Community Nursing

Chapter 17 Women’s Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Women’s Health “… essential to the development of health care for women are the concepts of health promotion, disease and accident prevention, education for self-care and responsibility, health risk identification and coordination for illness care when needed.” – Preamble to a New Paradigm for Women’s Health, Choi (1985) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Major Indicators of Health Life expectancy for Americans is at an all-time high.  Mortality rates ➢ ➢ ➢ ➢ Cardiovascular disease (CVD) continues to be the number one overall killer of women. Cancer rates are increasing because of lifestyle choices, environmental carcinogens, and increase in life expectancy. Diabetes mellitus causes the premature death of many women and is a risk factor for CVD. Gaps exist in the availability and quality of reproductive health care services globally. From http://www.nhlbi.nih.gov/educat ional/hearttruth/ From http://ndep.nih.gov/partn ers-communityorganization/campaigns/ SmallStepsBigRewards. aspx Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Major Indicators of Health (Cont.)  Morbidity rates ➢ More women than men are hospitalized each year in the United States. ➢ Women are more likely than men to be disabled from chronic conditions. ➢ Women are more likely than men to have surgery; many surgeries relate to reproductive health. ➢ The most frequently occurring interruption in women’s mental health relates to depression. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Social Factors Affecting Women’s Health      Health care access Education and work Employment and wages Working women and home life Family configuration and marital status Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Health Promotion Strategies for Women       Collaboration and an interdisciplinary approach are necessary to meet the health care needs of women. Women should receive services that promote health and detect disease at an early stage. Many women seek information that will allow them to be in control of their own health. Women desire to become more knowledgeable about their own health. Health promotion for low-income, underserved women may differ from that for middle-class women. Knowledge deficits about one’s own health prevail among women regardless of socioeconomic or educational level. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Common Acute Illnesses in Women   Urinary tract infection and dysuria Diseases of the reproductive tract ➢  Chronic diseases ➢  Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID), and toxic shock syndrome (TSS) Coronary vascular disease (CVD) and metabolic syndrome, hypertension, diabetes, arthritis, osteoporosis, and cancer (breast, lung, gynecological) Mental disorders and stress Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Reproductive Health Concerns  Nutrition ➢   Dysmenorrhea Family planning ➢ ➢  Includes total life nutritional experience Includes fertility control and infertility Need multiple safe options designed to meet the individual needs of all women STIs, HIV, and AIDS ➢ ➢ Women need age-appropriate STI prevention, education, and counseling. Worldwide, AIDS is a leading cause of death among young women. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Other Issues in Women’s Health  Unintentional injury or accidents ➢  Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States. Disabilities resulting from acute and chronic conditions ➢ Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Major Legislation Affecting Women’s Health Services  Public Health Service Act (1982) ➢ Provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery. ➢ Includes the Family Planning Public Service Act  Title VII of the Civil Rights Act of 1964 ➢ ➢ ➢ Prevents discrimination based on sex, race, color, religion, or national origin Amended to also include pregnancy and childbirth Sexual harassment is violation of Civil Rights Act Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Major Legislation Affecting Women’s Health Services (Cont.)  Social Security Act ➢  Occupational Safety and Health Act (OSHA) ➢ ➢  Provides monthly retirement and disability benefits to workers and survivor benefits to families Enacted in 1970 Ensures safe and healthful working conditions Family and Medical Leave Act (FMLA) ➢ ➢ Enacted in 1993 Provides 12 weeks of unpaid leave each year for family and medical reasons Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Health and Social Services to Promote the Health of Women  Affordable Care Act (ACA) of 2010 ➢ ➢ ➢ Protection from being denied coverage by insurance companies Protection from being charged more for health care services because of their gender Preventive care without copays including: • Well-women visits with screening and counseling for gestational diabetes, HPV, STIs, HIV, contraception, and domestic violence • Breastfeeding counseling support and supplies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Health and Social Services to Promote the Health of Women (Cont.)  Medicaid (1965) ➢ ➢ ➢ ➢ A federal- and state-funded health insurance program for the poor Expanded under ACA to persons under 65 with an income below 133% of poverty level Largest source of funding for people with limited income, regardless of age eligibility Five broad coverage groups: • Children, pregnant women, adults in families with dependent children, individuals with disabilities, individuals 65 years or older Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Health and Social Services to Promote the Health of Women (Cont.)  Women’s health services ➢ Provide primary health care needs, as well as reproductive and maternity care services including: • Eating disorders • All forms of abuse • Disease prevention, including smoking cessation

• Health promotion focusing on nutrition, exercise, and stress management ➢ The National Women’s Health Network is a strong advocate for women’s concerns. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Other Community Voluntary Services  Women’s organizations ➢  Networking ➢  Promote voluntary involvement with community; many others have made women’s health a major item on their agenda. Help women advance careers, improve lifestyles, and increase income and success. Crisis hotline services ➢ Provide counseling to battered women, battering parents, rape victims, those considering suicide, and those with multiple needs. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Levels of Prevention  Primary prevention ➢ ➢  Secondary prevention ➢  Recognize risk for disease and target health care behaviors to reduce risk Never smoking, following a nutritious diet, safe sex practice, avoiding drugs, limiting alcohol consumption, and staying physically active Routine screening for cervical cancer, STIs, breast self-exams, and mammograms Tertiary prevention ➢ Education and resource utilization

