Risk factors of homelessness

Back 81

Prolonged unemployment, sudden loss of a job, lack of affordable housing, domestic violence

Front 82

Age differences in homelessness

Back 82

39% under age 18, 25% adults 25-34, 6% 55-64

Front 83

Gender differences in homelessness?

Back 83

Single homeless adults more likely to be male than female

Front 84

Who are the fastest growing homeless population?

Back 84

Families with children

Front 85

Who accounts for half of all homeless families?

Back 85

Victims of domestic violence

Front 86

What % of homeless men have served in armed forces?

Back 86

40%

Front 87

What % of people in shelters are believed to mentally ill?

Back 87

26%

Front 88

Common homeless demographics

Back 88

Veterans, mentally ill, addiction disorders, unemployed, domestic violence victims

Front 89

Why were 32% of requests for shelters by homeless families denied in 1998?

Back 89

Due to lack if resources

Front 90

50% of cities surveyed by the US conference of mayors identified (blank) as a primary cause of homelessness?

Back 90

Domestic violence

Front 91

Half of all women and children experiencing homelessness are in the situation became of :

Back 91

domestic violence

Front 92

Relationship between homelessness and healthcare

Back 92

People who are homeless are overwhelming uninsured and often lack access to basic health care services for their complex health needs

Front 93

How has welfare reform impacted homelessness?

Back 93

Welfare reform has greatly impacted homelessness: many have lost their insurance when they lost Medicaid (in 1997 675,000 lost health insurance as a result of welfare reform)

Front 94

Definition of homeless youth

Back 94

Individuals under the age of 18 who lack parental, foster, or institutional care

Front 95

Unaccompanied youth account for what % of the urban homeless population?

Back 95

3%

Front 96

Common causes of homeless youth

Back 96

Family problems, economic problems, residential instability

Front 97

Why is residential instability a cause of homeless youth?

Back 97

A history of foster care has been correlated with becoming homeless at an earlier age and remaining homeless for longer periods of time

Front 98

Health differences in homeless children?

Back 98

61% of 2 year old homeless children in NYC had not received proper immunizations compared to 23% of all NYC 2 year olds

Incidence of asthma 4x higher in NYC homeless children

Homeless children suffer from middle ear infections at a rate 50% greater than the national average

Front 99

Causes of homeless families

Back 99

Poverty, lack of affordable housing, domestic violence

Front 100

Which homeless population suffers highest rates of depressive disorders?

Back 100

Female homeless parents

Front 101

Correlation between suicide and homelessness

Back 101

1/3 of homeless mothers had attempted at least one suicide attempt

Front 102

Primary prevention strategies for homelessness

Back 102

Emergency financial assistance, legal assistance, financial advisement, relocation programs

Front 103

Secondary prevention strategies for homelessness

Back 103

Address health care needs first; assess and evaluate community resources (increase availability of shelters)

Front 104

Common health problems of homeless

Back 104

Peripheral vascular disease, hypertension, TB, HIV, major trauma, minor trauma, mental health

Front 105

Why is peripheral vascular disease common in homeless?

Back 105

On feet for extended periods of tie. Cold hands and feet. Compromise peripheral circulation. Diabetes, neuropathy, loss of sensation.

Front 106

Why is hypertension common in the homeless?

Back 106

Alcohol use, high sodium content fast food, and shelters

Front 107

Health care for homeless often has what type of orientation?

Back 107

Crisis oriented: treated in emergency room

Front 108

Why is health care for the homeless typically crisis oriented?

Back 108

Emergency room for treatment

Difficulty following medical regimes: diabetic obtaining supplies, nutrition; child with scabies and lice, peripheral vascular disease, elevate legs when on street

Front 109

Tertiary prevention for homelessness

Back 109

Housing assistance, stabilize households in crisis, and help them connect with longer-term sources of support, programs that promote self-sufficiency, longer term subsidies and supports

Front 110

Main healthcare concerns for rural communities

Back 110

Scarcity of health professionals, poverty, limited access to services, lack of knowledge, and social isolation have plagued many rural communities for generations

Front 111

How did formal rural nursing begin?

Back 111

Began with the Red Cross Rural Nursing Service, which was organized in November 1912.

Front 112

What is defined as rural?

Back 112

Communities having fewer than 20,00 residents or fewer than 99 persons per square mile (farm residency)

Front 113

What is defined as urban?

Back 113

Geographical areas described as non-rural and having a higher population density; more than 99 persons per square mile; cities with a population of at least 20,000 but fewer than 50,000 (Non-farm residence)

Front 114

What is the rural-urban continuum?

Back 114

Residence ranging from living on a remote farm to a village or small town, to a large town or city, to a large metropolitan area with a "core inner city"

Front 115

What is defined as a metropolitan area?

Back 115

Contains a core urban area of 50,000 or more population. Consists of one or more counties containing the core urban area

Front 116

What is a micropolitan area?

Back 116

Contains an urban core of at least 10,000 (but less than 50,000) population. Consists of one or more counties containing the core urban area.

Front 117

What are the fastest-growing rural counties?

Back 117

Located in rural regions of the nation and along the edges of larger metropolitan counties--> referred to as the doughnut effect: people moving away from highly populated areas to outlying suburbs of urban centers

Front 118

Population and cultural considerations for rural populations?

Back 118

Higher proportion of whites, higher than average number of younger (age 6-17 years) and older (older than 65) residents, persons 18 and older more likely to be or to have been married, more likely to be widowed, adults in rural areas tend to have fewer years of formal schooling than urban adults, tend to be poorer, higher risk for being underinsured or uninsured

Front 119

Differences in health status of rural residents

Back 119

-Poorer perception of their overall health and functional status

-Less likely to engage in preventive behavior

-More likely to have one or more of the following chronic conditions: heart disease, COPD, HTN, arthritis, DM, cardiovascualr disease, and cancer

-Tend to have poorer health and less likely to seek medical care

-Traveling time and or distance to ambulatory care services affects access to care

Front 120

How do health providers in rural areas differ?

Back 120

Live and practice in a particular community for decades, may provide care to people who live in several counties, small staff to service large area

Front 121

Differences in women's health in rural areas

Back 121

Higher infant and maternal morbidity rates, high proportion of racial minorities and fewer specialists, extreme variations in pregnancy outcome

Front 122

What rural women are at particular health risks?

Back 122

Live on or near Indian reservations, are migrant workers, are of African-American descent and live in rural counties of states in the deep south, are victims of sexual assault

Front 123

Why do overall rural populations have higher infant and maternal morbidity rates?

Back 123

High proportion of racial minorities and fewer specialists, such as peds, OBs, and GYNs to care for at-risk populaitons

Front 124

Differences in health of children in rural areas

Back 124

Rural adults and children more likely to have general practitioner as regular caregiver (not pediatrician), more children working on farms, school nurses

Front 125

Mental health differences in rural communities

Back 125

Delay seeking care, depression because of high rate of poverty, geographic isolation, and insufficient number of mental health services; domestic violence; alcohol, tobacco, and other drug use and abuse

Front 126

Occupational and environmental health problems in rural area

Back 126

-High-risk industries found primarily in rural areas: forestry, mining, fishing, agriculture

-Lack of OSHA for farming and ranching

-Common injuries

-Exposure to chemicals, pesticide exposure

Front 127

Most common unintentional injuries in farming

Back 127

Being run over from tractor falls and trailing equipment

Front 128

Barriers to care in rural health care

Back 128

Availability, affordability, accessibility, acceptability of services and professionals

Front 129

Issues in migrant health

Back 129

Lack of knowledge about services, inability to afford care, availability of services, transportation, hours of service, mobility and tracking, language barriers, discrimination, documentation, cultural aspects, children of migrant workers, dental disease, incidence of TB, incidence of HIV/AIDS, depression, anxiety-related disorders, domestic violence, children of migrant workers

Front 130

Prevailing need in most rural areas especially for what areas?

Back 130

School nurses, family planning services, prenatal care, care for individuals with AIDS and their families, emergency care services, children with special needs, mental health services, services for older adults

Front 131

Purposes of case management and community health primary health care (COPHC)?

Back 131

Define and characterize the community, identify the community's health problems, develop or modify health care services in response to the community's identified needs, monitor and evaluate program process and client outcomes

Front 132

Relationship between technology use and rural communities

Back 132

Great potential for connecting rural providers and consumers with resources outside their community: text messages, telehealth, telephone, video conferencing

Front 133

Rural may be defined by:

Back 133

•Geographiclocation and population density•Distancefrom or time needed to commute to an urban center•Maylink with farm residency•Notypical rural town

Front 134

More common disease in rural people than urban residents

Back 134

Arthritis, heart disease, diabetes, HTN, and mental disorders

Front 135

General population characteristics of rural adults

Back 135

Less educated, poorer, lack insurance or underinsured, cannot afford insurance (self employed in family business, seasonal occupations, preexisting health condition)

Front 136

Income differences in rural communities

Back 136

Per capita income is $7417 lower than in urban areas, and rural Americans are more likely to live below the poverty level

Disparity in incomes is even greater for minorities living in rural areas

Front 137

What % of rural children live in poverty?

Back 137

24%

Front 138

Differences in rural economics

Back 138

Employment is tied regionally to one major industry: if that industry becomes depressed, effects the entire region

Front 139

Most high-poverty counties are:

Back 139

Rural, mostly in South and Southwest

Front 140

How do rural children differ economically from urban children?

Back 140

22.4% rural children participate in National School Lunch Program versus 17.1% national

18.3% rural had children in National School Breakfast Program versus 13.2%

9.4% rural had children participating in WIC program versus 6.8% nationally

Front 141

Differences in supplemental nutritional assistance program (SNAP) enrollment in rural communities

Back 141

Rural Americans are more likely than other Americans to participate in SNAP

Front 142

What is the uninsurance risk with living rurally?

Back 142

Famileis with 2 full time workers, married couples, and the employed are also at greater risk of being uninsured if they live in a remote rural county

Front 143

What % rural uninsured come from families with at least one full-time worker?

Back 143

68%

Front 144

What % rural resident rely on the individual insurance market?

Back 144

10%

Front 145

Dental insurance differences in rural communities

Back 145

35% rural lack dental coverage compared to 29% urban residents

Front 146

Differences in privately insured rural

Back 146

Rural privately insured 50% more likely to lack drug coverage

Front 147

Total annual healthcare expenses differences in rural area

Back 147

Total annual HC expenses per person for rural residents are 18% greater than urban areas; rural households spend 20% of their income on health care expenses compared to 13% for urban households

Front 148

Population changes in rural communities

Back 148

-Net loss of populations in rural areas

-Widespread job losses in rural manufacturing

Front 149

What is result of net loss of populations in rural areas?

Back 149

Reduces the demand for jobs, diminishes the quality of the workforce, raises the capita costs of providing services,

Front 150

What are causes of widespread job losses in rural manufacturing?

Back 150

Recession, increased global, competition, technological

Front 151

What is cause of net loss of populations in rural areas?

