Social Security Administration
In 1995, the Social Security Administration (SSA) split from the HHS to become an independent agency. The SSA provides retirement income for many people and financial assistance for healthcare to special populations.
Persons older than 62 or 65 years, and those of any age with special disabilities or handicaps, may receive financial support from this agency, as well as from Medicare and Medicaid,which the SSA oversees. Regular Social Security benefits are also available to persons younger than 62 years as a result of the death, disability, or retirement of a parent or spouse.
USDA: Women, Infants, and Children
The USDA is responsible for the control of insect- and animalborne diseases, meat and other food inspections, and school lunch programs. The USDA also administers the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The goal of this program is to improve the health of pregnant women, new mothers, and their infants. Most states also have a Department of Agriculture (DOA).
Other Nationwide Organizations
National Safety Council
The mission of the National Safety Council is to educate and influence society to adopt safety, health, and environmental policies, practices, and procedures that prevent and mitigate human suffering and economic losses arising from preventable causes.
The Council operates as a nongovernment organization to gather information regarding safety and health information in the United States. Founded in 1913, the Council started work in factories, construction sites, and other workplaces. It was later expanded to include highway, community, and recreational safety.
The national and state Councils promote safety by analyzing causes of accidents and suggesting preventive measures. They disseminate information about accident prevention in industry, in the home, and on public highways. For example, highway and traffic laws protect everyone by requiring inspection of motor vehicles, licensing of drivers, establishing speed regulations, and providing highway markings. All states now require seat belts and head rests as standard equipment in new motor vehicles.
The Council influences public opinion, attitudes, and behavior in other areas. Building and electrical codes require mandatory sprinkler systems, automatic alarm systems, emergency lighting, and regular inspections, which reduce fires, accidents, and health hazards. Educational programs and training help to convert the information gained by the Council into direct actions that affect community well-being.
The Red Cross and the Red Crescent
The International Red Cross and the Red Crescent Movement work worldwide to provide services that assist individuals, communities, and nations (see Special Considerations: Culture and Ethnicity). These agencies work independently of governments and are apolitical. Their goals are to be nondis-criminatory, assist the wounded of the battlefield, protect life and health, and ensure respect for the human being.
Special Considerations :CULTURE & ETHNICITY
The symbol of a red cross was adopted by the International Red Cross Movement as a symbol of neutrality. However; some societies view the Red Cross emblem as a religious symbol. In Islamic countries, the symbol of a Red Crescent is used. In Israel, a symbol of the Red Shield of David designates the function of the Movement.
Founded by nurse Clara Barton in 1881, the American Red Cross is a humanitarian organization led by volunteers and guided by its Congressional Charter and the Fundamental Principles of the International Red Cross Movement. The American Red Cross added the function of providing disaster relief to the basic international charter of providing assistance to soldiers on a battlefield. The mission of the Red Cross is to provide help to victims of disaster and to help people prevent, prepare for, and respond to emergencies.
Although not a federal agency, the Red Cross provides national services. For example, local Red Cross topics work with community health associations and public health departments to coordinate services during disasters. Well-known in the health service industry, the Red Cross manages blood banks and tissue donation services to recover skin, bone, heart valves, and other tissues for transplant. Services provided by the American Red Cross include:
• Armed forces emergency services: Communications, counseling, financial assistance
• Biomedical services: Blood, tissue, and plasma services in national testing laboratories
• Community services: Food and nutrition, homeless issues, and transportation
• Health and safety services: Swimming, youth programs, health and safety programs
• International services: Emergency disaster response, tracing individuals, and providing messages
Visiting Nurse Association
The Visiting Nurse Association (VNA) is a nationwide, not-for-profit, community-based home care agency. The VNA is an agency of the United Way charities, and should not be confused with the multiple private agencies that provide in-home care. The VNA provides care to any person regardless of his or her ability to pay. Services can also be billed to Medicare, Medicaid, and private insurance companies. VNAs collaborate with other health and social service agencies throughout the community, setting up health linkages and networks.
Health services may be provided in a person’s home or in a senior residence, board-and-care home, or homeless shelter. Services may be therapeutic or preventive in nature. For example, a VNA may conduct tuberculin screening, immunizations for communicable diseases, or education programs about sexually transmitted infections (STIs).Direct care services provided by the VNA include:
• Skilled nursing
• Physical therapy
• Maternal and child care
• Medical social work
• Pain management
• Hospice
• Private duty nursing
• Enterostomal therapies
• IV and enteral therapies
Organizations Related to Specific Diseases
The American Cancer Society, the National Society for the Prevention of Blindness, the American Heart Association, the American Diabetes Association, the Cystic Fibrosis Foundation, the National Easter Seal Society-March of Dimes, and numerous other organizations fulfill the need for funding and education devoted to specific diseases. These national voluntary agencies often have state or regional affiliates.