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Roles of the Community Health Nurse     Direct care Educator Counselor Researcher Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Research in Women’s Health     Research efforts to include women in studies have grown; not based only on male subjects NIH Office of Research on Women’s Health (ORWH) established in 1990 Many topics examined based on special task force recommendations Research on financing and delivery of health services for women Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Office of Research on Women’s Health  Overarching themes for research: ➢ Developmental, psychological, spiritual, and physiological factors effect on lifespan ➢ Female determinants’ (such as genetics and gender expectations) effect on health ➢ Health disparities and diversity ➢ Diseases and conditions affecting women ➢ Career development and advancement of women in the sciences Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 “Women are at the center of the health of the United States; therefore, if better models are developed for improving the health of women, the health of the entire nation will benefit.” – Nies and McEwen (2015) Community Nursing

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Chapter 15 Health in the Global Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Human health and its influence on every aspect of life are central to the global agenda. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health in the Global Community        Population characteristics Environmental factors Patterns of health and disease International agencies and organizations International health care delivery systems The CHN’s role in the global community Research in international health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 International Community Assessment Model Courtesy J. C. Novak. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Population Characteristics   Large populations create pressures Goal is to improve quality of life (QOL) ➢ ➢ ➢  Health promotion Effective health care delivery systems Enhancement of the environmental infrastructure World population distribution is uneven Community Nursing

➢ More than 50% live in China, India, United States, and Indonesia; 30% are children; 8% are over 60 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Population Characteristics (Cont.)  Life expectancy varies significantly in different countries. ➢  Japan 86 years, Zambia 43 years As the world population grows, a global trend toward urbanization occurs. ➢ ➢ Live closer together and migrate to urban areas for employment Increased living density and global travel threatens health of general population by environmental factors Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Environmental Factors  Environmental stressors ➢ Directly assault human health ➢ Damage society’s goods and services ➢ Affect quality of life (QOL) ➢ Interfere with the ecological balance ➢ Natural disasters, terrorism, and war affect all of the above  The field of environmental health and sustainable development has exploded since 1990. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Patterns of Health and Disease    Lifestyles, health and cultural beliefs, infrastructure, economics, and politics affect existing illnesses and society’s commitment to prevention. Disease patterns vary throughout the world.

Racial, ethnic, and access disparities exist within and between countries. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 International Organizations       WHO (World Health Organization) PAHO (Pan American Health Organization) UN (United Nations) UNICEF (United Nations International Children’s Fund) World Bank CDC (Centers for Disease Control and Prevention) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 “Health for All by the Year 2000” (WHO Goal, 1978)   Goal framed at the Alma-Ata conference in the Soviet Union in 1978; now extended to 2010 again without attainment Concept of primary health care ➢ ➢ ➢ ➢ Health as a fundamental human right for individuals, families, and communities Unacceptability of the gross inequalities in health status Importance of community involvement Active role for all sectors Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Millennium Development Goals (United Nations, 2000, 2006)  Target date of 2015 1. 2. 3. 4. 5. 6. Eradicate extreme hunger and poverty Achieve universal primary education Promote gender equality, and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria, and other infectious diseases 7. Ensure environmental sustainability 8. Develop global partnerships Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Other Organizations Impacting International Health  Nongovernmental organizations (NGOs)

➢ ➢   Carter Center Bill and Melinda Gates Foundation ICN (International Council of Nurses) HHS (U.S. Department of Health and Human Services) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 HHS and Healthy People  Serves as a foundation for efforts across the HHS to create a healthier nation ➢ ➢ ➢ ➢ ➢ 1979 Surgeon General’s Report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation Healthy People 2000: National Health Promotion and Disease Prevention Objectives Healthy People 2010: Objectives for Improving Health Healthy People 2020: Improving the Health of Americans Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 International Health Care Delivery Systems Community Nursing

       Much to learn from one another. Research and development must be relevant to infectious diseases that affect the poor. Need to systematically generate an information base. Need to consider determinants of health. Use population-based approaches to address access, cost, efficiency, and effectiveness. Collaborate to solve the problems of health care delivery systems. Market- and population-based approaches need to learn from each other. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 International Health Care Delivery Systems (Cont.)  Effective health care delivery systems must: ➢ Increase access and efficiency. ➢ Improve health status through health promotion and disease prevention.

➢ Eliminate health disparities. ➢ Protect individuals, families, and communities from financial loss caused by catastrophic illness. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Role of the CHN in International Health Care     Seek to ensure the attainment of health for all in a cost-effective, efficient, accessible health care system. Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation. Coordinate work with other health care personnel and community leaders as well as local and global community leaders. Utilize changes in the health environment to form the basis for the nursing role. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Role of the CHN in International Health Care (Cont.)  Primary health care Community Nursing

➢ ➢ Essential services that support a healthy life. Involves access, availability, service delivery, community participation, and the citizen’s right to health care.  Primary care ➢ ➢ First line or point-ofaccess medical and nursing care controlled by providers and focused on the individual. May not be the norm as needs of the group outweigh the needs of the individual. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Role of the CHN in International Health Care (Cont.)    All nurses in the world must understand and learn from one another. Nurses are health care’s most valuable assets. Community public health nurses can improve access to care for the most vulnerable and hard-to-reach groups in any country. The future demands evidence-based learning, engagement, service, and growth in information technology and local and global health policy. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Figure 15-2 Distinction Among Service Programs. Furco, Andrew.

“Service-Learning: A Balanced Approach to Experiential Education.” Expanding Boundaries: Service and Learning. Washington DC: Corporation for National Service, 1996. 2-6. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Population-based nursing experts are critical to solving the challenges of the fragmented, mismanaged, expensive, ineffective, inefficient health care delivery system that exists in many parts of the global community. – Nies and McEwen (2015) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Research in International Health  Since 1990, international nursing research has focused predominantly on: Community Nursing

➢ ➢ ➢  Student and faculty educational exchange programs Diverse clinical experiences The international development of home care or transition from hospital to home WHO Collaborating Centers contributed to a partnership for educational programming, clinical practice, and research for graduate students in primary health care nursing and community health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 . Community Nursing