CASE # 1 About: History of Public Health and Public and Community Health Nursing
Michael works as a home health nurse in his suburban community. He visits 7-10 clients each day. On today’s visitations, Michael will provide care for four clients who are recovering from hip replacement surgery and three clients who are recovering from heart surgery, and he will provide intravenous (IV) antibiotics for a man with an infected wound.
Among this list of clients, Michael visits Mrs. T., an 87-year-old white woman who lives alone and is recovering from triple bypass surgery that she underwent a month ago. Michael’s goals are to check on her recovery progress, reload her medications in her weekly medication container, and administer an influenza vaccine.
Upon entering Mrs. T.’s small house, Michael finds the house in disarray: clothes are scattered about, dirty dishes with crusted food line the kitchen counters, and no lights are on. Michael finds Mrs. T. lying in bed watching television. Mrs. T. complains to Michael of feeling too tired to do anything; she eats only what is already prepared (e.g., frozen dinners or snack foods like potato chips) because cooking requires too much effort. She spends most of her days lying in bed and has not bathed in a week.
Michael helps Mrs. T. out of bed and assists her with a bath. After the bath, Michael fixes Mrs. T. a quick lunch and refills her medication box while she eats. Michael encourages Mrs. T. to start getting some exercise by doing the household chores so that her heart can get stronger. “The stronger your heart is, the more energy you will have,” Michael tells Mrs. T. Michael also enlists several services for Mrs. T.: A home health aide will come to the house three times a week to help Mrs. T. bathe, and Meals-on-Wheels will bring her breakfast and lunch. Finally, Nurse Michael administers the influenza vaccine.
During Nurse Michael’s visit the following week, Mrs. T. is showing improvement. She tells Michael, “I just love that little girl who comes to help me; she is just so sweet. And the Meals-on-Wheels program is a blessing, I now have more energy to keep this place clean the way I like it.”
Questions
1. What challenges did Nurse Michael face in his first visit with Mrs. T. that public health nurses (PHNs) in the late 1800s also faced?
2. From your knowledge about the history of public health, compare an example of care displayed by nursing leaders of the past versus the current activities of Nurse Michael. For example, how was Nurse Michael’s nursing care similar to what Mary Breckinridge provided in the Frontier Nursing Service (FNS)?
3. How do the types of illnesses of Nurse Michael’s clients differ from the types of illnesses that were experienced by clients of PHNs in the early 1900s?
CASE STUDY # 2 ABOUT CULTURAL DIVERSITY IN THE COMMUNITY
Nurse Betty is teaching a health-promotion class to a group of Hispanic migrant workers. Nurse Betty is white, and this is her first time interacting with people of Hispanic culture. Nurse Betty speaks a little Spanish, but not enough to teach the whole class in Spanish. Most of the migrant workers speak only Spanish. Nurse Betty understands that she needs to provide culturally competent care to make her health-promotion class most effective but is not sure where to start.
Questions
1. What is the first step that Nurse Betty should take to prepare for her health-promotion class?
2. What are the language barriers, specific risk factors, and traditional healing practices that Nurse Betty must be aware of if she is to successfully interact with the group of Hispanic workers?
3. How can Nurse Betty involve the community to improve the effectiveness of her health-promotion class?
CASE # 3: ABOUT ENVIROMMENTAL HEALTH
John J. is a school nurse at Jackson Elementary School, which was built in 1960. Nurse John has noticed that many students from Ms. Zee’s second grade class have come to the clinic complaining about coughing, sneezing, runny nose, and watery eyes. Nurse John has also observed that Steven Tea, the only asthmatic student in Ms. Zee’s class, has had more asthma attacks this year than he did last year. Because the rest of the school is not experiencing the same respiratory problems, Nurse John is concerned that something in Ms. Zee’s classroom is causing students to feel ill.