Back 151

Out migration of younger family members often to seek employment in more urban settings

Front 152

Key concepts in rural nursing

Back 152

Work bleif and health, insider/outsider and oldtimer/newcomer, distance, isolation, hardiness, self-reliance, familiarity, informal networks

Front 153

How is health defined in rural communities?

Back 153

Defined in terms of the ability to do work

Front 154

Expectations of healthcare in rural communities?

Back 154

Treatment that will allow the client to return to work as soon as possible

Front 155

Orientation to health care in rural communities

Back 155

Present-time oriented, crisis-oriented

Front 156

What is the issue of distance in rural health?

Back 156

Distance is a barrier that mightinfluence the likelihood of deferring health care until one is very illRecovery time and optimal rehabilitationare compromised by inadequate and untimely treatmentDecreased communication or interactionwith other personsMay lead to personal isolation orprofessional isolation

Front 157

Hardiness is defined as:

What are the elements?

Back 157

(1) capable of enduring fatigue, hardship, or exposure and (2) requiring great physical courage, vigor, or endurance

Control, commitment, challenge

Front 158

Benefit of hardiness

Back 158

Constellation of personality characteristics that function as a resistance resource during stressful life events

Front 159

What is self-reliance?

Back 159

The capacity to provide for one's own needs

-makes decisions independently

-is own source of emotional strength

-manages life tasks

-believes in self and capabilities

Front 160

What is familiarity? Aspects in rural town?

Back 160

In-depth interpersonal knowledge

-Can be both positive and negative: positive---know a family well and can give good care; negative--no privacy in a rural town, may impede health seeking behaviors

Front 161

What are informal networks?

Back 161

Natural interpersonal linkages: a series of channels through which people request support and make demands

Front 162

Definition of insider

Role of insider in community health

Back 162

Accepted by the community, has access to information

In community health it is important to involve the insiders to have a successful program

Front 163

Outcomes related to health care in rural areas

Back 163

Low population, isolation, distance--> under service, lack of resources, difficulty recruiting health professionals

Front 164

Insider v. outsider

Back 164

Insider: member of group, has access to privileged information, an awareness of implicit assumptions and social context, a long-time resident

Outsider: differentness, unfamiliarity, unconnectedness

Front 165

Oldtimer v. newcomber

Back 165

Oldtimer: age, length of time in community, establishment of relationships within the community

Newcomer: newly arrived, unaware of history in area/institution, existence/presence may result in change

Front 166

What is an oldtimer/insider?

Back 166

Person who are community influentials with whom nurses need to work to make changes in the community

Front 167

What is an oldtimer/outsider?

Back 167

Hermit, seasonal resident, return to community (oldtimer) after education (outsider)

Front 168

What is a newtimer/insider?

Back 168

A wife (newcomer) marries husabnd (insider), member of oldtime family

Grandchild of oldtimer family raised somewhere else comes to the community

Front 169

Unique rural health needs

Back 169

•HealthProfessionals scarce•Fewerhealth care services available in rural areas•Poverty•Limitedaccess to medical specialty services•Lackof knowledge•Socialisolation•Maylack high speed internet•Cellphone service may be patchy•Migrantworkers

Front 170

Health problems and behaviors of rural resident

Back 170

-Higher infant and maternal morbidity rates

-Higher rates chronic illness: heart disease, COPD, HTN, cancer, DM

-Unique health risks associated with occupations and environment: machinery accidents, skin cancer, respiratory problems from exposure to chemicals and pesticides

-Stress related health problems and mental illness: unintentional motor vehicle traffic related injuries, suicide

Front 171

Differences in treatments for acute myocardial infarction (AMI) for rural individuals

Back 171

Medicare patients with acute myocardialinfarction (AMI) who were treated in rural hospitals were less likely thanthose treated in urban hospitals to receive recommended treatments and hadhigher adjusted 30-day post AMI death rates from all causes than those in urbanhospitals

Front 172

Cerebrovascular disease differences in rural areas

Back 172

Cerebrovascular disease was reportedly1.45 higher in non-Metropolitan Statistical Areas (MSAs) than in MSAs.

Front 173

Hypertension differences in rural areas

Back 173

Hypertension is higher in rural thanurban areas (101.3 per 1,000 individuals in MSAs and 128.8 per 1,000individuals in non-MSAs.)a

Front 174

Suicide differences for men in rural communities

Women in rural?

Back 174

Suicide rate among rural men signficiantly higher than in urban areas

Suicide rate among rural women is escalating rapidly and is approaching that of men

Front 175

Substance abuse issues in rural youth

Back 175

-Abuse of alcohol and use of smokeless tobacco significant problem among rural youth

-Rural 8th graders 2x likely to smoke cigarettes

-Rate of DUI arrests significantly greater in non-urban counties

-40% rural 12th graders reported using alcohol while driving compared to 25% of their urban counterparts

Front 176

Differences in unintentional injuries in rural population

Back 176

•Althoughonly one-third of all motor vehicle accidents occur in rural areas, two-thirdsof the deaths attributed to these accidents occur on rural roads.•Ruralresidents are nearly twice as likely to die from unintentional injuries otherthan motor vehicle accidents than are urban residents. Rural residents are alsoat a significantly higher risk of death by gunshot than urban residents.

Front 177

Emergency response differences in rural areas

Back 177

•Nationalaverage response times from motor vehicle accident to EMS arrival in ruralareas was 18 minutes, or eight minutes greater than in urban areas.•Anywherefrom 57 to 90 percent of first responders in rural areas are volunteers

Front 178

What % of physicians practice in rural America? How does this compare to % population in rural areas?

Back 178

Only about ten percent of physicianspractice in rural America despite the fact that nearly one-fourth of thepopulation lives in these areas.

Front 179

Differences in health professional shortage areas (HPSAs) in rural areas

Back 179

2157 HPSAs in rural compared to 910 in urban

Front 180

What is the Medicare Rural Hospital Flexibility Program (Flex Program, 1997)?

Back 180

•The CriticalAccess Hospital Program was created by the 1997 federal Balanced Budget Act asa safety net device to assure Medicare beneficiaries access to health careservices in rural areas. •It wasdesigned to allow more flexible staffing options relative to community need,simplify billing methods and create incentives to develop local integratedhealth delivery systems, including acute, primary, emergency and long-termcare.•The reimbursementthat CAHsreceive is intended to improve their financial performance and thereby reducehospital closures.

Front 181

What is a critical access hospital? What are some of the requirements?

Back 181

•ahospital certified under a set of Medicare Conditions of Participation •Someof the requirements for CAH certification include –havingno more than 25 inpatient beds; –maintainingan annual average length of stay of no more than 96 hours for acute inpatientcare; –offering24-hour, 7-day-a-week emergency care; –andbeing located in a rural area, at least 35 miles drive away from any otherhospital or CAH (fewer in some circumstances).

Front 182

What does critical access hospital certifications allow for?

Back 182

•toreceive cost-based reimbursement from Medicare, instead of standard fixedreimbursement rates. –Thisreimbursement has been shown to enhance the financial performance of smallrural hospitals that were losing money prior to CAH conversion and thus reducehospital closures.

Front 183

As many as what % of rural counties are classified as medically underserved areas?

Back 183

80%

Front 184

Why is there are health care provider and workforce shortage?

Back 184

Current providers are aging, providers cannot stay in business due to cost of running the medical service, lack of providers may lead to lack or poor preventive care leading to poorer health outcomes and more costly care in the long run

Front 185

Impact of ACA on rural hospitals

Back 185

•TheACA appropriates $9.5 billion to a new Community Health Centers Fund to expandthe operational capacity of health center and clinics across the nations–Thisallow 20 million new patients to receive services •$1.5billion over 5 years for construction and expansion needs•Increasedfunding to Federally Qualified Health Clinics•Allowsrural hospitals to participate in the 340B Prescription Drug Discount Program,allowing prescription drugs to be sold at a discount •Equalizationof MC and MA payments to rural hospitals, Value based purchasing and bundling

Front 186

Definition of disaster

Back 186

Disaster=Need > Resources

A natural or man-made incident causing human suffering and creates human needs that victims cannot alleviate without assistance

Front 187

What is the acronym DISASTER representing the disaster paradigm?

Back 187

D=detect

I=incident command

S= scene, security, and safety

A=assess hazards

S=support

T=triage and treatment

E=evacuation

R=recovery

Front 188

What did Dr. Gebbie do in 2001 to enhance nurses roles in disaster situations?

Back 188

in 2001, she identified Core Emergency and Disaster Preparedness Competencies for Nurses; prior to 2001, there were minimal nursing requirements related to disaster situations in nursing curricula

Front 189

Different types of disasters

Back 189

Natural: flooding, earthquake, hurricane, tornado, blizzard, communicable disease epidemic

Man made: train derailment, dam breakage, plane crash, nuclear reactor meltdown, bombing and warfare, hazardous material incident, water supply contamination, civil unrest

Front 190

What does working a nursing vacuum mean in a disaster setting?

Back 190

Focused only on our patient care at the present moment

Front 191

What is mitigation in disaster situations?

Back 191

Reducing risks to people and property from disasters BEFORE they occur

Front 192

Role of disaster preparedness in the 2002 Homeland Security Act?

Back 192

Created the US Department of Homeland Security which has a mission of developing and coordinating comprehensive national strategies to secure the US from terrorist threats/attacks

Front 193

Role of disaster preparedness in the 2003 (and revision in 2011) Homeland Security Presidential Directive 8?

Back 193

Established national policies to strengthen preparedness in the US to include diseaster

Front 194

Role of disaster preparedness in the 2004 National Incident Management System (NIMS)?

Back 194

Created an all disciplines, all hazards approach for an organized response to any disaster in the US including the Incident Command System (ICS), a multi-agency coordination of systems

Front 195

The National Incident Management System (NIMS) discusses the need for:

It also details:

Back 195

preparedness; resource management, communications, and information

Details command structure to assist you in understanding the response plan and implementation of resources

Front 196

What is the national response framework?

Back 196

Outlines how the federal government will use all of its agencies to respond to the needs of a community in a disaster

Front 197

Problems with the national response framework:

Back 197

In the past, response time is lagged behind what people needed. It is problematic to think disaster response a federal job

Front 198

What is the flow of disaster response?

Back 198

STARTS LOCALLY

Starts in home with families-->moves to local community response-->proceeds to the regional response-->next to the state office of emergency management-->finally to the state Govern's office (state of emergency) initiating a request to the US President for assistance

Front 199

Role of the Stafford Act in disaster response

Back 199

Stafford Act mandates the President to respond with a Declaration of Disasters for States; President assigns a Federal Coordinating Officer (FCO) to each disaster

Front 200

What are the phases of disasters?

Back 200

(1) Pre-impact phase

(2) Impact phase

(3) Honeymoon phase

(4) Disillusionment and Recovery phase

(5) Reconstruction phase

Front 201

What is the pre-impact phase of a disaster?

Back 201

Stage 1: thisis usually evident in disasters where we have some warnings issued(example: NOAA weather patterns indicate a storm or hurricane are coming). Predictionsprovide guidance for preparation (example: snow storm is coming with predicted3 feet of snow. We prepare the community for the storm).

