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Exam 2 Chapter Definitions NUR 496 1

Chapter 5
age-adjustment of rates—(also known as standardization of rates) method of reducing bias
when there are differences in the age distributions of two populations being compared
age-specific rates—rates that characterize a particular age-group in the population, usually with
regard to deaths and births
analytic epidemiology—method that investigates the causes of disease by determining why a
disease rate is lower in one population group than in another
attack rate—a type of incidence rate defined as the proportion of agent-exposed persons who
develop the disease, usually for a limited time in a specific population
cause-and-effect relationship—a relationship that is determined to exist after certain criteria
are met. The criteria are strength of association, dose-response relationship, temporally correct
relationship, biological plausibility, consistency with other studies, and specificity.
crude rates—rates that summarize the occurrence of births (crude birth rate), deaths (crude
death rates), or diseases (crude disease rates) in the general population. The numerator is the
number of events, and the denominator is the average population size or the population size at
midyear (usually July 1) multiplied by a constant.
descriptive epidemiology—a form of epidemiology that describes a disease according to its
person, place, or time
ecosocial epidemiology—a form of epidemiology that focuses on the sequencing of genes to
determine individual susceptibility to various diseases.
epidemiological triangle—an organized method of inquiry to derive an explanation of disease,
which analyzes three elements: (1) agent, (2) host, and (3) environment
epidemiology—the study of the distribution and determinants of health and disease in human
populations
incidence rates—rates that describe the occurrence of new cases of disease or condition (e.g.,
teen pregnancy) in a community over a period of time, relative to the size of the population at risk
for that disease or condition during that same period
morbidity rates—rates of illness
mortality rates—rates of death
natural history of disease—course or progression of a disease process from onset to
resolution
person-place-time model—"who" factors, such as demographic characteristics, health, and
disease status; "where" factors, such as geographic location, climate and environmental
conditions, and political and social environment; and "when" factors, such as time of day, week,
or month, and secular trends over months and years
prevalence rate—the number of all cases of a specific disease or condition (e.g., deafness) in a
population at a given point in time, relative to the population at the same point in time
proportionate mortality ratio (PMR)—number that represents the percentage of deaths
resulting from a specific cause relative to deaths from all causes
rates—arithmetic expressions that allow one to consider a count of an event relative to the size
of the population from which it is extracted
risk factor—a variable that increases the rate of disease in people who have them (e.g., a
genetic predisposition) or in people exposed to them (e.g., an infectious agent or a diet high in
saturated fat)
risk—the probability of an adverse event
screening program—a secondary prevention activity that identifies risk factors and diseases in
their earliest stages
screening—used to identify risk factors and diseases in their earliest stages
Exam 2 Chapter Definitions NUR 496 2
standardization of rates—(also known as age-adjustment rates) method of reducing bias when
there are differences in the age distributions of two populations being compared
surveillance—a mechanism for the ongoing collection of health information in a community
web of causation—a model that can be used to illustrate complex interrelationships of factors
interacting with each other to influence the risk for, or distribution of, health outcomes

Chapter 11
accreditation—a means to assess the quality of services and care of an organization. Specific
minimum standards must be met by an organization to obtain accreditation.
alternative therapies—therapies not considered mainstream health care, such as massage
therapy, herbal therapy, healing touch, energetic healing, acupuncture, and acupressure
client rights—rights that clients have regarding their own health
community health center—developed through federal funds in the 1960s, addresses broader
inputs into health such as education and housing
health care reform—government and private efforts to improve health care services
managed care organizations (MCOs)—groups of health care providers designed to implement
managed care, including health maintenance organizations (HMOs), preferred provider
organizations (PPOs), integrated delivery systems (IDSs), and physician hospital organizations
(PHOs)
managed care—any method of health care delivery designed to reduce unnecessary use of
services, increase cost containment and cost-effectiveness, and to ensure high-quality care
Medicaid—Title XIX Social Security Amendment (1965), a combined federal and state program.
The program provides access to care for the poor and medically needy of all ages.
Medicare—Title XVIII Social Security Amendment (1965), a federal program administered by the
Health Care Financing Administration that pays specified health care services for all persons
older than 65 years who are eligible to receive Social Security benefits
outcomes measures—measurement of the outcomes of care
public health—organized efforts made through governmental agencies such as health
departments, that are authorized by legislation, serve all people, and are supported by taxes
quality care—care designed to reduce illness, injury, and disability and improve health and
functioning
telehealth—health care provided to clients via technology, such as computer, video, or
interactive television