Nurse John decides to visit Ms. Zee’s classroom. Upon entering the classroom, one of the few located in the school’s basement, John is struck by the powerful musty smell that inhabits the room. While talking to Ms. Zee, John learns that the classroom has “smelled bad for years,” and that students from previous years have complained about respiratory problems. Nurse John notes that Ms. Zee has stuffed a blanket at the base of the classroom’s small rectangular window near the ceiling because the window does not close completely.
John suspects that Ms. Zee’s classroom walls are contaminated with mold. Upon further research, Nurse John learns that if water gets between the exterior and the interior of a building’s wall, mold can grow in the moist environment. This situation can occur as the result of construction defects in the building (e.g., leaky windows). Nurse John also learns that people who are exposed to extensive mold growth may experience allergic reactions, such as hay fever-like allergy symptoms, and that people who already have a chronic respiratory disease, such as asthma, may experience difficulty breathing when exposed to mold. Nurse John is concerned about the possible mold contamination effect on his asthmatic student, Steven.
Questions
1. Identify the agent, host, and environment in this case study, and describe how they interacted to bring about the occurrence of disease.
2. Is the mold contamination in Ms. Zee’s room a point-source pollutant or a non–point-source pollutant?
3. What can Nurse John do to learn more about indoor air quality (IAQ) and about what to do in case of mold?
4. What are some possible interventions that Nurse John could apply to address the mold contamination in Ms. Zee’s room?
CASE # 4: ABOUT INFECTIOUS DISEASE PREVENTION AND CONTROL
Hilary S. is a nurse health inspector at the county health department. Nurse Hilary visits businesses in the community that have the potential to spread infectious diseases to large and/or vulnerable populations. Today, Nurse Hilary will visit the We Love Kids daycare center and a nearby seafood restaurant.
The daycare center cares for children ages 1 month to 6 years. To enroll a child in daycare, parents must show proof that the child is up-to-date on all age-appropriate immunizations or must show proof of medical or religious exemption. Nurse Hilary finds the records in the office area and confirms that all children have received the necessary immunizations. She observes that employees use gloves when changing diapers, cleaning a baby’s spit-up, and tending to a scratched knee from a playground accident. Employees also wash their hands after each of these events, before and after giving a baby his bottle, and before entering the 1- to 6-month-old room after leaving the 2- to 3-year-old room. Nurse Hilary also notices a flyer posted in the employee break room that informs staff of the upcoming mandatory in-service that will be held to discuss the importance of checking bottles, especially those that contain breast milk, for the correct name before feeding a child.
The seafood restaurant is a chain restaurant that has become less popular over the past couple of years. Many customers have complained about the quality of the food. Recently, 20 cases of severe diarrhea were reported to the health department by people who had just eaten at the restaurant. Nurse Hilary observes the cooks in the kitchen. The refrigerator and the freezer are kept at appropriate temperatures for storing food. Food is stored in airtight, plastic containers. Nurse Hilary watches as the cook who is preparing the chicken for broiling is also in charge of prepping the plates that are going out to the customers. Upon cutting into a piece of chicken about to go out to the dining room, Nurse Hilary notes that the center looks pink and undercooked. Pieces of wilted lettuce are scattered on the countertops. During her 2-hour visit, the main chef washes his hands twice, although he leaves the kitchen four times for a smoking break.
Questions
1. How is the daycare center providing infectious disease control?
2. Describe the outbreak of diarrhea.
A. Endemic
B. Epidemic
C. Pandemic
3. Which of the five keys to safer food does the restaurant not follow?
CASE # 5: ABOUT FAMILY HEALTH RISK
The M. family consists of Mr. M. (Harry), Mrs. M. (Shirley), 18-year-old Annie, 15-year-old Michelle, 13-year-old Sean, and 7-year-old Bobby. Harry is the pastor of Faith Baptist Church, where he has served for the past 15 years. Shirley is a housemother and is the primary caretaker for the children.