Front 202

What is the impact phase of a disaster?

Back 202

Stage 2: whenthe disaster has occurred and we are in the mist of emergency response to thedisaster. Initialassessments are needed: how manyinjured, how many may need rescue, and how many need medical attention. Alsoreferred to the “heroic phase”Commonto see citizens working to rescueand help each other.Fireandemergency personnel performing daring rescues

Front 203

What is the honeymoon phase of a disaster?

Back 203

Stage 3: manyexpressions of joy at being alive and have survived the incident Outsideorganizations have brought in help. People from outside of the community feelthey can and want to help

Front 204

What is the disillusionment and recovery phase of a disaster?

Back 204

Stage 4: peoplewho have survived the ordeal now become frustrated Realizationof how long it may take to rebuild, claim insurance, and redevelop thecommunity Oftenmany are outspoken and resentful that the government did not do enough

Front 205

What is the reconstruction phase of a disaster?

Back 205

Stage 5: occurs anytime between between 3 months to yearsafter the disaster Rebuildinga community may not happen quickly and rebuilding businesses and otherinfrastructure may take longer then expected

Front 206

IDME triage basics of disasters

Back 206

I: Immediate care= life-threatening with a chance for survival

D: Delayed care=they can wait a few hours or days for surgical intervention, given pain medication and splinted fractures

M: Minor walking wounded, need minor care, first aid

E: Expectant= near deceased or impending death no chance for survival or recovery with resources on hand

Front 207

What is the chain of infection?

Back 207

Infectious agent-->reservoir-->portal of exit--> mode of transmission-->portal of entry-->susceptible host-->infectious agent

Front 208

How to break the chain of infection at the infectious agent stage?

Back 208

Rapid, accurate identification of organisms

Front 209

How to break the chain of infection at the reservoirs stage?

Back 209

Employee health, environmental sanitation, disinfection, sterilization

Front 210

How to break the chain of infection at the portal of exit stage?

Back 210

Proper attire, hand washing, control of excretion and secretions, trash and waste disposal

Front 211

How to break the chain of infection at the means of transmission stage?

Back 211

Isolation, food handling, air flow control, sterilization, handwashing

Front 212

How to break the chain of infection at the portal of entry stage?

Back 212

Aseptic technique, catheter care, wound care

Front 213

How to break the chain of infection at the susceptible host stage?

Back 213

Recognition of high-risk patients, treatment of underlying diseases

Front 214

What is the reservoir stage of the chain of infection?

Back 214

–Thehabitat in which an infectious agent usually lives, grows, & multiplies–Includeshumans, animals, and the environment–Mayor may not be the source from which an agent is transmitted–HumanReservoirs: •Personswith asymptomatic disease•Carriers

Front 215

Types of reservoirs

Back 215

-Human reservoirs

-Animal reservoirs

-Environmental reservoirs (plant, soil, water)

Front 216

What are carriers?

Back 216

Human reservoirs; a person may be asymptomatic but capable of transmitting the agent to others; chronic carrier continuously harbors an agent (Hep B or Salmonella typhi)

Front 217

What are zoonoses?

Back 217

Infectious diseases transmitted from animals to humans

Front 218

What is the portal of entry stage of the chain of infection?

Back 218

•The path by which agent enterssusceptible host•Usually same portal they exit eg.TB, Flu •Others include: skin, mucousmembrane•Enteric pathogenicagents---->“Fecal-oral”

Front 219

What is the portal of exit stage of the chain of infection?

Back 219

•The path by which an agent leavesthe source•Usually corresponds to the siteat which the agent is localized eg. TB, Flu , exit the resp. tract•Some blood borne agents can exitby crossing the placenta e.g. rubella, syphilis

Front 220

Possible modes of transmission

Back 220

Vertical, horizontal, vehicle, carrier, direct and/or indirect

Front 221

What is a vertical mode of transmission?

Back 221

Passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal during birth

Front 222

What is a horizontal mode of transmission?

Back 222

Person to person spread through 4 routes: direct/indirect, common vehicle, vector borne, airborne

Front 223

What is vehicle mode of transmission?

Back 223

Nonliving intermediary such as fomite, food, water, or infectious bodily fluids that convey the infectious agent from the reservoir to a susceptible host

Front 224

What is a carrier mode of transmission?

Back 224

Contains, spreads, or harbors a disease

Front 225

What is a direct mode of transmission?

Back 225

Direct contact: touching, kissing, biting, sex; droplet spread

Front 226

What are indirect modes of transmission?

Back 226

Airborne, vehicle-born, vector-borne (mechanical or biologic)

Front 227

Stages of disease process

Back 227

1. Pre-pathogenesis: susceptibility

2. Pathogenesis: preclinical and clinical

3. Resolution: death, disability, or recovery

Front 228

Natural history of disease theory

Back 228

Front 229

What is epidemiological?

Back 229

The study of the distribution, and determinants of health, disease/illness, and injuries in human populations and the application of this knowledge to improving the health of communities

Front 230

What is the purpose of epidemiology?

Back 230

•To provide a basis for developing diseasecontrol and prevention measures for groups at risk. This translates into developing measures toprevent or control disease.

Front 231

Definition of distribution

Back 231

The frequency of occurrence of states of health and illness

Front 232

Definition of determinants

Back 232

Factors or agents that contribute to the cause of various states of health and illness

Front 233

Definition of risk

Back 233

The probability of likelihood that a health event will occur in a group of people

Front 234

What are the uses of epidemiology?

Back 234

•To study the cause (or etiology) of disease(s), or conditions,disorders, disabilities, etc.–determine the primary agentresponsible or ascertain causative factors–determine the characteristics ofthe agent or causative factors–define the mode of transmission–determine contributing factors–identify and determine geographicpatterns

Front 235

Principal areas of use for epidemiology?

Back 235

•Historical Use–Epidemiologictransition–Demographictransition •Community Health Use•Health Services Use•Risk Assessment Use•Disease Causality Use

Front 236

Eras in the evolution of modern epidemiology

Back 236

Sanitary statistics, infectious disease epidemiology, chronic disease epidemiology, eco-epidemiology

Front 237

What is the sanitary statistics era in the evolution of modern epidemiology?

Back 237

200-600 BC Religious era through Environmental Era 1800-1850

Focused on miasma theory: poisoning from foul emissions; sanitation, sewage, and drainage primary concerns

Front 238

What is the infectious disease era in the evolution of modern epidemiology?

Back 238

1850-1950

Germ theory: single agent related to specific disease

Primary concerns: vaccines, isolation, and antibiotics

Front 239

What is the chronic disease era in the evolution of modern epidemiology?

Back 239

Exposure is related to outcome, control risk factors by modifying behavior

Front 240

What is the eco-epidemiology era in the evolution of modern epidemiology?

Back 240

Analysis of determinants and outcomes using new info systems and biomedical techniques eg. DNA studies

Front 241

History of epidemiology in the 4th century BC

Back 241

Hippocrates was the first person to use the ideas that are now part of epidemiology

Front 242

History of epidemiology in the nineteenth century

Back 242

-Louis Pasteur developed both germtheory and pasteurization

-Joseph Lister developedantiseptic surgery

-Robert Koch developed pureculture and identified the organisms that cause TB, anthrax, and choleradisease

- John Snow (“father ofepidemiology”) – water pump cholera outbreak map

-Florence Nightingale –environmental conditions during Crimean War

Front 243

Who was John Snow and what did he study?

Back 243

1813-1858

Studied the Broad St. Pump Cholera Outbreak in London, England, of 1854

Front 244

What was the Broad St. Pump Cholera Outbreak in London, England in 1854?

Back 244

Increase of cases August 31 and September 1; 79 deaths on Sept 1 and 2; 87% of deaths clustered around Broad St. pump; pump handle removed Sept. 8th

Front 245

When did smallpox eradication occur?

Back 245

Initiated in 1967, last naturally occuring case in 1977, declared dead in 1980

Front 246

US Department of Health and Human Services requirement for smallpox vaccination

Back 246

requiresstates to be prepared to immunize their entire population within 10 days

Front 247

What are the 3 foremost triumphs of epidemiology?

Back 247

-Cigarette smoking found to be a major cause of lung cancer, emphysemaand cardiovascular disease (1951-1963)

-Eradication of smallpox (1978)

-Identification of the AIDS syndrome, prediction that the cause was asexually-transmitted virus (1981-1983), and development of prevention measures BEFORE the virus was identified

Front 248

Sources of epidemiologic data

Back 248

•Census data•Reportable diseases•Vital records such as death,marriage, birth, abortion•Disease registries•Surveillance system•Medical•Health department•Insurance records•Scientific studies

Front 249

What are the three major epidemiological models?

Back 249

Epidemiologic triangle, wheel model, web of causation

Front 250

Epidemiologic models look at what factors that influence health status?

Back 250

-Intrinsic factors: host factors

-Extrinsic factors: agent, environment

Front 251

What is the epidemiologic triangle model?

Back 251

Epidemiologic homeostasis between agent, host, and environment (represent each point of a triangle)

Front 252

What is the wheel model of causation?

Back 252

Front 253

What are host factors?

Back 253

Genetic susceptibility, immutable characteristics (age, gender), acquired characteristics: immunological status, lifestyle factors

Front 254

What is immunity?

Back 254

-The host's ability to resist a particular infectious disease-causing agent

-The body forms antibodies that react with a foreign antigen and makes them harmless

Front 255

Types of immunity

Back 255

Passive, active, cross, and herd

Front 256

What is passive immunity?

Back 256

Short-term resistance acquired either naturally or artificially

Front 257

What is active immunity?

Back 257

Long-term and sometimes life-long resistance acquired either naturally/artificially

Front 258

What is cross immunity?

Back 258

Immunity to one agent provides a person with immunity to another agent

Front 259

What is herd immunity?

Back 259

Immunity level present in a population

Front 260

What are agents within epidemiologic models?

Back 260

Biological agents, chemical agents, physical agents, nutrient agent, genetic agent, psychological agent

Front 261

What are possible biologic agents?

Back 261

Bacteria, viruses, fungi, parasites

Front 262

What are possible chemical agents?

Back 262

Heavy metals, toxic chemicals, pesticides

Front 263

What are possible physical agents?

Back 263

Radiation, heat and cold, machinery

Front 264

What a nutrient agent?

Back 264

Basic dietary components needed to survive

Front 265

What is a genetic agent?

Back 265

Transmitted from child to parent through genes

Front 266

What is psychological agent?

Back 266

Stressful circumstances in the environment (e.g. studying)

Front 267

Characteristics of agents

Back 267

Infectivity, pathogenicity, virulence

Front 268

Environmental factors of epidemiologic models

Back 268

-Physical: climate

-Biological: living plants and animals; human population distribution

-Socioeconomic factors: working conditions, codes and laws

Front 269

Possible patterns of disease occurrence

Back 269

Epidemic, endemic, sporadic, hyperendemic, pandemic

Front 270

When do epidemics arise? What are possible ways for these conditions to arise?

