Intervention Wheel/Public Health Intro Post, Health Teaching- February 4th, 2013

             Reflecting back on the teaching learning project from last semester, one intervention on the Public Health Wheel immediately jumped out at me. As our project targeted an elderly population in an assisted living community, we focused on how getting involved in different activities and social situations benefits physical and psychological health. That being said, health teaching is the intervention that I would apply to this project.  According to the text, a community can be defined as “a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging” (Nies & McEwen, 2011, p. 3). An assisted living community has the word community right in the name. It is a place where many common traits are shared whether it may be past experiences, age, retirement, grandchildren, or health problems. During our presentation, many of the participants agreed that they wanted to get involved more in their community. It is essential that this population understands the health benefits and follows through with participation in activities. This is why health teaching is a critical intervention because many of the elderly population suffer from or are at risk for physical and/or mental health declination. 
            As we carried out our presentation, many of the participants agreed that they would like to be more active and social. According to the text, “many elderly people share concern for the maintenance of good health, the pursuit of an active lifestyle, and the security of needed services to support a quality life” (Nies & McEwen, 2011, p. 92). Many elderly may already understand why it is important to get involved, they just don’t know where or how to start. Implementation of this plan needs to start with getting the word out to the community. First, I think there needs to be a community newsletter either put in the resident’s mail boxes or brought to their room with large print articles and a legible calendar of activities for whatever month they are in. It could even be possible that some of the residents are delegated to write and distribute these themselves. Also, I think if residents have a TV in their room that there should be a local learning channel specific to their living community with current events, socials, news, and indoor/outdoor activities. Each month, I think nurses, CNA’s, or volunteers should come in and demonstrate an “activity of the month.” It may be learning to use exercise equipment, cooking a new recipe, or learning to text on a cell phone. Also, at these monthly seminars, it is critical that nurses show visual aids demonstrating the benefits and also explaining why the elderly are more at risk for depression and other health problems. Residents should have the option of being an “activity leader” and come up with something as they desire. There should be a sign up sheet which allows them to work around their schedules. Residents will be more educated on why activities will help maintain their health, which is what many of them wish to do. 

            An example comes from the journal article I selected. Evidence shows that when elderly are engaged in social gatherings and activities, they have increased self-esteem and a lowered risk for developing depression or feelings of worthlessness. Also, a direct correlation is found from the primary research in this article that demonstrates those who are more involved are those in better health (Schafer, 2011). These are just a few of the psychological benefits from social interaction noted. Overall, health teaching will not only open up the community to new activities, but it can also promote health in this elderly population and improve their way of living.

References

Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promotion the health of populations (5th ed.) St. Louis, MO: Saunders/Elsevier.

Schafer, M. (2011). Health and network centrality in a continuing care retirement community. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 66B(6), 795-803.

We're Washing Our Hands - 02/04/13

According to a January report in the Milwaukee Journal Sentinel (2013), "Wisconsin already has more than double the number of confirmed influenza cases than all of last season, and is approaching four times the number of flu-related hospitalizations."  Although an annual vaccination is recommended by the Centers for Disease Control (2013) to first and foremost protect yourself and others from the flu, there are other everyday preventative actions to take.   

Handwashing is an effective way of preventing the spread of infection.
Bacteria and viruses, such as the flu, get on our hands through touching objects and surfaces infected.  Without proper handwashing, these germs continue to spread.  Proper handwashing is an extremely important aspect of public health.  It is important that the entire population be educated on this simple preventative action. 
 
One intervention from the Public Health Wheel that could be applied by nurses, is outreach.  Outreach locates populations of interest at risk and provides information about the nature of concern, what can be done about it and how services can be obtained" (Nies & McEwen, 2011).