For the past year, Shirley has felt tired and “rundown.” At her annual physical, Shirley describes her symptoms to her physician. After several tests, Shirley is diagnosed with stomach cancer. Shirley starts to cry and says, “How will I tell my family?”
Shirley’s primary physician refers the family to Trisha F., a mental health nurse specialist. Nurse Trisha calls the household and speaks to Shirley. Nurse Trisha tells Shirley that she was referred by the physician, and she can help Shirley cope with the diagnosis. Shirley confides in Trisha that it has been 2 weeks since she received the diagnosis, but she has yet to tell her husband and children. Shirley asks Trisha if she can help her tell her family and explain what it all means. Nurse Trisha makes an appointment to go to the M. household and facilitate the family meeting.
Questions
1. Use the five interacting variables (physiological, psychological, sociocultural, developmental, and spiritual) of the Neuman Systems Model to assess the family’s ability to adapt to this life event. Think of one question Nurse Trisha can ask the family regarding each variable.
2. Is this life event a normative event or a nonnormative event?
3. Which phase of the home visit has Nurse Trisha reached (initiation phase, previsit phase, in-home phase, termination phase, or postvisit phase)?
CASE # 6: ABOUT CHILD AND ADOLESCENT HEALTH
Glenda R. is a parish nurse for Holy Cross Catholic Church. The church’s youth group teacher has overheard several of the 13- and 14-year-old teenagers talking about dating and sexual behaviors. The youth group teacher invites the parish nurse to speak to the group about sex and abstinence. Nurse Glenda sends letters to the parents describing when she will speak to the group about these topics and what will be discussed. Parents who would like their child to attend this class are asked to fill out the permission form.
On the night of the class, 18 of the 20 youth group members arrive for the class with their consent forms in hand. The room is set up with chairs in a circle and a computer with projector next to Nurse Glenda’s chair. Using pictures on the computer, Nurse Glenda illustrates the basic anatomy of the reproductive system and discusses what should be expected during puberty. Most of the class time is then spent discussing reasons for abstinence, how to know when you are ready for sex, and how to say no if you are not.
Questions
1. 1. Which teaching intervention designed to gather questions and feedback about the lesson would be most effective for this age group?
A. A confidential question box passed around for students to submit any questions they have about sex. Each student is asked to write something on a piece of paper, even if it is not a question or a comment, and to place it inside the box. Nurse Glenda reviews the papers and answers questions at the end of the class.
B. An open forum where students raise their hands and ask questions. Nurse Glenda responds appropriately.
C. A survey completed at the end of the class that students give to Nurse Glenda as they leave.
2. After the class has been given, Nurse Glenda talks to the parents and the church’s religious education teacher. Nurse Glenda believes that she can do more with this age group and would like to offer her services to them. She suggests that an evening of preventive screenings should be offered. What should Nurse Glenda screen for in this group of teenagers?
3. How can Nurse Glenda use interactive health communication (IHC) to reinforce the lesson?
CASE # 7: ABOUT POVERTY AND HOMELESSNESS
The community of Finnytown has identified the need for a shelter to serve homeless women and children. Finnytown currently has a homeless shelter for men. Women and children can obtain health care services there but are not allowed to stay overnight. The Finnytown health care task force performed a community assessment that revealed that a higher number of homeless men than women reside in Finnytown, but the percentage of homeless women is steadily increasing. Results further showed that more women with children than men are living in poverty. The task force speculated that many women who are living in poverty are being overlooked and thus are becoming women without homes.
The task force and the community of Finnytown decide to open a homeless shelter for women and children. The new shelter will primarily serve women with children who are homeless or in poverty. Georgia B. is the community health nurse who is a member of the task force team. Nurse Georgia and other health care professionals are charged with planning health care services for women with children to be provided at the new homeless shelter.
Questions
1. What common health problems should Nurse Georgia and the task force be aware of when planning health services to be provided at the new shelter?
2. What effects of poverty on the health of children should Nurse Georgia and the task force be aware of when planning appropriate services?