Back 270

When host, agent, and environmental factors are not in balance

•new agent•change in existing agent(infectivity, pathogenicity, virulence)•change in number of susceptiblehosts in the population•environmental changes that affecttransmission of the agent or growth of the agent

Front 271

What is the web of causation model?

Back 271

Front 272

What are the two broad types of epidemiology?

Back 272

Descriptive and analytic epidemiology

Front 273

What is descriptive epidemiology?

Back 273

–Examining the distribution ofdisease ina population, and observing the basic features of its distribution

–Describes disease in terms of person,place or time–What is the disease? Who isaffected? Where are those people? When do events occur?

Front 274

What is analytic epidemiology?

Back 274

–Testing a hypothesis about the cause ofdisease by studying how exposures relate to the disease

–built around the analysis of therelationship between two items•Exposures•Effects (disease)

–looking for determinants orpossible causes of disease

–useful for•hypothesis testing

Front 275

Descriptive epidemiology includes investigations that seek to observe what patterns?

Back 275

Patterns of health related conditions that occur naturally in a population

Front 276

What is the focus of descriptive epidemiology?

Back 276

Focuses on the frequency and distribution of states of health within a population

Front 277

What are the three essential characteristics of disease examined in descriptive epidemiology studies?

Back 277

Person, place, and time

Front 278

What are the aspects of the "person" characteristics of disease?

Back 278

•Age, gender, ethnicity•Genetic predisposition•Concurrent disease•Diet, exercise, smoking•Risk taking behavior•SES, education, occupation

Front 279

What are the aspects of the "place" characteristics of disease?

Back 279

•Geographicplace–presence or agents or vectors–climate–geology–population density–economic development–nutritional practices–medical practices

Front 280

What are the aspects of the "time" characteristics of disease?

Back 280

•Calendar Time•Time since an event•Physiologic cycles•Age (time since birth)•Seasonality•Temporal trends

Front 281

What are the basic measures in descriptive epidemiology?

Back 281

Counts, ratio, proportion, rates

Front 282

What are "counts" in descriptive epidemiology?

Back 282

Simplest measure of description, # of people affected

Front 283

What are "ratios" in descriptive epidemiology?

Back 283

Fraction obtained by dividing one quantity by another; relationship between 2 numbers, the numerator is not included in the denominator

Front 284

What are "proportions" in descriptive epidemiology?

Back 284

Part of a whole; numerator is included in the denominator

Front 285

What are types of "rates" within descriptive epidemiology?

Back 285

-Incidence rates

-Prevalence: point prevalence, period prevalence, attack rate (the # of persons that develop a disease among all those exposed to a particular risk)

Front 286

What are attack rates?

Back 286

The # of persons that develop a disease among all those exposed to a particular risk

Front 287

What are prevalence rates a measure of?

Back 287

Measure of the number of existing cases of a disease or health condition in a population

Front 288

Point v. period prevalence

Back 288

Point prevalence: all cases of disease/health condition/deaths that exist at a particular point in time

Period prevalence: within a specific period of time

Front 289

Formula for calculating prevalence rate

Back 289

(Number of persons with a condition/Total number in a population) x K (constant)

Front 290

What do incidence rates measure?

Back 290

–measuresNEW cases of specific disease or health problem within a specific period oftime in a specific population previously free of disease

Front 291

Formula for calculating incidence rate

Back 291

(# of persons developing a disease/Total # at risk per unit of time) x K (constant)

Front 292

Relationship between incidence and prevalence

Back 292

•Incidenceand prevalence are related to each other. Incident cases are new cases, whileprevalent cases are cases with the disease at a given point in time. New cases,or incident cases, add to the cases that are already there, or prevalent cases.People who die from a disease, or who recover from a disease, fall out of thepool of prevalent cases, because they are no longer counted as having thedisease.

Front 293

Prevalence is a function of:

Back 293

the incidence of disease and the duration of disease

Front 294

Bathtub model for prevalence and incidence

Back 294

Front 295

What are attack rates and how are the used?

Back 295

•The proportion of a group or a population that develops a disease amongthose exposed to the a particular risk•Used frequently in investigations of outbreaks in the populations suchas flu, food-bourne illnesses

Front 296

Analytic epidemiology looks at what aspects of disease?

Back 296

The etiology of disease and deals with determinants of health and disease (How does it occur? Why are some people affected more than others)

Front 297

Three essential characteristics that are examined to study the causes for disease in analytic epidemiology?

Back 297

Host, agent, environment

Front 298

What are the types of analytic epidemiology?

Back 298

Front 299

What are the core functions and 10 essential services of public health nursing?

Back 299

Core functions= assurance, assessment, policy development

Front 300

When are windshield surveys are particularly useful?

Back 300

When the area you want to observe is large, and the aspects you're interested in can be seen from the road

Front 301

When should a windshield survey be done?

Back 301

-To understandthe community,asurvey should be conducted at varying times to capture a full picture of thecommunity interaction and involvement with a community. -Toget the best picture of the community, a number of surveys at different times ofthe day, week, and/or yearshould be conducted

Front 302

What is group orientation, which is common element of all community definitions?

Back 302

The groups needs and goals take priority over those of individual members. Communities take collective action with regard to common concerns

Front 303

Common elements of all community definitions

Back 303

Group orientation, a bond between individuals (common lifestyle, ethnicity, culture, specific geographic location, similar interests/goals/occupations), human interaction

Front 304

What is human interaction, a common element of all community definitions?

Back 304

Significantsocial interaction must exist for a community to exist. Without socialinteraction, there is just a collection of isolated individuals

Front 305

Aggregate v. community

Back 305

Aggregate=a group of people with some common characteristic (e.g. people with arthritis)

Community= a group of people with some common characteristics that also have people with arthritis meeting weekly for a support group

Front 306

What is community competence?

Back 306

Ability of the community to: identify needs effectively, achieve working consensus on issues, agree on ways to implement change, work together to implement desired changes

Front 307

Types of communities

Back 307

-Geographic (neighborhood, village, town,county, state, country)

-Common Interest

-Communities of solution

-Community of action capability

-Community of political jurisdiction

Front 308

Primary focuses of community health nursing

Back 308

On health care of individuals, families, and groups in the community; community as a whole, highrisk aggregates or subgroups of the populations and organizations such asschools and workplace, individualsand their families,particularlythose at for poor health outcomes or who are already experiencing healthproblems

Front 309

What is the goal of community health nursing?

Back 309

To preserve, protect, promote, or maintain health

Front 310

Possible practice settings for community health nursing

Back 310

Practice setting may be community agencies, home, work, school, organization or government

Front 311

Levels of community health practice

Back 311

Individual focused, systems focused, or community focused

Front 312

What is individual-focused community health practice?

Back 312

-Practicedirected at individuals for the purpose of changing knowledge, attitudes,beliefs & behaviors of individuals

Front 313

What is systems-focused community health practice?

Back 313

-Focuson systems that impact health; changes organizations, policies, laws, powerstructures

Front 314

What is community focused community health practice?

Back 314

Changes community norms, attitudes, practices, awareness, & behaviors

Front 315

What does a healthy community look like?

Back 315

§Clean,high quality physical environment§Strongand mutually supportive of all residents§Highdegree of public participation§Meetingof basic needs (food, water, income, safe work places)§Connectednesswith the past and heritage§Goodhealth status and access to health care§Communityidentity§Preparedto meet crises§Openchannels of communication§Isable to problem-solve§Usesits natural resources while ensuring use for future generations

Front 316

What is a community health assessment?

Back 316

§Description of the community§Statistical data on health risk factors§Data on health status§Information on physical, social,political environment

Front 317

Purpose of community health assessments?

Back 317

-Many required by PH law -Gives picture of the community -Drives funding for PH activties and programs -Allows for allocation of resources -Identifies health problems -To identify factors (positive &negative) which impact the health of the community -To develop strategies for healthpromotion and prevention -May include information about the causes& consequences of health problems -Helps identify gaps in service

Front 318

In any community assessment, what three aspects must be included?

Back 318

Status, structure, and process

Front 319

What is the status aspect of a community assessment?

Back 319

Morbidity,mortality, life expectancy, education, crime rates

Front 320

What is structure aspect of a community assessment?

Back 320

Socioeconomic, age, gender, ethnic distribution, available resources

Front 321

What is the process aspect of a community assessment?

Back 321

How the community operates, how it functions to solve problems

Front 322

Methods of data collection in a community health assessment

Back 322

Informant interviews, participant observation, secondary analysis of existing data, surveys, windshield survey

Front 323

Process of a community assessment

Back 323

Front 324

Quantitative data sources of community assessment data

Back 324

§Censusdemographics, housing information§Vitalstatistics, birth, death, marriages§Identifyinglocal service agencies§Observation(windshield survey)§Phonebook (yes, the phone book!)

Front 325

Qualitative data and methods for sources of community assessment data

Back 325

§QualitativeData:perceptionsof health, attitudes, & health concerns as voiced by the members of thepopulation§Communitysurveys§Keyinformant interviews§Focusgroups§Residentinterviews

Front 326

Why is a community defined as a whole system?

Back 326

Due to the fact that it functions because of the interdependence of its parts

Front 327

What is Anderson & McFarlane's Community as Partner model?

Back 327

-Systemsmodel

-Nurseworks with the community, both with individuals or with groups collaborativelytoidentify public health problems in the community, to identify acceptableinterventions, & to evaluate their effectiveness.

-Worktoward a common goal

-Nurseactively engages community partners in the process

Front 328

What are the aspects (wedges) of the community as partner model?

Back 328

Front 329

Aspects of a community core

Back 329

Demographics, religion, race and ethnicity, history

Front 330

What are the 8 community subsystems that must be assessed?

Back 330

Physical environment, economics, safety and transportation, communication, education, politics and government, health and social services, recreation

Front 331

What are the components of the physical environment community subsystem?

Back 331

Location, type of community, topography, climate, type and adequacy of housing, water supply and waste disposal, air quality

Front 332

What are the components of the economics community subsystem?

Back 332

§Occupationand business§Lookat the cars- are they in good repair? Newer models?§Whatdo the houses look like?§Isthere evidence of homelessness?§Canyou tell if there is unemployment?§Howare people dressed?

Front 333

What are the components of the transportation community subsystem?

Back 333

Private transportation, public transportation, roads, air service, rail service

Front 334

What are the components of the safety community subsystem?

Back 334

Protection services (fire, police, sanitation), water source and treatment, solid waste management, air quality (pollution, asthma triggers, radon)

Front 335

What are the components of the communication community subsystem?

Back 335

-Formalcommunication: newspapers, radio, tv, mail delivery, cable tv

-Informalcommunication: bulletin boards, posters, billboards, newsletters, keyinformants

-Communicationnetworks

-Relationshipsbetween subgroups in the community: Wheredo people gather?

-Protectiveservices within the community

Front 336

What are the components of the education subsystem of a community?

Back 336

§Arethere schools in the community?§Isthere higher education in the community?§Daycare available?§Libraryservices?

Front 337

What are the components of the politics and government subsystem of a community?

Back 337

§Whois the predominant political party?§Anysigns of political activity?§Canyou tell what some of the issues are for the local community?§Whatdo the billboards tell you?