In many cases, volunteer organizations sponsor activities or conduct fund drives to raise money for treatment or research relating to their particular area of interest. They may also receive some funding from campaigns, such as those conducted by the United Way. Many organizations publish pamphlets, and audiovisual materials to educate the public. Clinics, waiting and reception areas, and physician’s offices are often sources of free brochures, as depicted in Figure 7-1.
Voluntary health agencies include those that provide direct service and those that provide education and conduct fund-raising. Voluntary organizations have a great impact because they appeal to public sentiment, and citizens participate in them directly.
FIGURE 7-1 · Clinics and physicians’ offices are often sources of free brochures. Nurses have access to or receive quite a lot of free, educational materials. Be responsible and use these materials in your waiting or reception areas and give them to clients, friends, and families.
Organizations that Promote Specific Health Goals
Some voluntary health agencies are concerned not with disease, but with the promotion of one aspect of health. For example, Planned Parenthood of America focuses on family planning and prevention of STIs. Their counselors, physicians, and nurses assist people by providing genetic counseling, abortion counseling, infertility examination, and birth control. They may also provide prenatal care. Another such organization, the La Leche League, advances maternal and newborn health by encouraging breastfeeding.
HEALTHCARE AT THE STATE LEVEL
State health laws must conform to federal laws, but states also have the right to make their own health laws, if necessary. Many state agencies are also affiliated with federal agencies such as OSHA. Sometimes funding for programs is derived from money received from both federal and state agencies, as is the case with Medicaid.
Typically, state healthcare services may be grouped into separate programs under a State Department of Health, or under broader umbrellas, such as a Department of Consumer Affairs or a Department of Health and Human Services. Regardless of the titles, the services that the states provide remain basically standard. However, the comprehensiveness of services in each state may differ widely. Programs or agencies on state levels address many specific healthcare concerns including:
• Aging
• Children’s health
• Families in need
• Mental health
• Special populations, such as minorities and persons with disabilities (hearing and vision impaired, physical disabilities)
• Alcohol and substance abuse
• Environmental health
• Communicable diseases
• Safety and disability issues
In addition to services that are directly related to the healthcare of a community, state agencies provide certification and licensing requirements for healthcare professionals (nurse aides, nurses, and physicians). Additional regulatory agencies may be available for ancillary healthcare providers such as chiropractors, optometrists, midwives, pharmacists, or physical therapists.
State health departments serve as consultants to local health departments and exercise regulatory powers over them. State health departments often serve as surveyors to enforce federal health requirements, along with planning health requirements for their own jurisdictions.
HEALTHCARE AT THE LOCAL LEVEL
City, town, or county health departments focus on the health protection of persons within their jurisdiction. Usually the Department of Health operates under a Board of Health or Public Health Service. These departments carry out policies and regulations under the direction of a health officer. State regulations mandate requirements for health officer licensure; public health education is a prerequisite.
Health departments provide services dealing with conditions that affect all residents. Their personnel inspect places where food is sold and the people who handle food. They check water and milk supplies, housing, and sewage and other waste disposal facilities. They monitor and control air quality. They may provide school health services and health education, community clinics, or hospital/nursing home care.
Public health and home care nursing services are often provided through city or regional health departments. Other services that local health departments may provide include occupational health services (to industries) and school nursing services.
The Community Health Center
The local or regional health department often sponsors community-based healthcare, sometimes in the form of a community health center or family health center. Centers with similar functions may be referred to as public health centers and function under the state’s Public Health Department.
Community health centers usually belong to an organization called the National Association of Healthcare Centers (NAHCC). These centers provide a wide range of services, including primary healthcare, which is family-focused healthcare that emphasizes health education and healthy lifestyles. The goal is to decrease the potential for illness and to provide early treatment if illness does occur. Thus, primary healthcare emphasizes health promotion and disease prevention.
Community health centers may provide healthcare services in locations where specific populations known as target populations are found. Target populations are subgroups in a community with unique or special healthcare needs, such as the homeless, the elderly, the young, migrant workers, or immigrants. When health centers are located near the target population, individuals have easier access to healthcare. Compared with traditional medical clinics, community-based healthcare is more cost-effective; it is less disruptive to the individual’s lifestyle and promotes better compliance with follow-up care.
Sites for community health centers vary. Some sites include housing projects, churches, schools, homeless shelters, or locations on major streets near bus lines or commuter train stations. Primary healthcare is also available in schools, neighborhood centers, day care centers, retirement communities, group homes for the mentally ill or mentally retarded, municipal buildings, homeless shelters, and battered women’s shelters.
The community health center may provide testing for various disorders, including tuberculosis, STIs (including HIV), and lead poisoning. It provides immunizations and prenatal services.