3. After the shelter opens, Nurse Georgia becomes one of the nurses who works in the clinic. What strategies are important for Nurse Georgia to implement when working with this population?
CASE # 8: ABOUT THE NURSE LEADER IN THE COMMUNITY
Ann T. is the state school nurse consultant. Nurse Ann provides guidance for school nurses across the state and organizes policy development for school nursing. Many of Nurse Ann’s hours are spent communicating by phone, face-to-face, or by e-mail with nurses and families who have questions regarding health services in the schools.
Terry L. contacts Nurse Ann. This is Terry’s first year as a school nurse, and she is working in a rural high school. She is worried about delegating medication administration to unlicensed personnel. “What exactly can be delegated, to whom, and how should I document it?” asks Nurse Terry.
Nurse Ann explains to Terry that some state laws specify who may delegate tasks, and the State Board of Nursing gives advice on which nursing tasks can be delegated. Nurse Ann tells Terry where on the Internet she can find these laws along with advisory opinions, and she e-mails copies to Terry. Nurse Ann shows Terry how to use the delegation decision tree and discusses some of Nurse Terry’s more challenging delegation issues. Nurse Terry must then use the materials to decide what she is comfortable delegating. Nurse Ann also gives Nurse Terry some sample training materials and documentation forms that other nurses in the state are currently using.
Questions
1. Which type of consultation model did Nurse Ann use? Explain your answer.
2. What can Nurse Ann do to reduce for other school nurses the confusion that surrounds delegation in school nursing?
3. What should Nurse Ann do to communicate effectively with the nurses and families whom she encounters?
CASE # 9: ABOUT FORENSIC NURSING IN THE COMMUNITY
Amanda J. is a forensic nurse who has been trained as a sexual assault nurse examiner (SANE). Amanda works part-time in the emergency room, where she occasionally examines victims of rape and sexual assault. Amanda also works part-time as a consultant for a local domestic-violence shelter for women and children. Every year Nurse Amanda helps to organize a Walk to Prevent Domestic Violence in her community. Proceeds raised from the walk go toward the domestic-violence shelter. Nurse Amanda provides literature about domestic violence at the walk as well as at other organizations in town.
Questions
1. Which levels of prevention does Nurse Amanda address in her practice?
A. Primary only
B. Secondary only
C. Tertiary only
D. Two of the above
E. All of the above
F. None of the above
2. What are the most common types of trace evidence of victims of violence, including those who are raped?
3. The concepts in forensic nursing theory include, but are not confined to, safety, injury, presence, perceptivity, victimization, and justice. How might Nurse Amanda address these concepts in her nursing practice?
History of Public Health and Public and Community Health Nursing
**CASE #1: History of Public Health and Public and Community Health Nursing**
- **Challenges Faced by Nurse Michael and Late 1800s PHNs:**
Nurse Michael faced challenges similar to those encountered by public health nurses in the late 1800s, such as addressing the living conditions and social determinants of health of his clients. Just like PHNs of the past, Nurse Michael had to navigate issues related to poverty, lack of social support, and unhealthy living environments that directly impacted his client’s health.
- **Comparison of Nursing Care:**
Nurse Michael’s nursing care shares similarities with the work of nursing leaders like Mary Breckinridge of the Frontier Nursing Service (FNS). Both provided comprehensive care to underserved populations in their communities, addressing not only medical needs but also social and environmental factors impacting health. Nurse Michael’s provision of holistic care, including assistance with activities of daily living, health education, and connecting clients with community resources, mirrors the approach of nursing pioneers like Mary Breckinridge.
- **Difference in Types of Illnesses:**
The types of illnesses experienced by Nurse Michael’s clients, such as post-surgical recovery and chronic conditions like heart disease, reflect advancements in medical care and changing demographics compared to the illnesses prevalent in the early 1900s. PHNs in the early 1900s often dealt with infectious diseases, maternal and child health issues, and sanitation-related illnesses due to poor living conditions and limited access to healthcare services at the time.