In the case of hand-hygiene, a population-of-interest or population-at-risk would undoubtedly be children.  Children are notorious "germ sharers" and spreaders of illness.  In 2009, ABC News spotlighted an elementary school in Washington D.C.  The children were asked to place clear lotion on their hands which could only be seen by black light.  Despite the knowledge of how to wash their hands, at the end of the day "out of 25 students, just two had washed well" (De Nies, 2009).  Chances are, these habits are carried into adulthood and although we know "the nature of the concern" and that germs spread illness, knowing and putting it into practice are two different things.  Children, adults, and the elderly all need to be educated and reeducated. 

For the outreach to be successful, direct and indirect education must occur.  It is important to not only teach and demonstrate to individuals face-to-face the importance of hand hygiene, but also indirectly though reminders.  Many facilities hang signs demonstrating proper handwashing that encourages and reminds people.  But in our busy and hectic lives we become desensitized to all the signs and sometimes need a gentle verbal reminder. A study in the American Journal Of Infection Control increased the adherence of visitors and nonclinical staff from 10.6% to 63.7% eight months post-intervention when "an electronic motion sensor-triggered audible hand hygiene reminder was installed at hospital ward entrances" (Fakhry, 2012).  

By educating the population and implementing unique strategies, public health nurses can decrease the spread of germs between individuals and help keep everyone healthier during this influenza season and all year round.

References
  abc

Centers for disease control and prevention. (2011, July 13). Retrieved from http://www.cdc.gov/flu/
     protect/preventing.htm  

De Nies, Y.  (2009, Sep 6). Black light shows how kids spread the germs. Retrieved from 
     http://abcnews.go.com/GMA/Weekend/experiment-reveals-kids-wash-hands/story?id=8501323

Fakhry, M. , Hanna, G. , Anderson, O. , Holmes, A. , & Nathwani, D. (2012). Effectiveness of an
     audible reminder on hand hygiene adherence. American Journal of Infection Control, 40(4), 
     320-323.  

Herzog, K. (2013, January 11).  Wisconsin flu cases already double last season's count.  Retrieved
     from http://www.jsonline.com/features/health/wisconsin-flu-cases-already-double-last-seasons-
     count-6d8bnan-186577651.html

Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promotion the health of 
     populations (5^th ed.) St. Louis, MO: Saunders/Elsevier.

Interesting to think about...Think good hand hygiene!

Outreach for Immunizations- February 4, 2013

Immunizations are a very important part of the public health system at all population levels. At an individual level immunizations promote health by preventing certain diseases from occurring. At a community level immunizations work to create herd immunity which helps to protect individuals who aren't able to be vaccinated. According to the text "herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune" (Nies & McEwen, 2011, p. 496). At a national level immunization efforts can cause elimination of a certain disease within a specific geographic area and at a world-wide level immunizations can lead to eradication (Nies & McEwen, 2011). 

There is no doubt that immunizations are an extremely important aspect of public health and it is important that all populations are aware of these benefits and have access to vaccination services. One specific intervention from the public health wheel that could be beneficial when discussing immunization efforts is outreach. "Outreach locates populations of interest at risk and provides information about the nature of concern, what can be done about it and how services can be obtained" (Nies & McEwen, 2011, p. 15). In order to successfully implement an outreach plan basic steps much be taken. 

The first step in outreach is identifying the problem, in this case immunizations. Then we must locate a population at risk such as a community with limited access to health care services or one that lacks knowledge about vaccinations. After identifying the problem and population it is necessary to determine interest and learning needs. Tailoring a plan specific to a population promotes adherence. For any outreach plan to be successful there needs to be adequate resources, funds and people involved. In order for a successful outreach plan to be implemented all these components and others must work together to meet a common goal.

A real life example can be taken from an article from the American Journal of Public Health. This article discusses attempts made to improve childhood immunization practices in an urban city in New York. The plan, Start Right, was implemented in a Latino urban community where vaccination rates were very low. The program relied upon outreach, education and immunization reminders to increase immunization rates among children. Upon evaluation the plan appears to be successful. The children in the Start Right program were 53% more likely to be up-to-date on immunizations when compared to children in the controlled group (Findley, 2008).  As seen through this specific study outreach interventions can be successful in improving immunization efforts. 