Front 338

What are the components of the health and social services subsystem of a community?

Back 338

§Hospitals, providers, Public Healthservices, home health agencies, long-term care, emergency services§Levels of performance and types ofservices

Front 339

What are the components of the recreation subsystem of a community?

Back 339

§Whattype of recreational facilities are available? Bicycle paths? Walking trails?§Organizedsports?§Healthclubs?§Availabilityof parks and pools?§Playgrounds?§Naturalresources for recreation

Front 340

Sources of public funding for health care

Back 340

•Medicare•Medicaid•ChildHealth Plus (CHIP)/Family Health Plus•Military/Veterans•IndianHealth Service•Workers’Compensation•PublicHealth Services, Community Health Centers•Statemental hospitals, county and city hospitals

Front 341

What are insurance exchanges?

Back 341

Offered through the Affordable Care Act, either Federal or State. Are a "marketplace" for private and public coverage. Offers insurance to individuals or small business owners. Different level plans with different costs and benefits, subsidies based on income level.

Front 342

Sources of health insurance coverage for nonelderly adults in 2011

Back 342

Front 343

Sources of health insurance coverage of children, 2011

Back 343

Front 344

% Populations that comprise the enrollees in Medicaid? % Populations that comprise the expenditures of Medicaid?

Back 344

Front 345

How do illness and disability rates differ between Medicaid enrollees and the privately insured?

Back 345

Front 346

How has Medicaid enrollment changed since the recession?

Back 346

More than 7 million have enrolled in Medicaid

Front 347

What is the impact of the rise in unemployment since 2008 on health coverage?

Back 347

2.8% increase in national unemployment rate since 2009= 6.9 million decrease in employer sponsored insurance + 2.8 million increase in Medicaid/CHIP enrollment increase and 3.0 million increase in the uninsured

Front 348

What is Medicare? When was it established?

Back 348

•Federal health insurance for people 65years and older, people with end stage renal disease (ESRD), or disabled, LouGehrig’s Disease (ALS)•Established in 1965 as an amendment tothe Social Security Act

Front 349

Who is eligible for free Medicare hospital insurance (Part A)?

Back 349

Mostpeople age 65 or older who are citizens or permanent residents of the UnitedStates: •Youreceive or are eligible to receive Social Security benefits;•Youreceive or are eligible to receive railroad retirement benefits; •Youor your spouse (living or deceased, including divorced spouses) worked longenough in a government job where Medicare taxes were paid

Front 350

How has Medicare enrollment changed between 1966-2011?

Back 350

Front 351

Changes and projected changes in the number of Medicare beneficiaries versus the number of workers per beneficiary 2000-2030

Back 351

Front 352

What are the parts of Medicare?

Back 352

Part A: hospital insurance

Part B: Medical insurance

Part C: Medicare Advantage Plans

Part D: Prescription Drug Coverage

Front 353

What is included under Medicare Part A?

Back 353

•inpatienthospital stays, care in a skilled nursing facility, hospice care, and some homehealth care

Front 354

What is included under Medicare Part B?

Back 354

•certaindoctors' services, outpatient care, medical supplies, and preventive services

Front 355

What is included under Medicare Part C?

Back 355

•AMedicare Advantage Plan is a type of Medicare health plan offered by a privatecompany that contracts with Medicare to provide your Part A and Part Bbenefits. Medicare Advantage Plans include Health Maintenance Organizations,Preferred Provider Organizations, Private Fee-for-Service Plans, Special NeedsPlans, and Medicare Medical Savings Account Plans. In a Medicare Advantage Plan, Medicareservices are covered through the plan and aren't paid for under OriginalMedicare. Most Medicare Advantage Plans offer prescription drug coverage.

Front 356

What is included in Medicare Part D?

Back 356

•PartD adds prescription drug coverage to Original Medicare, some Medicare CostPlans, some Medicare Private-Fee-for-Service Plans, and Medicare MedicalSavings Account Plans. These plans are offered by insurance companies and otherprivate companies approved by Medicare. Medicare Advantage Plans may also offerprescription drug coverage that follows the same rules as Medicare PrescriptionDrug Plans.

Front 357

Timelines for how long Medicare Part A will cover

Back 357

•Hospitalization:covers 90 days with a lifetime reserve of 60 additional days•Skillednursing facility if within 30 days of a hospitalization of 3 or more days.Covers up to 100 days•Homehealth services •Covers 80% of the cost of home careequipment needs•Careprovided by a Medicare-certified hospice: recertification every 6 months•Inpatientpsychiatric care: 190 days lifetime limit

Front 358

How long of a hospitalization will Medicare Part A cover?

Back 358

90 days with lifetime reserve of 60 additional days

Front 359

How long of a skilled nursing facility stay will Medicare Part A cover?

Back 359

If within 30 days of a hospitalization of 3 or more days, will cover up to 100 days

Front 360

Medicare Part A coverage of home health services

Back 360

Covers 80% of the cost of home care equipment needs, part-time skilled nursing care, home health aide, rehab therapies, medical supplies

Front 361

Length of time of hospice care covered by Medicare?

Back 361

Any care provided by a Medicare-certified hospice: recertification every 6 months

Front 362

Length of time of inpatient psychiatric care covered by Medicare?

Back 362

190 days lifetime limit

Front 363

Medicare Part B is what type of coverage? Where does funding come from? Who is eligible?

Back 363

Voluntary coverage (Supplementary medical insurance)

Supported by general tax revenues and required income-based premium

Can only obtain Part B coverage if eligible for PartA

Front 364

What is included under Medicare Part B Coverage?

Back 364

•MDservices•Includesannual PE and preventive and screening services•outpatienthospital services ( outpatient surgery, diagnostic tests, radiology andpathology•ERvisits•ambulancefees•Outpatientrehab services•Renaldialysis•Radiationtx•Tissuetransplants•prostheses•Medicalequipment and supplies

Front 365

Eligibility for home health care under Medicare

Back 365

Eligible clients must be homebound, show decreasing acuity, and care must be intermittent

Front 366

What is the goal of Medicare Part C Coverage?

Back 366

To channel enrollees into Managed Care Plans

Front 367

What authorized Medicare Part C Coverage?

Back 367

Authorized by the Balanced Budget Act of 1997 "Medicare and CHoice Program"-->renamed Medicare Advantage with the passage of Medicare prescription Drug Improvement and Modernization act of 2003

Front 368

What type of coverage is Medicare Part C? What is its aim?

Back 368

Optional, most offer some type of prescription coverage

Designed to lower out of pocket expenses

Front 369

What is required to have Medicare Part D?

Back 369

Requires monthly premium which varies by plan and a deductible; Must have Part A or B

Front 370

When was Medicare Part D implemented?

Back 370

Added to the MMA of 2003; fully implemented in 2006

Front 371

What are the two options for Medicare Part D?

Back 371

1. Stand alone for those who want to remain in original Medicare

2. For those who have Part C

Front 372

How did the ACA change Medicare Part D?

Back 372

All drugs must be covered under a manufacturer discount agreement while in coverage gap: 50% brand, 70% generic; coverage gap to be phased out in 2020

Front 373

Standard Medicare Prescription Drug Benefits before and after health reform

Back 373

Before health reform: 100% paid by enrollee between initial coverage limit and start of catastrophic coverage

After health reform: Between initial coverage limit and start of catastrophic coverage, 25% paid by enrollee with 75% generics paid by plan

Front 374

What would be net reduction in federal spending be in 2014 if Medicare eligibility age was 67?

Back 374

Net federal saving of $7.6 billion

Front 375

What % of non-elderly with private health insurance are covered through employee-sponsored health plans?

Back 375

90%

Front 376

What are defined contributions?

Back 376

•employersgive employees a fixed amount of $ for insurance premiums. The employee thencan pick their own insurance company and deal directly with the insurance company. Any premium increases would bepassed directly to the employee

Front 377

Reasons for decline in employer-based health insurance

Back 377

Increasing health care costs, shift from manufacturing jobs to service sector jobs, increase in the number of low-income families

Front 378

What is managed care?

Back 378

•Managed care refers, in general, to efforts tocoordinate, rationalize,and channel the use of services to achieve desired access, service, andoutcomes while controlling costs. •Managed care organizations use various strategies to control costs.

Front 379

How does managed care differ from conventional health insurance?

Back 379

•Managed care differs from conventionalhealth insurance in that the MCO either provides the services directly orenters into contracts to provide them

Front 380

Goal of managed care organizations?

Back 380

•To provide the highest quality of care toa population, efficiently and affordability, within the limits of availablefunding

Front 381

What do managed care organizations do? What is the role of providers?

Back 381

•Managed Care links health insurance withthe delivery of health care for a defined population •Providers assume responsibility andaccountability for the health of a given population, and share the financialrisk inherent in that responsibility

Front 382

What is the emphasis of managed care organizations?

Back 382

•Emphasis on coordinated and comprehensiveservices, appropriate use of health care services, evidence-based decisionmaking, cost-effective diagnosis and treatment, population-based planning, andhealth promotion and disease prevention

Front 383

What are the specific cost containment strategies of managed care?

Back 383

•Contracting with only those providers whooffer the MCO a discount•Monitoring the use of both basic andancillary services by providers and punishing excessive (more than average) use•Restricting the use of tests or drugs•Requiring that access to specialty carebe granted by a PCP, who serves as a gatekeeper (and is held responsible forthe use of such specialty care)•Providing financial rewards for usingfewer or less expensive services in the form of bonuses (or penalties in theform of withheld payments if heavy usage is made) •Encouraging or even requiring that theproviders share the risk of the costs of elements of care under their direct orindirect control

Front 384

Types of HMOs

Back 384

Staff Model, Group Model, Network Model, Independent Practice Association (IPO), and Preferred Provider Organizations (PPO)

Front 385

What is the staff model type of HMOs?

Back 385

Employs own salaried physicians. Contracts with hospitals. The HMO controls providers.

Front 386

What is the group model type of HMO?

Back 386

Contracts with a multi-specialty group practice and also with one of more hospitals; group practice controls providers

Front 387

What is network model type of HMO?

Back 387

Contracts with more than one medical group practice; usually only primary care, may contract with a panel of specialists

Front 388

What is an Independent Practice Association (IPA) type of HMO?

Back 388

The IPA contracts with the providers and the HMO contracts with the IPA

Front 389

How do managed care organizations get funding?

Back 389

•an MCOin this definition receives a fixed sum of money to pay for the benefits in theplans for the defined population of enrollees. •Typically,this fixed sum of money is constructed through premiums paid by the enrollees,capitation payments made on behalf of the enrollees from a third party, orboth.

Front 390

Employer and employee role in managed care organizations

Back 390

•Employer and employee each contribute tothe premium•Employeepays co-pay for each visit and for each prescription •Employee can only see those providers whoparticipate in the MCO or have drugs prescribed that are on the MCO formulary•Physician acts as gatekeeper•Physician receives withholding orincentives for care provided/not provided

Front 391

What access to physicians do employees have under managed care

Back 391

•Employeepays co-pay for each visit and for each prescription •Employee can only see those providers whoparticipate in the MCO or have drugs prescribed that are on the MCO formulary•Physician acts as gatekeeper•Physician receives withholding orincentives for care provided/not provided

Front 392

What are consumer-focused strategies for cost control in health insurance?