**CASE #2: Cultural Diversity in the Community**
- **First Step for Nurse Betty:**
Nurse Betty should engage in cultural competence training and education to better understand the Hispanic culture, including language, customs, beliefs, and healthcare practices. This will help her effectively communicate and provide culturally sensitive care to the Hispanic migrant workers.
- **Awareness of Language Barriers, Risk Factors, and Healing Practices:**
Nurse Betty should be aware of language barriers that may hinder effective communication, specific health risk factors prevalent among Hispanic migrant workers (e.g., occupational hazards, limited access to healthcare), and traditional healing practices commonly used within the Hispanic community.
- **Involving the Community:**
Nurse Betty can involve community members, cultural liaisons, or interpreters to bridge communication gaps and ensure culturally competent care. Collaborating with community leaders and organizations can also enhance the effectiveness of her health-promotion class by incorporating culturally relevant content and strategies.
(Continued in next message)
**CASE #3: Environmental Health**
- **Agent, Host, and Environment Interaction:**
– **Agent:** Mold contamination in Ms. Zee’s classroom.
– **Host:** Students, including asthmatic student Steven Tea.
– **Environment:** Ms. Zee’s basement classroom with poor ventilation and a musty smell.
These factors interact to expose the students, particularly Steven, to mold spores, exacerbating respiratory symptoms and increasing the risk of asthma attacks.
- **Point-Source or Non-Point-Source Pollutant:**
The mold contamination in Ms. Zee’s room is a point-source pollutant since it originates from a specific location, i.e., the classroom. Non-point-source pollutants are diffuse and arise from multiple, dispersed sources.
- **Learning More About Indoor Air Quality (IAQ) and Mold:**
Nurse John can collaborate with environmental health experts or conduct IAQ assessments to identify mold sources and assess air quality. Educating school staff and students about IAQ, mold prevention, and proper ventilation practices can also be beneficial.
- **Possible Interventions:**
Nurse John could:
– Coordinate with school administration to address structural issues causing moisture buildup and mold growth.
– Implement regular cleaning and maintenance protocols to prevent mold recurrence.
– Provide education on asthma management and environmental triggers to students like Steven Tea.
– Advocate for improvements in school infrastructure to ensure a healthier learning environment.
**CASE #4: Infectious Disease Prevention and Control**
- **Infectious Disease Control at Daycare Center:**
The daycare center implements various measures for infectious disease control, including:
– Ensuring children are up-to-date on immunizations.
– Using gloves and hand hygiene protocols during diaper changes and other caregiving tasks.
– Training staff on proper food handling practices.
– Conducting regular staff training on infection control.
- **Description of Diarrhea Outbreak:**
The outbreak of severe diarrhea reported by customers of the seafood restaurant is an epidemic, as it involves the sudden increase in cases of a specific disease within a localized area and time frame.
- **Five Keys to Safer Food Not Followed by Restaurant:**
The restaurant fails to follow the key of ensuring food is cooked thoroughly, as evidenced by undercooked chicken. This violates food safety standards and increases the risk of foodborne illness transmission.
(Continued in next message)
**CASE #5: Family Health Risk**
- **Assessment Using Neuman Systems Model:**
– **Physiological:** How is Shirley’s cancer diagnosis affecting her physical health and functioning?
– **Psychological:** How are Shirley and her family coping emotionally with the diagnosis and its implications?
– **Sociocultural:** What cultural beliefs or values influence the family’s understanding and response to illness?
– **Developmental:** How are Shirley’s children, at different ages, processing and adjusting to their mother’s illness?
– **Spiritual:** How does the family’s faith and spirituality provide support and meaning during this challenging time?
- **Normative or Nonnormative Event:**
Shirley’s cancer diagnosis represents a nonnormative event, as it deviates from the expected life course and poses significant challenges for the family’s adaptation and functioning.
