Class notes
Community and mental health exam 2
- Course
- Community & Mental Health
- Institution
- Rockhurst University
Lecture notes of 27 pages for the course Community & Mental Health at Rockhurst University (Study guide)
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Community and Mental Health Exam 2Disease Definitions **
Endemic – diseases that are always present in a population (ex: colds and pneumonia)
Epidemic – diseases that are not always present in a population but flare up on occasion (ex: diphtheria, measles)
Pandemic – the existence of disease in a large proportion of the population – a global epidemic (ex: HIV, AIDS,
annual outbreaks of influenza type A) COVID!
Assessment
Establish a professional relationship good
-
communication
Meet with group leaders to clarify mutual expectations and available meeting times
Determine sociodemographic characteristics -
age ,
race , gender
Gather information from a variety of sources and interview a key informant (concerned citizen)
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the health problems and needs to create an effective plan
Four Types of Needs to Assess
Expressed needs – demand for services and the market behavior of the targeted population
Normative needs – lack, deficit, or inadequacy as determined by expert health professionals
Perceived needs – population’s wants and preferences
Relative needs – gap showing health disparities between the advantaged and disadvantaged populations
Factors When Determining Priorities
The aggregate’s preferences
Number of individuals in the aggregate affected by the health problem
Severity of the health need or problem
Availability of potential solutions to the problem
Practical considerations such as individual skills, time limitations, and available resources
Refine the priorities by applying a framework such as Maslow’s hierarchy of needs or Leavell and Clark’s levels of
prevention
BASIC NEEDS TAKE PRIORITY
Community Involvement is Essential
The nurse is responsible for advocating for client empowerment throughout the assessment, planning,
implementation, and evaluation steps of the process
Successful health programs rely on empowering citizens to make decisions about individual and community health
Empowering citizens causses power to shift from health providers to community members in addressing health
priorities
Planning
Determine the intervention levels
- Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
- Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned interventions according to available resources
, - Personal, aggregate, and suprasystem
Coordinate the planned interventions with the aggregates input to maximize participation
Development of Goals and Objectives
Goals – where the nurse wants to be
Objectives – steps needed to get there
- Measurable objectives are the specific measures used to determine whether the nurse is successful in
achieving the goal
- Objectives are instructions about what the nurse wants the population to be able to do – use verbs and include
specific conditions (how well or how many)
- Used to measure outcome – describes behavior rather than knowledge
- May also be referred to as behavioral objectives or outcomes
Interventions/Evaluation
Interventions
- Often the most enjoyable stage for the nurse and the clients
- Implementation should follow the initial plan
- Prepare for unexpected problems
- If the intervention is not able to be completed, analyze the reasons for failure
- Should include a range of strategies
Evaluation
- Include the participants verbal or written feedback and the nurse’s detailed analysis
- Reflect on each previous stage to determine the plan’s strengths and weaknesses (process or formative)
- Reflect on whether or not the desired outcomes were achieved (product or summative)
- Communicate follow-up recommendations
Importance of Each Step in the Nursing Process
Aggregate assessments must be thorough
- Should elicit answers to key questions about the aggregate’s health and demographic profile
- Should compare this information with similar aggregates presented in the literature
The nurse must complete careful planning and set goals that the nurse and the aggregate accept
- Mutual planning is very important
Interventions must include aggregate participation and must meet the mutual goals
Evaluation must include process and product evaluation and aggregate input
Affordable Care Act (ACA) of 2010
National health insurance program HEAVILY AFFECTEDBY POLITICS
Reduced premium costs
Capped out-of-pocket expenses
Required preventative care to be fully covered without any out-of-pocket
Set clear rules for insurance companies
Prohibited insurance companies for denying coverage because of a person’s preexisting medical conditions
, Purpose of Home Health Services
Primary purpose is to provide nursing care to individuals and their families to their home
Services vary according to the type of agency providing services and the population served
Reimbursement – fixed amount of money based on reasonable cost given the client’s diagnosis and plan of care
Focuses on care of sick patients and is expanding to include health promotion and disease prevention interventions,
including client and family education
Nurses must document that the care provided is of a skilled nature that requires the knowledge and assessment skills
of a nurse and must verify that the patient or a family member could not provide the same level of care
Services may also include physical, occupational, and speech therapists; social workers; and home health aids
Telephone support services are becoming an increasingly important aspect of home health care
Intermittent – can’t be 24 hours!!
Special Home Health Programs
Many home health agencies offer special, high-technology home care services
- Beneficial to the patient’s health
- Less costly than hospitalization
Examples of high-tech services: **
- Daily infusions of TPN or antibiotic therapy
- Pediatric services for children with chronic health problems
- Follow-up for premature infants at risk for complications
- Ventilator therapy
- Home dialysis programs
Reimbursement for Home Care **
May be eligible for home care through a Medicare-certified home health agency
- Individuals 65 or older
- Homebound and under the care of a physician
- Requires medically necessary skilled nursing care or therapy services
- Services must be intermittent or part-time and require physician authorization and periodic review of the plan
of care
- Home care RN determines the schedule and number of visits without calling Medicare to get pre-approval
- Only exception is hospice care
Private health insurance
- Requires preapproval of services and referrals from primary care providers
- RN at the insurance company determines the number of visits that the insurance company will cover
Generalist Home Health Nurse
Expectations at generalist level
- Community health assessment skills
- Provide client and caregiver education
- Perform nursing actions following the client’s plan of care
- Manage resources to facilitate the best possible outcome
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