References

Findley, S.E., Irigoyen, M., Sanchez, M., Stockwell, M. S., Mejia, M., Guxman, L., & Andres-Martinez, R. (2008).                        

          Effectiveness of a community coalition for improving child vaccination rates in new york city. American Journal of 

          Public Health, 98(11), 1959-1962. 

Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promotion the health of populations (5^th ed.) St.

          Louis, MO: Saunders/Elsevier.

Public Health Intervention

One intervention on the Public Health Nursing Intervention Wheel that could be applied to my teaching-learning project was health teaching. Outreach would also apply to this teaching-learning project. My partner and I researched different types of teas and how they were good for the body and presented our findings to an elderly community in Eau Claire. By teaching people about the many benefits of drinking tea and what it does for a person’s body, people can try this alternative versus using many medications or could prevent a person from having to take many medications in the future. According to The Medicinal Benefits of Green Tea by Cooper, Cooper and Morre drinking tea helps a person’s body in more ways than one. There are antioxidants, anti-cancer activity and improvement in cardiac health and atherosclerosis (2005). We also reached out to the elderly community because they have the highest rates of medication use and could benefit from this alternative.

In order to teach people about the benefits of drinking different types of tea and what they do for the body would require an event that would get the community to come together such as a health fair or something similar to that.  Nurses could also reach out to the populations that would benefit most such as the elderly in nursing homes, assisted living facilities, and retirement communities. By reaching out to these communities people could get to know this alternative to conventional medicine and be able to understand it better.

Reference

Cooper, R. C., Morre, D. J., & Morre, D. M. (2005). Medicinal benefits of green tea: Part

i. review of noncancer health benefits. The Journal of Alternative and Complementary Medicine, 11(3), 521-528. Retrieved from http://online.liebertpub.com/doi/abs/10.1089/acm.2005.11.521

Stress Management: An outreach PH intervention

Last semester’s teaching learning project involved educating the community on stress management. A great public health (PH) intervention I chose to discuss for this project is outreach. According to the Community/Public Health Nursing text, outreach “locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained” (Nies & McEwen, 2011). Stress management fits into an outreach intervention because stress is a problem factored into many health recovery and preventative measure populations.  

In order to implement this PH intervention it is important to identify the populations at high risk for stress. Stress can go on unnoticed by individuals. Those who feel the weight of everyday living as an overwhelming demand need to address their situation as being a stressor and understand that it is manageable. After assessing the need for stress management among populations, it is important to reach out to those populations and develop a way to spread awareness of stress, ways it can be managed, and the public services available to assist in that management.

An example population I found rather interesting involved stresses of parenting in mothers and how those stresses went in hand with symptoms of depression. In the article, Heneghan, Mercer, and DeLeone (2004) stated mothers felt parenting was “stressful”, “consuming”, and “overwhelming”. The outreach intervention that was conducted in this article involved mothers confiding in their child’s pediatrician about the stresses put on them while trying to raise a family. It was the responsibility then for the pediatrician to refer mothers with a certain level of depressive symptoms to adult healthcare providers for treatment. If looked at from a public health nurse (PHN) perspective, mothers found that having a good support system helped them feel less stressed and therefore made them less inclined to have depressive thoughts (Heneghan, 2004). Further out reach on stress management by spreading awareness and developing supportive services, could promote mental health and reduce incidences of depression.     

      

Heneghan, A., Mercer, M., & DeLeone, N. (2004). Will mothers discuss parenting stress and    depressive symptoms with their child's pediatrician?. Pediatrics, 113(3 Part 1), 460-467.

Nies, M.S. & McEwen, M. (2011). Community/public health nursing: promoting the health of populations (5^th ed.) St. Louis, MO: Saunders/Elsevier.

