Exam 7

facilitate normal development, safety, case management and collaboration

school

uninsured status of youths

increaed absenteesim

over 100

Assessment, tx minor conditions, referrals

1960

• kids with disabilities have access to education
• increases nurse responsibilities to work with special needs kids

Funded state education agencies to develop and implement programs aimed at alcohol and tobacco use, PE, and reduction of STDs

Safe and Drug Free Schools and Committees Act

Created safe, drug free enviornment

r/t childhood obesity- kids get healthier school lunches

• Awareded funds to 278 school-based health service centers to create new sites and expand services
• Led to expanded services in medically underserved areas

• Heath education
• physical education
• heath services 
• nutrition services
• counseling, psych and social services
• healthy enviornment
• health promotion for staff
• family and community envolvement

• Alcohol and drug use
• injury and violence
• tobacco
• poor nutrition
• lack of physical activity
• sexual behavior resulting in STDS

• promoted positive health behaviors in all grades
• gave students families and communities a framework for development of health education programs

2 years

• Reports provided valuable info that can help improve health education programs in schools
• Utilizes Healty People 2020

• Bicycle safety- helmets
• proper use of backpacks
• schoolyard and playground safety
• motor vehicle safety- teens
• sport safety- equipment, hydration, stretching, pool safety

alcohol

marijuana

younger ages

highest vs other developing countries

• 21
• controversial

• not finishing school
• poverty
• single parent

Increased success rate if adequate support system

• increased
• gay/bisexual men 18-24

attention seeking

Hep c & MRSA common

dental

early and periodic screenig, dx and tx

ADHD

strong pt protection act of education and health records

delegate fundtions to teachres/secretaries

nurse resonsible for education, written proceudes, ongoing supervision and eval

obesity

syndrome of: eating disorders, amenorrhea, and osteoporosis

Psych and physiologic problem

Can result in: menstrual irregularies, premature osteoporosis, decreased bone mineral density---possibly life threatening

violence

elementary schools

focus on stress management, confilict and anger resolution, and personal and self-esteem development

• every school expected to have emergy plan
• nurse potential first responder and should be activie participant

• BP control, daily exercise, smoking cessation, weight control, improve moral, reduce job stress
• increase educaiton: health related topics

community

education, resource leadership, consultant, advocat

• Single parent
• Household with 1 high school dropout
• Poverty
• Ling with parents with no steady income
• Family on welfare
• No health insurance

bachelours

school health centers

NP, social workers, psychologist, Drs

• lessons no more than 10 minutes
• Use lots of examples, pictures, and stuffed animals

• 1: fishing
• 2: logging

focuses on promotion, prevention, and restoration of health with in the context of safe and healthy enviornment

• very autonomous
• independent and able to make nursing judgements

OHN multidiciplanary bases

context of health care delivery and recognizes needs

specific to treatment and management of injury or illness

• Toxicology_ recognizes routs of exposure, examin relationships between exposuers nad workplace and health effects
• Industrial hygiene- ID and evaluate workplace hazards so control mechanisms can be implemented
• Safety- ID and control workplace injuries through activie safeguards and worker training
• Ergonomics- to match the job to the worker, emphasizing capabilities and minimizing limitations

study heatlh and illness trends and characteristcs of worker population

strategic and operational palnning for quality and cost-effective service

explores influences of arious envornments ( home and work) relationships, and lifestyle factors on worker health to detrmine interactions affecting workers

compliance with mandates and ethical considreations

toxicology and ergonomics

betty moulder hired by group of coal mining companies to take care of miners and their families

Ada Mayo Stewart was first industrial nurse (hired by Vermont marble company)

Anna Duncan emplyed to visit sick emplyees at home

• Workers comp legislation passed- 38 nurses were emplyed by business firms
• Cost effectiness of providing health care to employes more recongized

Factor Nurses Converance Organized

Gov demanded health services for workers at factories and shipyards holding defense contracts

increased number of women in workforce

OSHA established

RE-energized the concept of OH into practice: Established competencies

• Changing demographics
• increase healthcare costs
• diverstiy of healthcare systems
• influence of world economy
• shift in production: goods to services
• advanced technology

away from large facilities to smaller, service-based businesses

management

• bloody, body fluid
• example: hep B

• solvents, lead, asbestos, acids, glycol ethers, mercury, arsenic
• Ex: HA, CNS dysfunction, asbestosis, burns, reproductive problems, ataxia, periph neuropathy

• static/nonneutral postures, repetitive exertions, lighting, shift-work, electrical, slips and falls, struck by object
• Ex: muculoskeletal disorders, back injuries, HA, eye strain, sleep disorders, electrocution

• noise, radiation, vibration, heat
• Ex: hearing loss, reproductive effects and cancer, Raynaud's disease, heat exhaustion/stroke