- **Phase of Home Visit Reached by Nurse Trisha:**
Nurse Trisha has reached the initiation phase of the home visit, where initial contact is made, and the purpose of the visit is established. Subsequent phases will involve previsit preparation, conducting the visit, and follow-up.
**CASE #6: Child and Adolescent Health**
- **Effective Teaching Intervention:**
- A confidential question box allows students to submit questions anonymously, encouraging open communication about sensitive topics while respecting privacy and confidentiality.
- **Preventive Screenings for Teenagers:**
Nurse Glenda can screen for:
– Developmental milestones and growth parameters.
– Vision and hearing impairments.
– Mental health concerns, including depression and anxiety.
– Risky behaviors such as substance abuse and sexual activity.
- **Using Interactive Health Communication (IHC):**
Nurse Glenda can utilize IHC by:
– Incorporating multimedia resources and interactive activities into her teaching sessions.
– Establishing online platforms or support groups for ongoing discussion and information sharing.
– Encouraging peer-to-peer interaction and collaboration in health promotion efforts.
(Continued in next message)
**CASE #7: Poverty and Homelessness**
- **Common Health Problems in Homeless Women and Children:**
Nurse Georgia and the task force should be aware of:
– Malnutrition and food insecurity.
– Mental health issues, including depression and anxiety.
– Infectious diseases due to crowded living conditions.
– Chronic health conditions exacerbated by lack of access to healthcare.
– Substance abuse and addiction.
- **Effects of Poverty on Children’s Health:**
Poverty can impact children’s health by:
– Limiting access to nutritious food and adequate housing.
– Increasing exposure to environmental hazards and stressors.
– Impeding access to healthcare services and preventive care.
– Contributing to developmental delays and educational disparities.
- **Strategies for Nurse Georgia:**
Nurse Georgia can:
– Provide culturally sensitive and accessible healthcare services at the shelter.
– Collaborate with community organizations to address social determinants of health.
– Offer health education and preventive screenings targeting homeless women and children.
– Advocate for policies and resources to alleviate poverty and homelessness in the community.
**CASE #8: Nurse Leader in the Community**
- **Consultation Model Used by Nurse Ann:**
Nurse Ann utilizes a collaborative consultation model, where she provides guidance, resources, and expertise to Nurse Terry while empowering her to make informed decisions based on her unique context and needs.
- **Reducing Confusion Surrounding Delegation:**
Nurse Ann can:
– Develop clear guidelines and protocols for delegation in school nursing settings.
– Offer regular training sessions and workshops on delegation principles and best practices.
– Provide ongoing support and mentorship to school nurses facing delegation challenges.
- **Effective Communication Strategies:**
Nurse Ann can communicate effectively by:
– Using various communication channels, including phone, email, and face-to-face meetings.
– Providing clear and concise information tailored to the recipient’s level of understanding.
– Offering opportunities for feedback and clarification to ensure messages are received and understood.
**CASE #9: Forensic Nursing in the Community**
- **Levels of Prevention Addressed by Nurse Amanda:**
Nurse Amanda addresses all levels of prevention (D. Two of the above) by:
– Providing primary prevention through community education and advocacy efforts.
– Offering secondary prevention by conducting forensic examinations and providing support to victims.
– Supporting tertiary prevention by participating in efforts to address the long-term effects of violence and promote recovery.
- **Common Types of Trace Evidence:**
Common types of trace evidence found on victims of violence, including rape victims, may include:
– DNA evidence.
– Fibers from clothing.
– Hair or bodily fluids.
– Fingerprints or skin cells.
- **Addressing Forensic Nursing Concepts:**
Nurse Amanda can address forensic nursing concepts by:
– Ensuring safety and privacy during forensic examinations.
– Documenting injuries and evidence accurately and comprehensively.
– Providing support and referrals for victims seeking justice and healing.
– Advocating for policies and practices that enhance victim rights and forensic nursing practice.
History of Public Health and Public and Community Health Nursing
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