NCLEX Alert Use the ABC acronym as a guide for prioritization on the NCLEX. ABC = Airway Breathing/ Bleeding, and Circulation. Acute, life-sustaining needs always take precedence before chronic concerns (e.g. hygiene) or preventive needs (e.g. immunizations).
Infants and older adults are served in wellness programs or through nursing care and preventive services provided in the home. Other services of the community health center include programs for special clients, such as those with AIDS, the homeless, migrant workers, and teen parents. The centers refer clients as necessary to other providers for further care.
The U.S. Public Health Service designates and monitors certain community health centers, called Federally Qualified Healthcare (FQHC). FQHCs provide healthcare in parts of the United States identified as medically underserved areas (MUA). Bilingual staff members are present in many centers, to better serve the varied populations in the local service area.
Advanced practice nurses (nurse practitioners), working with physicians, often provide primary healthcare in community health centers. Available services include physical screenings, maternal and prenatal care, and specialized examinations for both men and women.
In some areas, local and state health departments no longer provide direct client services. These departments now refer clients to private providers through Medicaid, managed care programs, and contracted care with private physicians or clinics.
THE ENVIRONMENT
Humanity is only one part of a complex system that depends on the balance of life, growth, and death of all living organisms on the planet. This growing recognition has awakened many concerned citizens to the need to preserve this balance. The study of mutual relationships between living beings and their environment is called ecology or bionomics. The federal EPA was established in an attempt to control problems relating to the environment and its ecology.
Pollution
The task of maintaining ecologic balances to preserve safe air to breathe, water to drink, and food to eat is complicated.
Pollution (contamination and impurity) severely compromises the ecologic balance. New sources of energy that will not pollute the air, the land, or water are being sought. As a nurse and member of the healthcare team, you will be called on to know about and to work for a healthy and safe environment.
Air Pollution
Air pollution is greatest in industrial areas. However, every community has some air pollution, even though it may have comparatively few industries. Pollution also tends to drift from cities to the nearby countryside and suburbs. For instance, Philadelphia’s air pollution often drifts over its suburbs and southern New Jersey.
A great source of air pollution is exhaust from automobiles, although methods are being developed to alleviate this problem. In cities such as Denver and Los Angeles, atmospheric conditions, geography, fog, smoke, and automobile exhaust gases combine to produce smog. The harmful substances in this smog cannot blow away naturally because of the location of mountain ranges. Similar situations have developed in many other cities, particularly those surrounded by mountains. Some cities have alerts during which schoolchildren are not allowed to play outside and residents are warned about the dangers. Some larger cities of the Americas, such as Mexico City, have driving bans (when residents are allowed to drive their cars only on alternate days to decrease smog levels).
Air pollution is responsible for increases in respiratory infections, such as chronic bronchitis and emphysema. The incidence of asthma is increasing, especially in the young. Poor air quality, tobacco smoke, and numerous other pollutants are directly connected to asthma. Heavy pollution irritates the eyes, nose, and throat and may have other serious health effects as yet unknown. Polluted air damages plant life, including farm crops. For example, many vineyards on the West Coast have been abandoned because smog adversely affected the growth of grapes. Pollution is also destructive to building materials.
Pollution inside buildings is a growing concern. Persons who work in certain industrial environments must wear protective gear to prevent lung disorders. In addition, office buildings, hotels, and other public buildings are now tightly sealed, with air cooling, heating, and ventilation controlled mechanically. Such regulation may contribute to respiratory disorders, such as asthma and sinusitis, particularly if the air is not exchanged often enough. Smoking is not allowed in many public buildings.
Furnaces or tuck-under garages may release carbon monoxide and other dangerous gases into a home’s atmosphere. Homes should not be too tightly sealed, to avoid buildup of these gases. A carbon monoxide detector should be present in every home, along with a smoke detector.
Smoking studies have shown that the risks of some disorders are almost as great, if not greater, for the person who inhales secondhand smoke as for the person who actually smokes. This concern is of importance to all people, particularly families with small children, because secondhand smoke is likely to influence the development of disorders such as asthma and ear infections. Older adults who inhale secondhand smoke are particularly susceptible to pneumonia— a leading cause of death among senior citizens.
Many companies, healthcare facilities, schools, and other public buildings are now smoke-free. Smoking is not allowed on commercial airline flights within the United States and on many international flights. Schools and healthcare facilities usually declare their buildings and grounds as totally nonsmoking premises; in many cases, this designation is mandated by law or by accrediting agencies. Most restaurants have nonsmoking areas, hotels have nonsmoking rooms, and smoke-free rental cars are available.
Water Pollution
Water pollution is a serious and increasing health hazard. Contaminated water transmits a number of diseases, including typhoid fever, dysentery, and infectious hepatitis. Water pollution not only affects people, but is also a menace to recreation areas, wildlife, and fish. Each year, polluted water kills millions of fish and shellfish in the United States. The mercury level in water and seafood is particularly dangerous for pregnant women. Guidelines from public health officials establish amounts of seafood and fish from designated areas that can be eaten safely in a specified time.