Back 392

•directedatimposing some barriers to use by levying various forms of co-insurance. •Deductibles•co-payments•or a combination of both.

Front 393

What did the 1970 RAND corporation study of the effect of different health insurance patterns on health care utilization and outcomes for working age people and their children reveal?

Back 393

Co-payments led to a decline in utilization of health services; however, those who were poor and sick were especially disadvantaged by the co-payments, even though these payments had been adjusted for differences in people's incomes

Front 394

What are provider-based strategies for cost control in health insurance?

Back 394

Addressed the price paid for services via Medicare's Prospective Payment System (PPS): •Medicareno longer reimbursed hospitals their actual costs incurred but insteadreimbursed them for a preset amount per admission (or discharge) based on thetype of illness or the procedure performed

Front 395

What is Medicare's Prospective Payment System (PPS)?

Back 395

•Medicareno longer reimbursed hospitals their actual costs incurred but insteadreimbursed them for a preset amount per admission (or discharge) based on thetype of illness or the procedure performed

Front 396

What are Diagnostic-Related Groups or DRGs? What payment system is it a part of?

Back 396

•Some 470 payment categories of illnessesand procedures (called Diagnostic-Related Groups or DRGs) were created fromavailable data that used diagnoses, patient age and the presence ofcomplications as the basis for estimating hospital costs.

-Under Medicare's Prospective Payment System (PPS)

Front 397

Pitfalls of Managed Care

Back 397

Loss of customary doctor, restricted access to hospitals, restricted access to specialty care, restricted access to tests, restricted access to medications, managed care has an incentive for under-service

Front 398

Why is loss of customary doctor a pitfall of managed care?

Back 398

If the person's doctor is not a participant in the managed care program, the person will have to choose one who does participate.

Front 399

Why is restricted access to hospitals a pitfall of managed care?

Back 399

The managed care plan may not contract with the hospitals a patient prefers.

Front 400

Why is restricted access to specialty care a pitfall of managed care?

Back 400

Many managed care programs require that patients see specialists only on the referral of their PCP: could be a major impediment if the PCP feels pressure to restrict access to; in some cases, managed care firms may restrict the number of specialists with whom they contract

Front 401

Why is restricted access to tests a pitfall of managed care?

Back 401

If the PCPs (or specialists) are judged on their use of laboratory testing, there will be pressure to avoid such tests in marginal situations; many managed care programs use clinical protocols to establish norms for ordering tests. Practitioners often complain that these protocols are too restrictive

Front 402

Why is restricted access to medications a pitfall of managed care?

Back 402

•When the benefit package includes drugcoverage, consumers may find that certain expensive medications are notincluded on the plan's formulary; •Theymayalso be required to attempt to use less expensive drugs with more knownside-effects before being offered drugs that have better results

Front 403

How does managed care have an incentive for under-service?

Back 403

•Just as fee-for-service has an incentivefor too much service, managed care has an incentive to provide too little. Ingeneral, most practitioners who have worked under the aegis of managed carenote that the greatest effect is in areas where health care decisions are notclear-cut. Without clear evidence that a given course of action is indicated,the balance may swing to less intensive care under capitation.

Front 404

Two major goals of health care reform

Back 404

•Increase access to health care coveragefor all Americans•Introduce new protections for people whohave health insuranceartners-container

Front 405

Provision of ACA for sick individuals

Back 405

-Peoplecannot lose their insurance coverage when they get sick; insurance companiesare prohibited from dropping coverage.

-Individualswith pre-existing health problems will be able to access insurance. Childrenwith pre-existing conditions cannot be denied coverage by insurance companies.Adults with pre-existing conditions can enroll in the Pre-existing InsurancePlan.

-Consumerswill not be at risk of losing benefits due to costly treatments; lifetime capson insurance coverage are banned; annual caps on coverage are restricted.

Front 406

Provision for young adults in ACA

Back 406

Children up to age 26 can be covered on their parents' insurance plans

Front 407

Provision of ACA for preventive services

Back 407

-Consumerswill not have to share the costs for preventive services. Individuals who joinnew plans will have greater access to preventive care services such as breastcancer screenings, immunizations and colonoscopies; co-pays for these serviceswill be eliminated.

Front 408

Provision of ACA for OB/GYN care

Back 408

-Womenmay receive obstetric or gynecological care from any provider and insurancecompanies will treat their authorizations the same as a primary care provider’s

Front 409

Provision of ACA for emergency services

Back 409

Consumerswill have greater access to emergency services; insurers must provide coveredemergency services regardless of whether the provider is in-network.

Front 410

Provision of ACA for primary care providers

Back 410

Patientswill have a greater choice of primary care providers including nursepractitioners and certified nurse midwives. New plans will allow patients thechoice of any primary care provider available.

Front 411

Provision of ACA for discrimination of insurance

Back 411

Consumerswill have stronger rights to appeal insurers’ decisions they feel are unfair ordiscriminatory.

Front 412

Provision of ACA for donut hole gap in Medicare

Back 412

Seniorswho reach the ‘donut hole’ gap in their Medicare prescription drug coveragebenefit will receive rebates until the “hole” is eliminated in 2014.

Front 413

What were the four main actions of the Affordable Care Act

Back 413

•Medicaidexpansion to 138% of the FPL

•Creationof Health Insurance Exchanges for people who do not qualify for public coverage or employer coverage–Subsidies will be available toassist with premiums

•Individualmandate

•EmployerPenalties

Front 414

What is the individual mandate of the ACA?

Back 414

•RequireU.S. citizens and legal residents to have qualifying health coverage. •Thosewithoutcoverage pay a taxpenalty of the greater of $695 per year up to a maximum of three times thatamount ($2,085) perfamilyor 2.5% of household income.

Front 415

Schedule for phasing in penalty of ACA

Back 415

•Thepenaltywill be phased-in according to the following schedule: –$95 or1% of taxable income in 2014,–$325 or 2% of taxable income in 2015,and –$695 or 2.5% of taxable income in2016

Front 416

Individual mandate exemptions

Back 416

•financialhardship•religiousobjections•AmericanIndian•thosewithout coverage for less than three months•undocumentedimmigrants•incarceratedindividuals•thosefor whom the lowest cost plan option exceeds 8% of an individual’s income•thosewith incomes below the tax filing threshold (in 2009 the threshold fortaxpayers under age 65 was $9,350 for singles and $18,700 for couples

Front 417

What are exchanges designed to help with?

Back 417

–Look for and compare private healthplans.–Get answers to questions about yourhealth coverage options.–Find out if you’re eligible for healthprograms or tax credits that make coverage more affordable.–Enroll in a health plan that meets yourneeds.

Front 418

Essential health benefits required in exchanges starting in 2014

Back 418

•ambulatorypatient services•emergencyservices•hospitalization•maternityand newborn care•mentalhealth/substance use disorder services, including behavioral health treatment•prescriptiondrugs•rehabilitative/habilitativeservices/devices•laboratoryservices•preventive/wellnessservices and chronic disease management•pediatricservices, including oral & vision

Front 419

Types of plans under health insurance exchanges

Back 419

Bronze, silver, gold, and platinum plans

Front 420

What are bronze plans on the health insurance exchanges?

Back 420

–represents minimum coveragewith the essentialhealth benefits–Covers 60% of the benefit costs of the plan–out-of-pocket limitequal to the Health Savings Account (HSA) current law limit ($5,950 forindividuals and $11,900 for families in 2010)

Front 421

What are silver plans on health insurance exchanges?

Back 421

Provides the essential health benefits, covers 70% of the benefit costs of the plan, with the HS out-of-pocket limits

Front 422

What are gold plans on the health insurance exchanges?

Back 422

–provides the essential health benefits,covers 80% of the benefit costs of the plan, with the HSA out-of-pocketlimits

Front 423

What are platinum plans on the health insurance exchanges?

Back 423

–provides the essential health benefits,covers 90% of the benefit costs of the plan, with the HSAout-of-pocket limits

Front 424

What % of Americans with Marketplace insurance plans feel they can afford care if sick?

Back 424

70%

Front 425

What % ofconsumers who signed up for insurance in the new Health Insurance Marketplacereceived financial assistance that lowered the cost of their monthly premium?

Back 425

85%

Front 426

How many consumers who selected plans with tax credits through federal marketplace during open enrollment got covered for $100 month or less? What % were able to get covered for $50 a month or less?

Back 426

•Nearly7 in 10 consumers who selected plans with tax credits through the federalMarketplace during Open Enrollment got covered for $100 a month or less. Nearly half – 46% – were able to get covered for $50 a month or less.

Front 427

How many people got Marketplace plans since ACA?

Back 427

7.3 million on Marketplace plans, 8 million enrolled in Medicaid

Front 428

According to the New England Journal of Medicine, the ACA reduced the uninsurance rate by what %?

Back 428

26%

Front 429

How many Americans are predicted to remain uninsured through 2016?

Back 429

•approximately30 million Americans will remain uninsured in 2016.

Front 430

Issues with rationing after ACA

Back 430

•Unintendedrationing is likely to occur because of a projected shortage of physicians,mainly primary carephysicians

Front 431

Issues with reimbursement after ACA

Back 431

•Medicaidreimbursement for primary care physicians beyond 2014 is unknown. Specialistsdo not get special reimbursement in 2013 and 2014. Physicians could refuse totreat Medicaid patients.

Front 432

Issues with disproportionate share hospitals under ACA

Back 432

•DisproportionateShare Hospitals are likely to face fiscal constraints because they do notreceive additional funding under the ACA

Front 433

Issues with care after ACA

Back 433

Many US residents will continue to rely on emergency departments for basic care

Front 434

Issues with premiums after ACA

Back 434

•Insurancepremiums continue to escalate; hence, it is unknown how this issue will beaddressed

Front 435

Effect of ACA on labor markets

Back 435

•TheACA has likely adverse consequences for the labor markets, e.g., smaller raisesin pay and an increase in part-time versus full-time workers•Theescalating national debt creates doubts about the ACA’s affordability

Front 436

Why does the number of uninsured continue to grow?

Back 436

•Shift from manufacturing to servicesector jobs•Shift from full-time to part-timeemployment•Decreasing unionization•Decline in real wages•Increasing health care costs

Front 437

How does being uninsured harm individuals and families?

Back 437

•Uninsured receive less preventive care,are diagnosed at more advanced disease stages, and once diagnosed, tend toreceive less therapeutic care and have higher mortality rates than insuredindividuals.