Chapter 12
access—ability to obtain health care services in a timely manner, at a reasonable cost, by a
qualified practitioner, at an accessible location
actuarial classification—individuals enrolled in specific programs are classified using the
statistical mathematics of insurance, including probabilities to ensure the premium payments will
adequately provide future payouts
adverse selection—when a larger proportion of people with poorer health status enroll in
specific plans or options. Plans that enroll a subpopulation with lower-than-average costs are
favorably selected.
ambulatory care—medical services provided on an outpatient basis in a hospital or clinic setting
Exam 2 Chapter Definitions NUR 496 3
capitated reimbursement—a method of payment for health services in which the provider is
paid a fixed amount for each patient without regard to the actual number or nature of services
provided.
carrier—(1) a person or animal who harbors and spreads an organism that causes disease in
others but does not become ill (Chapter 25); (2) an organization that contracts with the Health
Care Financing Administration to administer claims processing and make Medicare payments to
health care providers
carve-out services—services provided within a standard benefit package but delivered
exclusively by a designated provider or group, such as mental health care
co-payment—cost sharing required by the health plan whereby the individual must pay a fixed
dollar amount for each service
coinsurance—cost sharing required by a health plan whereby the individual is responsible for a
set percentage of the charge for each service
cost containment—reduction of inefficiencies in the consumption, allocation, or production of
health care services
cost shifting—cost of uncompensated care is passed on to the insured, resulting in higher costs
for those with insurance coverage
current procedural terminology (CPT) codes—a list of codes for medical services and
procedures performed by physicians and other health care providers that has become the health
care industry's standard for reporting physician procedures and services
deductible—cost sharing whereby the individual pays a specified amount before the health plan
pays for covered services
diagnosis-related group (DRG)—a system of payment classification for inpatient hospital
services based on the principal diagnosis, procedure, age, gender of the patient, and any
complications
effectiveness—net health benefit provided by a medical service or technology for a typical
patient in community practice
flexible spending account—a mechanism by which an employee may pay for uncovered health
care expenses through payroll deductions
gatekeeper—person in a managed care organization who decides whether or not a person will
be referred for specialty care. (Doctors, nurses, nurse practitioners, and physician assistants
function as gatekeepers.)
health care providers—individuals or institutions that provide medical services
health insurance plan—pays a predetermined amount for covered services
health maintenance organization (HMO)—managed care plan that acts as an insurer and
sometimes a provider for a fixed prepaid premium. HMOs usually employ the physicians.
indemnity plan—health plan that pays covered services on a fee-for-service basis
managed care groups—groups that negotiate with health care providers to render care for a
specified amount of reimbursement based on community ratings modified by group-specific
demographics
managed care plan—health plan that uses financial incentives to encourage enrollees to use
selected providers who have contracted with the plan
mandate—a state or federal statute or regulation that requires coverage for certain health
services
Medicaid—Title XIX Social Security Amendment (1965), a combined federal and state program.
The program provides access to care for the poor and medically needy of all ages.
Medicare—Title XVIII Social Security Amendment (1965), a federal program administered by the
Health Care Financing Administration that pays for specified health care services for all persons
older than 65 years who are eligible to receive Social Security benefits
Exam 2 Chapter Definitions NUR 496 4
Medigap insurance—privately purchased individual or group health insurance plans designed to
supplement Medicare coverage
out-of-pocket expenses—payment made by the individual for medical services
outcome—the consequences of a medical intervention on a patient
preferred provider organization (PPO)—a health plan that contracts with providers to furnish
services to the enrollees of the plan
premiums—amounts paid periodically to purchase health insurance benefits
primary care provider—a generalist physician, typically a family physician, internist,
gynecologist, or pediatrician, who provides comprehensive medical services
prospective payment system—reimbursement based on a classification system that indentified
costs according to diagnosis and client characteristics