Increasing demands on the national water supply make it necessary to reuse water, thereby requiring that wastewater be treated to make it safe for reuse. In many areas, this treatment is inadequate. Legislation now gives the USPHS authority and funds to establish water treatment projects. The federal government has also enacted legislation establishing sanitary sewer districts around many lakes and along rivers. In this manner, the quality of public waters will be maintained and improved.
Land Pollution
As the population grows, it produces more garbage and trash. Large cities are running out of places to dump their trash. People often do not want landfills or incinerators in their neighborhoods. In previous years, barges of trash and garbage were shipped to smaller nations or dumped into the ocean. More recently, the United States has become aware of its worldwide responsibilities. Trash cannot continue to pollute foreign lands or the planet’s largest natural resource, the oceans. As a result, most communities have developed recycling programs, well-managed landfills, and pollutionfree incinerators.
A new danger exists regarding landfills. As land near cities becomes increasingly scarce, homes and other buildings are being built on old landfill sites. This practice has been proven to contribute to diseases (including cancer), particularly in children.
Radon is a chemical element that occurs in nature as a byproduct of the disintegration of radium. It contributes to diseases, including lung cancer. Radon can collect in spaces that are poorly ventilated, such as caves. It can also seep into homes through cracks in the foundation or the basement floor. The more tightly sealed a home is, the greater the danger of radon exposure. Each home should be tested periodically for radon and appropriate measures taken to eliminate it.
Noise Pollution
Damage to the delicate structures of the ear is caused by loud noise or music. Chronic exposure to loud noise, such as loud music, poses the greatest hazard to hearing. Noise pollution also causes stress. Laws are in place to regulate noise. OSHA requires workers in occupations that are extremely noisy to wear ear protection. Recreational activities such as target shooting require ear protection.
Other Types of Pollution
Other situations contribute to pollution and endanger the environment. An oil spill can kill many fish and animals, and thus limit or contaminate food supplies. Insecticides and agricultural chemicals pose a threat to water and clean air. Workers may bring hazardous substances home on their clothing, thereby endangering the health of their family members. For example, in addition to causing cancer that may affect the workers themselves, asbestos particles on clothing contribute to chronic obstructive pulmonary disease in the families of workers.
Lead Poisoning (Plumbism). Lead poisoning (plumbism) continues to be a significant public health problem. It causes serious mental and physical disabilities, particularly in young children. Many cities have programs to test children for lead poisoning and to remove leaded paint and lead pipes from older buildings. Lead can also be present in the soil, partially as a result of exhaust from cars that used leaded gasoline. Lead can also be found in newspaper print and old toys with chipped paint.
Radiation. Citizens are concerned about radiation (ionizing waves of energy that penetrate objects). Many disputes between the public and power companies using nuclear fuel remain unresolved. One problem concerns the disposal of radioactive wastes. Repercussions from events such as Three Mile Island in 1979 in Pennsylvania, USA, Chernobyl in the Ukraine in 1986, and at the Fukushima nuclear power plant in norther Japan in 2011 continue to raise questions about the world’s freedom from dangerous radiation.
Biohazardous Waste Disposal. Proper and safe disposal of biohazardous medical wastes, which are infectious and harmful to humans or animals, is the responsibility of every institutional and individual healthcare provider. Policies and procedures dictate the processes by which the disposal of medical wastes should occur. These processes must meet the multiple-standard regulations of OSHA, the Department of Environmental Protection, and local and state health departments.
Nurses performing home care must be especially careful to dispose of medical waste properly and to teach clients and families correct disposal methods. Medical equipment companies can provide containers and bags for proper disposal of sharps and biohazardous materials.
Key Concept You are part of the world community Participate in protecting the world you live in. Teach others to protect the environment as well.
KEY POINTS
• You are a member of many communities and should serve as an advocate and educator to protect those communities.
• Healthcare services are provided on international, national, state, and local levels.
• Federal agencies include the United States Public Health Service and the Department of Health and Human Services. These agencies have many branches and numerous programs.
• The blood-borne pathogen standard established by OSHA has significantly affected nursing procedures and delivery of services in healthcare facilities.
• The Social Security Administration supervises the Medicare and Medicaid programs.
• Voluntary health agencies may be set up to provide direct service, education, or fund-raising to combat a particular disease or for specific health concerns.
• Public and private agencies often work together to provide healthcare services.
• Many primary healthcare services are provided at community health centers. These services include examinations, health screening, immunizations, education, support groups, and illness care.
• Community health is concerned with environmental issues, including air, water, land, and noise pollution; plumbism; radiation; and biohazardous waste disposal.