Front 438

Rising costs of health care are attributable to:

Back 438

•Newmedical technology•Overuseand misuse of medical services•Oversupplyof hospital beds•Highadministrative costs•Pressureon for-profit health plans to raise premiums in order to increase profits•Rapidlyescalating prescription drug costs and utilization•Consumerdemands for easier and broader access to health care•Themedical needs and demands of 77 million baby boomers

Front 439

Factors contributing to increased health care costs

Back 439

•Increasein chronic illnesses: people are living longer•Prescriptiondrugs: includes direct-to-consumer marketing•Physiciansalaries: physician as employee vs. physician as self-employed•Insurancecompany mergers: less competition•Moralhazard

Front 440

What ages are most likely to be without health insurance coverage?

Back 440

20-65; highest rates 20-35

Front 441

By income, who is most likely to be without health insruance

Back 441

Lowest income most likely to be uninsured

Front 442

Race differences in uninsurance rates

Back 442

Hispanics more uninsured than Blacks>Asians>Whites

Front 443

Nativity differences in uninsurance rates

Back 443

Noncitizen more uninsured than naturalized citizens> native-born citizen

Front 444

Why are so many Americans uninsured?

Back 444

•Thehigh cost of insurance is the main reason why people go without coverage. •Manypeople do not have access to coverage through a job, and gaps in eligibilityfor public coverage leave many without an affordable option.

Front 445

What has been happening to the uninsured over time?

Back 445

•Thetrend in the uninsured tracks economic conditions, with the number of uninsuredpeople increasing during recessionary periods when people lose their jobs. •Publicprograms fill in some of the loss of coverage, but many adults are currentlyineligible. •Inrecent years, as the economy has stabilized, coverage losses have slowed.

Front 446

Who are the uninsured?

Back 446

•Themajority of the uninsured are in low-income working families. •Reflectingthe more limited availability of public coverage, adults are more likely to beuninsured than children. •Peopleof color are at higher risk of being uninsured than non-Hispanic Whites.

Front 447

How does lack of insurance affect access to health care?

Back 447

•Peoplewithout insurance coverage have worse access to care than people who areinsured. Studiesrepeatedly demonstrate that the uninsured are less likely than those withinsurance to receive preventive care and services for major health conditionsand chronic diseases

Front 448

What are the financial implications of lack of coverage?

Back 448

•Theuninsured often face unaffordable medical bills when they do seek care. •Thesebills can quickly translate into medical debt since most of the uninsured havelow or moderate incomes and have little, if any, savings.

Front 449

Reasons for being uninsured among uninsured nonelderly adults

Back 449

Front 450

Family work status, family income, and race characterisitcs of the nonelderly uninsured?

Back 450

Front 451

Barriers to health care among nonelderly adults by insurance status

Back 451

No usual source of care, postponed seeking care due to cost, went without needed care due to cost, could not afford prescription drug

Front 452

Cumulative Increases in HealthInsurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’Earnings, 1999-2013

Back 452

Front 453

Changes in average annual premiums for single and family coverage, 1999-2013

Back 453

Front 454

Drug cost increases 2011-2013

Back 454

Front 455

Projected prescription drug expenditures 2000-2018

Back 455

Front 456

Financial consequences of medical bills by insurance status 2012

Back 456

Front 457

What is the number one cause of bankruptcy filing?

Back 457

Unpaid medical bills

Front 458

Mission of public health nursing

Back 458

Preserve, protect, and improve the health of populations through activities that improve the environment, encourage lifestyle and behavior change, and assure access to care

Front 459

State of public health in the medieval period

Back 459

Overpopulated walled towns crowded people together in very unsanitary conditions: plague, development of diseases, rapid spread of disease, little treatment, most deaths related to infectious disease

Front 460

State of public health in the Renaissance period

Back 460

•Developmentof the idea that only a political jurisdiction that protected and cared for itscitizens could reap the economic benefits of production and world trade•Healthylaborers and soldiers became valuable commodities

Front 461

Bellers and his connection to public health in England

Back 461

Bellers argues that the health of the people was too valuable to be left to the indiviual and was the responsibility of the state, which led to the establishment of poor houses, workhouses, hospitals, and provision of services to the poor

Front 462

Edwin Chadwick and his connection to public health in England

Back 462

Poor Law Commission of 1834 which advocated the use of data to link population characteristics, environmental conditions, and the incidence of disease

Front 463

What was England's Elizabethan Poor Law of 1601?

Back 463

guaranteedmedical care for poor, blind, and “lame” individuals; minimal care provided byalmshouses; this care tried to regulate the poor as well as to provide careduring illness. Early county or township government was responsible for thecare of all dependent residents, but provided almshouse charity carefully,economically, and only for local residents. Travelers and those who livedelsewhere were returned home for their care.

Front 464

What inspired first public health initiatives in US?

Back 464

Early epidemics of cholera and yellow fever led early cities and towns to responsibility for the collective health of the people; at first it was a family/friend system of care

Front 465

What was the New York Poor Law of 1788?

Back 465

Provided for the establishment by the towns of almshouses for the care of the poor, persisted into the 1930s

Front 466

Early public health initiatives in the US were motivated by:

Back 466

Economic concerns rather than humanitarian ones

Front 467

Relationship between Lemuel Shattuck and US public health

Back 467

In 1850, the Shattuck Report was released, which was the first effort that described a modern approach to public health organization. Documented the the differences in morbidity and mortality in different locations and linked them to the environment

Front 468

Who is believed to have been the first epidemiologist? What did he study?

Back 468

John Snow, studied the cholera epidemic in London in 1854

Front 469

What did John Snow discover about the cholera epidemic in London 1854 and what were his reactions?

Back 469

1854cholera epidemic. The John Snow Pub is currently located on the site of thenotorious wellhead pump that supplied the cholera-infected water that took thelives of 600 Londoners in September 1854. During that swift and terribleepidemic, Dr. John Snow did his brilliant street corner detective work(founding modern epidemiology), discovered the cause of the epidemic, andinduced the Parish Council to remove the handle of the Broad Street pump, whichended the epidemic. It's more complicated than that, but the great contributionof John Snow was to identify the public health policy thatended cholera epidemics in England: keep the drinking water clean and free ofsewage.

Front 470

Why is Florence Nightingale considered an early epidemiologist?

Back 470

Reformed military health care by using statistical data to prove her theories, and became a political reformer

Front 471

What and who were the origins of trained nursing?

Back 471

Florence Nightingale, organized nursing practice and nursing education in hospitals (1858)

Front 472

William Rathbone and his connection to trained nursing development

Back 472

In 1859 he started the District Nursing Association after realizing that there was a lack of trained nurses and that nurse training was disorganized and very variable in quality

Front 473

Origins of trained nursing and Lillian Wald and Mary Brewster

Back 473

Lillian Wald and Mary Brewster established the Henry Street Settlement 1893

Front 474

Who was Jessie Sleet (Scales)?

Back 474

The first African-American public health nurse

Front 475

Who was Clara Barton?

Back 475

Founded the American Red Cross in 1888 and its Rural Nursing Service initiated home nursing care in areas outside larger cities

Front 476

Who was Ada Mayo Stewart?

Back 476

Occupational health nursing grew out of her early home visiting efforts in 1895 with employees and families of the Vermont Marble Company in Proctor, Vermont

Front 477

Who was Lina Rogers?

Back 477

A Henry Street Settlement resident, who became the first school nurse. She worked with the children in NYC schools and made home visits to teach parents and to follow up on children absent from school.

Front 478

Where were the origins of home visiting?

Back 478

Saint Vincent de Paul in 1633, Irish Sisters of Charity in 1812, Deaconesses-- incorporated the care of the sick at home, developed a system of district nursing

Front 479

Why was the American Public Health Association (APHA) established? What else was formed within it?

Back 479

Formed to facilitate interdisciplinary efforts and promote the practical application of public hygiene

In 1923, the Public Health Nursing Section was formed within the APHA

Front 480

Who was Lillian Wald?

Back 480

firstpublic health nurse in the United States. She also established the first publichealth nursing program for life insurance policyholders at the Metropolitanlife insurance company. She provided home nursing care on a fee for servicebasis, established an effective cost accounting system for visiting nurses,used advertisements in newspapers and on radio to recruit nurses, and reducedmortality for infectious diseases

Front 481

Who was Mary Adelaide Nutting?

Back 481

1914: working with the Henry street settlement, she began the first post-training shcool course in public health nursing at Teachers College in NYC

Front 482

What and when was the first life insurance company established?

Back 482

1909 The Metropolitan Life Insurance Company was founded

Front 483

Changes with public health nursing in WWI

Back 483

Need for public health nurses to stay in the US to care for those not serving in the military

Front 484

Who was Mary Breckinridge?

Back 484

In 1925 founded the Frontier Nursing Services (FNS)

Front 485

Challenges for African-American Nurses in public health nursing? What efforts were made to help with these challenges?

Back 485

Segregated nursing education in the South until the 1960s, lower salaries in the South than for White People

The National Health circle for Colored People was established in 1919 to promote public health in African-American communities in the South and established scholarships

Front 486

What was the effect of the Economic Depression on public health?

Back 486

1930s Depression. Agencies andcommunities were unprepared to address the increased needs and numbers of theimpoverished, but decreased funding for nursing services reduced the number ofemployed nurses in hospitals and in community agencies; Federal Relief administration supportednurse employment through increased grants for state programs for home medicalcarem|viralthread.com|woundedamericanwarrior.com

Front 487

Who was the first nurse employed the US Public Health Services?

Back 487

Pearl McIver

Front 488

Purpose of the Social Security Act of 1935

Back 488

designed to prevent reoccurrence of theproblems of the depression. It provided funding for expanded opportunities forhealth protection and promotion through education and employment of publichealth nurses. It provided for education and research of medical personnel

Front 489

Relationship between World War II and public health nursing

Back 489

There was an increased need for nurses both for the war and at home. Bolton Act of 1943 established the cadet nursing corps which supported increase undergraduate and graduate enrollment in schools of nursing by providing funding, some increases in community and public health nursing training

Front 490

How did post WWII impact public health nursing?

Back 490

Sudden increases in demand for care of emotional problems, accidents, alcoholism, and other issues resulting from the war

Front 491

Purpose of the Hill-Burton Act-National Survey and Construction Act after WWII?

Back 491

Stimulated the growth of the health care industry by providing funds for hospital and health center construction

Front 492

When was the Department of Health and Human Services established?

Back 492

In 1953, it was established as the Department of Health, Education, and Welfare (HEW)

Front 493

How did health care emphasis change from WWII to the 1970s?

Back 493

Americans living longer, leading cause of death changes from infectious diseases to heart disease, cancer, and cardiovascular disease

Front 494

What new nursing organizations were established between WWII and the 1970s?

Back 494

National League for Nursing (NLN) and the American Nurses Association (ANA)

Front 495

When was the American Association of Colleges of Nursing (AACN) established?

Back 495

1969

Front 496

When Medicaid was established what was it's purpose?

Back 496

Support medical and hospital care for people classified as medically indigent, required states to establish joint federal-state programs, states have broad discretion over eligibility, benefits, and reimbursement

Front 497

Social and political influences on nursing in 50s, 60s, and 70s

Back 497

Establishment of nursing homes, county nursing services, increased need for mental health services, mass vaccination campaigns, emphasis on child growth and development, increase in chronic disease, decrease in communicable diseases, establishment of school health programs, contraceptive information and general reproductive health

Front 498

What change in public health nursing happened in 1970s?