• stress, work-home balance
• Ex: anxiety, interpersonal relationships

• Work overload
• Time pressure
• Lack of social support
• Exposure to infectious disease
• Needle sticks injuries
• Exposrue to work related violence
• Sleep deprivation
• Understaffing
• Dealing with difficult pts

• Lung Disease- cancer, asthma
• Musculoskeletal- back, arms, shoulders
• Cancer- leukemia, bladder, skin
• Trauma- death, amputation, fracture
• CV- HTN, heart disease
• Reproductive- infertility, miscarriage
• Neurotoxic- neuropathy, toxic psychosis
• Noise-induced hearing loss
• Skin- burns, allergies
• Psych- neurosis, alcholol/substance abuse

• Facilitates lifestyle change- enhances awareness, increases motivation, builds skills, and creates supportive enviornment
• Recognize risks: routinely do walk through
• size the moment with every employee encounter- ALWAYS BE OBSERVENT
• CV health, cancer awareness, personal safety, immunizaiton, prenatl and postpartum heatlh, accident prevention, retirement health, stress management, relaxation techniques, maternal-child

• Focuse on id of health needs, probs, empolyees at risk
• preplacement, periodic and job transfer evals
• vision, cancer, cholesterol, HTN, DM, TB, pulmonary, mammography screenings

• Case managemtn, negotion of workplace accomodations, counseling and support for workers continually affected by chronic disease and disability
• Disability syndrome: a state in which an individual chooses not to work when medical clearance has been granted
• If a pt has na injury- always get them back to work ASAP even if it is a modified job

Employers must “furnish a place of employment free from recognized harm that are causing or likely to cause death or serious physical harm to employees.

• State based
• Provided income replacement & health care for employees who sustained a work related injury or death

Employers must make “reasonable accommodations” to enhance opportunities for individuals w/ disabilities

Prohibits discrimination on basis of disability

application of nursing process to public or legal proceedings, & the application of forensic health care in the scientific investigation of trauma &/or death r/t abuse, violence, criminal activity, liability, & accidents

• Screening
• Assessment and collection of evidence
• Documentation and expert testimony 
• Involvement with workplace injuries, malpractice, vehicle accidents, food and drug tampering, and medical equipment defects

• Collect forensic evidence r/t a reported crime & frequently testifies as a witness
• Conducts a thorough exam & history
• Crisis intervention referral
• Eval of victim for STDs
• Pregnancy risk assessment & care
• Client referral for additional support –follow up testing

• critical
• no curtains
• Walls

Exam process is voluntary nad pt has right to refuse or leave at any point during the exam or evidence collection

• holistic perspective
• Posesses essential knowledge of anatomy, physiology, pharmacology, G&D, physical exam, and heatlh hx interviewing techniques
• Might interpret scene differently than professionals w/o medical knowledge

• Responsible for ensuring that appropriate measures were taken to perform death investigation & certify death certificates
• Use nursing knowledge to ID disease processes that lay coroners might not recognize as foul play
• Utilize crucial communication skills when dealing w/ grieving families
• Board certified by American Board of Medicolegal Death Investigation

• Provides assistance w/in legal system using specialized nursing knowledge
• Evaluates, analyzes, renders informed opinions on delivery of care
• Review/interprets medical records
• Provides objective opinions based on standards of care
• Testifies in court as expert

• Educated in law & nursing
• Often involved in malpractice cases
• May be involved in licensure disciplinary action or agency oversight
• Serves as legal consultant

• Connects gap b/w criminal justice, legal, & mental health systems
• Applies nursing process to cts pending criminal hearing or trial
• Determines intent or diminished capacity in pts thinking @ time of the incident
• May be called on to testify as expert witness

• Emergency and critical care
• Delivers care to living and dead
• Works with survivors (DV, assault, homicide)
• ID forensic cases
• Initiates proper colleciton, preservation, and chain or command of evidence
• provides accurate documentation

• Conducts & provides detailed physical exam & collects evidence
• ID acceptable candidates & potential organs & tissues for harvest
• Must be knowledgeable about legal specifications r/t organ donations & have familiarity when determining brain death
• Has excellent communication skills and ability to relate empathetically with grieving families

• Prevention & Treatment Act (CAPTA) & DHHS – neglect, sexual abuse, physical abuse, emotional abuse
• Ensures abuse is swiftly identified & reported to proper authorities

• Most underdx & under reported crime in U.S.
• Forms: physical, psych, financial, neglect, sexual Most frequent abusers = adult children

• Well documented that disabled more likely to be mistreated
• Across lifespan, risk of 1+ forms of maltreatment triples compared w/ risk for individuals w/o disability

• Primary goal: maintain a safe, secure, & humane environment for inmates
• Recognize safety & security issues for nurse: care wont be given if safety and security needs arent met
• Always maintain an escapse route
• Undersand prison culture: inmates maniuplate nurses and environment is highly isolated