Pubic Health Intervention

              From the public health wheel, “Health Teaching” could be applied to our teaching and learning project.  We presented to older adults at Oakwood Homes the benefits of incorporating a healthy snack into one’s daily diet.  Older adults are at a greater risk for many complications as they age, and we perfected a simple idea that could increase their quality of daily life.  We shared with them a simple snack idea that could greatly benefit them by providing a serving of calcium, fruit, and fiber.  Consuming fiber daily helps to regulate the digestive system as one ages, along with decreasing the risk of heart disease (Boyles, 2003).  As one ages, their risk of osteoporosis increases, especially with inadequate consumption of calcium and for women specifically (“Osteoporosis,” 2006). 

                In order to implement an intervention of inadequate knowledge in the aging population, public health nurses could do patient teaching when elderly patients come in for a visit and have easy to read pamphlets that they could bring home with them.  Also, to reach out to older adults that do not schedule regular check-ups, public health nurses could reach out by either performing informational presentations in older communities or putting up informational posters that could be easily read and understood.   Another idea for an intervention would be to have informational booths set up at local supermarkets.  The public health nurses could have easy to read brochures and some samples of easy, healthy meals to make at home.  This would provide a great opportunity for one-on-one question and answer for the older population.

Boyles, S. (April 1, 2003).  Elderly get same fiber benefit as others. WebMD health news. Retrieved from http://www.webmd.com/heart-disease/news/20030401/elderly-get-same-fiber-benefit-as-others

Osteoporosis. (October 2006). Health problems of the elderly. Retrieved from http://www.info.gov.hk/elderly/english/healthinfo/healthproblems/osteoporosis-e.htm

Stress Management & Counseling: Public Health Intervention

Of the many possibilities from the Public Health Wheel, I found counseling as one of the many interventions that could be applied to our teaching-learning project of “Stress Management”.  According to the text, “counseling establishes an interpersonal relationship with a community, system, family, or individual intended to increase or enhance their capacity for self-care and coping” (Nies & McEwen, 2011). This intervention interacts with someone on an emotional level and usually is used in alongside of health teaching.

There are many things that are needed to implement counseling such as the ability to establish a relationship with an individual(s), assisting to identify priorities in their life and exploring them in an emotional context, identifying alternative choices, and providing support in decisions or changes.

Stress is an issue that can effect an individual or group of people their entire lives. Whether it is a teenager trying to find out where to fit in or and 80 year old who lost their spouse, learning to handle these situations is critical for our health and well being. Our targeted audience for our teaching-learning project was aimed specifically at the elderly population living within an assisted living community. Although one might believe that after retirement things would become less stressful, however counseling could be beneficial as our lives will and continue to change. According to an article published in Harvard Health, as we age things such as retirement, loss of a spouse, decline health status and physical ability, and even isolation from seeing loved ones, puts this population at great risk for stress (Benson & Casey, 2011).  During our time, we emphasized the systemic effects stress can have on the body, along with identifying stressful situations, successful means of alleviating stress, asking individuals to volunteer personal stories, and how they have learned to manage stress currently. Although we did use a lot of health teaching during our time presenting, there were many opportunities people of the community were more than willing to share with us some of their life experiences. In by no means we are experts or medically qualified to give psychological help, but through our presentation many people enjoyed the alternative stress alleviation we promoted and individualized to their needs, and our ability relating to them on a personal level. Stress is a situation that everyone deals with differently. Stress can negatively affect the body’s immunity, mental clarity, and cardiovascular system (Benson & Casey, 2011). For people who are open to the use of counseling, one is able to share feelings rather than keeping their stress and anxieties bottled up inside. Different perspectives are brought to light on experiences and one can learn how to cope and handle situations successfully.  

Jillian

References

Benson, H., & Casey, A. (2011). Stress management: Approaches for preventing & reducing stress. Harvard Medical School Special Health Report, 2-45. Retrieved from Harvard Health Publications & Harvard Medical School website:  www.health.harvard.edu

           *( Article was a health report and therefore had no volume number) 

Nies, M.S. & McEwen, M. (2011). Community/public health nursing: promotion the health of populations (5^th ed.) St. Louis, MO: Saunders/Elsevier.