Back 498

The hospice movement, development of birthing centers, day care for elderly and disabled persons, drug-abuse treatment programs, and rehabilitation services in long-term care

Front 499

When was the first Health People initiave?

Back 499

1979

Front 500

Changes in public health in 1980s

Back 500

Continued to emphasis on child health and well being, emergence of case management, increase in old communicable diseases and emergence of new infecitous diseases

Front 501

Changes in healthcare/nursing in the 1900s and early 2000s

Back 501

Focus on cost, quality, and access to services; health care reform debate, nurse-managed centers, nursing shortage

Front 502

What historical celebration in public health nursing occurred in 1993?

Back 502

1993 marked "Celebrating A Century of Caring" with the centennial of the establishment of the Henry Street Settlement House

Front 503

10 great public health achievements 1900-1990

Back 503

•Vaccination•MotorVehicle Safety•SaferWorkplaces•Controlof Infectious Diseases•Declinein deaths from heart disease and Stroke•Saferand healthier foods•Healthiermothers and babies•Familyplanning•Fluoridationof drinking water•Recognitionop tobacco use as a health hazard

Front 504

What are the 10 ANA Scope and Standards for Environmental Health (2007)?

Back 504

Thereare 10 principles that comprise the standards. These principles say that: (1) it is essential that nurses know aboutenvironmental health; (2) nurses should not use products or practices that harmhealth or the environment; (3) nurses have a right to work in a safe andhealthy place and nurses and other health care professionals have the right toknow in a timely manner about any possible harmful products, chemicals,pollutants, and hazards to which they may be exposed; (4) multidisciplinarycollaboration is a factor that sustains a healthy environment; (5) the choiceof materials, products, technology and practices in the environment that affectnurses is based on best practices; (6 and 7) nurses should respect thediversity of the people whom they serve and also focus on the quality of theenvironment in which they and their clients work and live; (8) nurses, otherhealth care workers, families, patients and communities have the right to knowtimely information about potentially harmful products; (9 and 10) nurses shouldparticipate in both research and advocacy related to promoting a safe andhealthy environment

Front 505

Healthy People 2020 objectives related to environmental health

Back 505

Eliminate elevated blood lead levels inchildrenMinimize the risks to human health andthe environment posed by hazardous sitesReduce pesticide exposures that result invisits to a health care facilityReduce the amount of toxic pollutantsreleased into the environmentReduce indoor allergen levelsDecrease the number of US homes that arefound to have lead based paint or related hazards

Front 506

Who developed the Environmental Model of Nursing?

Back 506

Florence Nightingale

Front 507

What is toxicology?

Back 507

thebasic science that studies the health effects associated with chemicalexposures

Front 508

Point versus nonpoint sources for air pollution

Back 508

Point sources are single site such as smoke stacks

Nonpoint sources are diffuse such as vechiles

Front 509

What is the "I PREPARE" acronym of environmental health assessment?

Back 509

Investigatepotential exposures (symptoms/timing), Presentwork (exposure, protection), Residence(year built, heating, drinking water, chemical storage), Environmentalconcerns (industry or farms near home, hazardous waste, etc), Pastwork (exposure, years in job), Activities(hobbies, garden, fish or hunt, do you consume what you eat, use of pesticides,etc), Referrals(Resources for referral ie EPA,NLM, Health department, OSHA), Educate(are educational materials available)

Front 510

What are Right to Know Laws and what do they include?

Back 510

State that the public has a right to know about hazardous chemicals in the environment--> includes CCRs (right to know reports to learn what pollutant has been found in drinking water) and MSDS (enforced by the occupational safety and health administration)

Front 511

What are unique environmental health threats in the health care industry?

Back 511

Mercury, synthetic chemical (persistent bio accumulate toxins and persistent organic pollutants), dioxin

Front 512

What is the Health Care Without Harm campaign?

Back 512

working on the reduction andelimination of mercury and polyvinyl chloride plastic in the health careindustry as well as the elimination of incineration of medical waste. (dioxinis by product of of thecombustion of PVCs)

Front 513

Roles for nurses in environmental health

Back 513

Individual and population risk assessment, referral, community involvement and public participation, risk communication, epidemiologic investigations, policy development

Front 514

What is occupational health nursing?

Back 514

*Specialty practice that focuses on thepreventive healthcare, health promotion, and health restoration within thecontext of a safe and healthy environment; includes prevention of adversehealth effects from occupational and environmental hazards and health promotionin general S

Front 515

Scope of practice for the occupational health nurse

Back 515

Worker/workplace assessment and surveillance, primary care, case management, consulting, counseling, health promotion/protection, administration and management, research, legal-ethical monitoring, community orientation

Front 516

Who was the first industrial (occupational) nurse?

Back 516

Ada Mayo Stewart

Front 517

Who was Betty Moulder?

Back 517

Hired by coal miners in 1988 to take care of ailing workers and their families

Front 518

Why was there rapid growth in Employee Health Services in the early 1990s?

Back 518

Companies recognized that the provision of worksite health services led to more productive workforce

Front 519

What contributed to the evolution of Occupational Health Nursing?

Back 519

Worker's compensation, the American Association of Occupational Health Nurses 1942, Occupational Safety and Health Act (OSHA) (1970)

Front 520

Roles of occupational health nurses

Back 520

Clinician, case manager, coordinator, manager, nurse practitioner, corporate director, health promotion specialist, educator, consultant, researchers

Front 521

Purpose of the American Association of Occupational Health Nurses

Back 521

Promotes health and safety ofworkers, defines the scope of practice and sets standards for occupationalhealth nursing practice, develops the Code of Ethics for occupational healthnursing, supports research, provides continuing education and responds to andinfluences public policy

Front 522

What is Occupational Safety and Health Administration (OSHA)?

Back 522

*Occupational Safety and HealthAdministration (OSHA):federal agency charged with improving worker health and safety by establishingstandards and regulations and by educating workers

Front 523

National Institute for Occupational Safety and Health (NIOSH)

Back 523

*thebranch of the U.S. Public Health Service that is responsible for investigatingworkplace illnesses, accidents, and hazards

Front 524

What is the Hazard Communication Standard?

Back 524

*the“right-to-know” standard that requires all manufacturing firms to inventorytoxic agents, label them, develop information sheets, and educate employeesabout these agents

Front 525

What is the Superfund Amendment and Reauthorization Act (SARA)?

Back 525

*Effective disaster plans aredesigned by those with knowledge of the work processors and materials, theworkers and workplace, and the resources of the community.*Specific steps must be detailedfor actions to be put in place by specific individuals in the event of adisaster.

Front 526

A nursing student during WWII would likely join which group?

Back 526

The Cadet Nursing Corps

Front 527

Which of the following nurses is famous for creating public health nursing in the United States?

Back 527

Lillian Wald, the creator of the Henry Street Settlement

Front 528

Why were nurses so unprepared for public health nursing in the early twentieth century?

Back 528

Nurses were educated in diploma schools which focused on hospital nursing

Front 529

A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed?

Back 529

Collecting vital statistics and improving sanitation.

Front 530

Which client would have been most likely to recieve care from the Frontier Nursing Service? 1. A child with measles2. A woman in labor3. An injured soldier4. A homebound, elderly man

Back 530

2. A woman in labor

Front 531

True or False: All states created their own insurance exchanges under the Affordable Care Act

Back 531

False

Front 532

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided?

Back 532

Capitation

Front 533

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost?

Back 533

Managed care

Front 534

True or False: The indivudal mandate of the ACA requires parental insurance companies to cover children until age 26 years

Back 534

False

Front 535

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care?

Back 535

The ability to pay for health care

Front 536

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family?

Back 536

Medicaid

Front 537

Which of the following accurately describes a challenge that will be faced by health care providers in the twenty-first century?

Back 537

emergence of new and old communicable and infectious diseases

Front 538

Which of the following would be covered under Medicare Part A? A. transportation by an ambulanceB. stay in a skilled nursing facilityC. physical therapy visitD. blood draws to assess bleeding status

Back 538

B. Stay in a skilled nursing facility

Front 539

True or false: A windshield survey is the preferred method for gathering data about a community when compared to a walking survey

Back 539

False

Front 540

Political decisions can affect the health status of a community. Use the Community as Partner Model, which theory helps explain this relationship?

Back 540

General systems theory

Front 541

Assessing air quality to determine the impact on the residents with asthma is part of which system of the Community as Partner Model?

Back 541

Physical environment

Front 542

When assessing the population's age, rleigion and ethnicity, the nurse is gathering data pertinent to which aspect of the Community as Partner Model?

Back 542

Community core

Front 543

True or false: County Health Departments conduct community health assessments so they can justify the number of nurses they have on payroll

Back 543

False

Front 544

The parasites that cause malaria are spread to people through the bites of infected Anopheles mosquitoes. The mosquito is a:

Back 544

Vector

Front 545

Ebola is now present in at least 3 continents and more than 5 countries. This would be considered:

Back 545

pandemic

Front 546

The parasites that cause malaria are spread to people through the bites of infected Anopheles mosquitoes. The parasite in this scenario is the:

Back 546

Agent

Front 547

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? A. analyzing locations where family violence is increasingB. documenting population characteristics for healthy older citizensC. reviewing commnicable disease statisticsD. determining factors contributing to childhood obesity

Back 547

D. Determining factors contributing to childhood obesity

Front 548

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement?Answers:A. Designing a game in which students select healthy food choicesB. Putting students on a diet if they weigh greater than 20% of their ideal weightC. Giving a presentation on the importance of exercise and physical fitnessD. Weighing students to identify those who are overweight

Back 548

D. Weighing students to identify those who are overweight

Front 549

Deckerville residents have been afflicted with a new viral illness. Prevalence went from 0 to 800 per 1000 residents by July 1. By August 1, the prevalance rate was 20 per 1000 residents. Which of the following statements best explains this situation?Answers:A. the virus has high infectivityB. the virus has low pathogenicityC. the virus has high virulenceD. the virus has low virulence

Back 549

A. The virus has high infectivity

Front 550

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use?Answers:A. Levels of PreventionB. Wheel ModelC. Epidemiological TriangleD. Web of Causation

Back 550

D. Web of Causation

Front 551

Which of the following is the primary cause of vulnerability to health problems?

Back 551

Poverty

Front 552

Which of the following factors predisposes many migrant farmworkers to disenfranchisement?

Back 552

Short length of time in the community

Front 553

A nurse offers homeless clients yearly TB screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used?

Back 553

Secondary prevention

Front 554

The school nurse was talking to the teacher of an 8 year old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child?Answers:A. Concern that the child may need to sit in the front in order to be able to see wellB. Concern that the child is being mistreated by other childrenC. Concern that the child has developmental delaysD. Concern that the child is given adequate food during lunch

Back 554

C. Concern that the child has developmental delays

Front 555

What racial group experiences the highest rates of poverty?

Back 555

Blacks

Front 556

What is the most rapidly growing group of homeless individuals?

Back 556

Families with children