• Screening each inmate upon entry into facility
• Health care triage – psychical & mental exam
• Chronic & communicable diseases: HIV, hepatitis, TB
• Women – drug use, victimization, stress (separation from kids)
• Teens – ill equipped to deal w/ adult challenges (r/t development) & must be aware of vulnerability

• Specialty education needed to obtain certificate in forensic nursing, a minor or concentration, or graduate degree
• Specialized curriculum: fundamentals of forensic nursing, forensic law, forensic science
• Minimum # of supervised clinical hours
• Clinical internship maybe required

care of the spirit, assist to maintain/regain wholeness in body, mind, & spirit

Nurse State Practice Act, ANA, FCN Scope, & Code of Ethics

Intentional integration of the practices of faith & nursing so that people can achieve wholeness in, with, & through the community of faith in which they serve.

• Lutheran Minister 
• Founder of Parish Nurse/FCN
• 1984: proposed first FCN program
• Huge advocate for nurses and recognized team approach to incorporate nures into pastoral team
• "To attempt to practice medicine and nursing as if they were pure sciences is impossible. They are also arts and as such are intimately connected with the faith both of the healer and the healed."

parish nursing gained national attention because huge money crunches and reimburements changes lead to push of pts outside hosiptal

Standards and Scope of Parish nursing

parish nursing changed to FCN

American Nurse Credentialing Center – portfolio based certification Internationally Practices (>23 countries)

• Spiritual dimension = central to practice
• Balances nursing science & technology w/ service & spiritual care
• Cts are members of faith community/church & public service
• Services built on principles of self-care & capacity
• Holistic health—connects spiritual, psych, physical, & social

• Role of church in healthcare
• Hx & philosophy of FCN
• Models of faith
• Roles & functions of FCN
• Community Assessment & Resources
• Health promotion across the lifespan
• Philosophy of self-care
• Legal & ethical issues
• Ministerial team & nsg role
• FCN’s role in worship, prayer, healing
• Starting FCN program

• heatlhy eating
• exercise
• CPR
• first aid

Transportation, go to Dr with ct

counselor- DO NO replace other tyeps of nursing ( home health)

spiritual care NOT nursing tasks

• Diversity – still use nsg process
• Sponsor & support refugees
• Develop homeless programs
• Assistance to low-income families
• Resources to communities during disasters

• Partner w/ Hospice & home health
• Education on living wills
• Establish surrogates
• Home visits
• Emotional support
• Develop grief support groups

• Understand Risk factors
• Knowledge of cycle of abuse
• Assessment skills critical

• Same degree as paid employees
• Not exempt from discrimination laws
• May required to disclose confidential info in court
• Nsg standards & civil laws

human desire for sense of meaning, purpose, connection. & fulfillment thru intimate relationships & life experiences

• a disruption in the life principles that pervades a person’s entire being & that integrates & transcends one’s theological & psych nature.
• Disruption in what people believe & how they incorporate that into their lives

• Caring
• Intuition
• Respect
• Caution
• Listening
• Emotional support

women

builidng rapport

• Organized, operated, and funded by local or state governments.
• Located within the county public health system. Taxpayers fund official home health agencies.
• Agencies also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies

Not required to pay federal taxes because of tax exempt status

• Agency reinvests any profits into the agency
• Eamples: independent home health agencies and some hospital-based home health agencies

• Agencies classified as for-profit pay federal taxes on the profits generated.
• Can be individual owned, profit partnerships, or profit corporations.
• Investors in corporate proprietary partnerships receive financial returns on their investments in the agencies. – larger agencies buy out smaller agencies
• A percentage of the profits are also reinvested into the agency.
• Agencies within chains have financial advantage over single agencies.

• Receive fixed reimbursement under PPS and the hospitals’ incentive to decrease length of stay.
• Hospitals are able to discharge patients who have skilled health care needs, provide necessary services to patient, and receive reimbursement through third-party payers.
• Often considered profitable endeavors that provide hospitals with an additional revenue source

• meet fed standards
• receive medicare payments for services provided to eligible individuals

• Operate outside the medicare system
• Provide non-medicare-covered services
• Do not provide skilled nursing care and are not eligble to recieve medicare reimbursement
• Do not require Drs. order- bathing, shopping, cooking
• Companion Care

family or caregivers support

• 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

data set that dtermines Medicare pay rate and measures outcomes of adult home care patients to monitor outcome-based quality improvement

• sociodemographic
• environmental
• support system
• health status
• functional status attributes of an adult patient

all Medicare and MEdicaid patients receiving skilled care

• Prescribes pharmacological and nonpharmacological treatment to manage chronic illnesses
• Provides consultation and serves as a resource to the generalist home health nurse
• Participates at all levels of quality improvement and research
• Educates all members of the health care team about emerging trends in home health care

Provides grief support to the family after the patient has died

good for air hunger