Chapter 13
biomedical—a theory of illness causation based on the assumptions that: (1) all events in life
have a cause and effect; (2) the human body functions more or less mechanically (i.e., the
functioning of the human body is analogous to the functioning of an automobile); (3) all life can
be reduced or divided into smaller parts (e.g., the human person can be reduced into body, mind,
and spirit); and (4) all of reality can be observed and measured (e.g., with intelligence tests and
psychometric measures of behavior)
cultural competence—respecting and understanding the values and beliefs of a certain cultural
group so that one can function effectively in caring for members of that cultural group
cultural imposition—the tendency to impose one's own beliefs, values, and patterns of
behavior on individuals from another culture
cultural negotiation—the process in which messages, instructions, and belief systems are
manipulated, linked, or processed between the professional and the lay models of health
problems and preferred treatment
cultural stereotyping—the tendency to view individuals of common cultural backgrounds
similarly and according to a preconceived notion of how they behave
culture shock—the state of disorientation or inability to respond to the behavior of a different
cultural group because it holds sudden strangeness, unfamiliarity, and incompatibility to the
newcomer's perceptions and expectations
culture specific—the "particularistic values, beliefs, and patterning of behavior that tend to be
special, 'local,' or unique to a designated culture and which do not tend to be shared with
members of other cultures"
culture universal—the "commonalties of values, norms of behavior, and life patterns that are
similarly held among cultures about human behavior and lifestyles and form the bases for
formulating theories for developing cross-cultural laws of human behavior"
culture-bound syndrome—a health condition that is culturally defined
culture—the complex whole, including knowledge, belief, art, morals, law, customs, and any
other capabilities and habits acquired by virtue of the fact that one is a member of a particular
society
culturological assessment—"a systematic appraisal or examination of individuals, groups, and
communities as to their cultural beliefs, values, and practices to determine specific needs and
interventions within the cultural context of the people being evaluated"
dominant value orientation—a basic value orientation that is shared by the majority of a
society's members as a result of early common experiences
Exam 2 Chapter Definitions NUR 496 5
ethnocentrism—the tendency to view one's own way of life as the most desirable, acceptable,
or best and to act in a superior manner toward another culture
Leininger's theory of culture care diversity and universality—theory that is concerned with
describing, explaining, and projecting nursing similarities and differences within a cultural
dimension. This theory maintains that human beings and their health are inseparable from their
cultural background and social structure.
magicoreligious—health perspective model that sees the world as an arena in which
supernatural forces dominate
naturalistic—a viewpoint found most frequently among Native Americans, Asians, and others
who believe that human life is only one aspect of nature and a part of the general order of the
cosmos
norms—the rules by which human behavior is governed; norms result from the cultural values
held by the group
poverty—lacking resources to meet basic living expenses for food, shelter, clothing,
transportation, and medical care
religion—an organized system of beliefs concerning the cause, nature, and purpose of the
universe, especially belief in or the worship of a god or gods
socioeconomic status (SES)—a composite of the economic status of a family or unrelated
individuals based on income, wealth, occupation, educational attainment, and power
spirituality—efforts to find purpose and meaning in life, born out of the individual's unique life
experience
subculture—fairly large aggregates of people who share characteristics that are not common to
all members of the culture and enable them to be thought of as a distinguishable subgroup
transcultural nursing—"a formal area of study and practice focused on a comparative analysis
of different cultures and subcultures in the world with respect to cultural care, health and illness
beliefs, values, and practices with the goal of using this knowledge to provide culture-specific
and culture-universal nursing care to people"
value—a desirable or undesirable state of affairs. Values are a universal feature of all cultures,
although the types and expressions of values differ widely
yin-yang theory—theory in which health is believed to exist when all aspects of the person are
in perfect balance. In Chinese philosophy, yin-yang theory states that all organisms and objects
in the universe consist of yin or yang energy forces. The origin of the energy forces is within the
autonomic nervous system, where balance between the opposing forces is necessary to
maintain health.

Chapter 22
Annual Homeless Assessment Report (AHAR)—The U.S. Department of Housing and Urban
Development (HUD) submits this report (AHAR) to Congress. It contains information about the
total population and subpopulations in the U.S. experiencing homelessness.
Chronically homeless—The U.S. Department of Housing and Urban Development designates
unaccompanied adults who are homeless for extended or numerous periods of time and have
one or more disabling conditions as chronically homeless.
Continuum of Care (CoC)—A CoC is responsible for providing a range of housing and related
services, including emergency and preventive responses, to persons in a local area who are
experiencing homelessness. A CoC is established through a competitive grant-funded program
administered by the U.S. Department of Housing and Urban Development.
Education for Homeless Children and Youth (ECHY)—The Education for Homeless Children
and Youth (ECHY) program provides services to homeless children and youth who are not
Exam 2 Chapter Definitions NUR 496 6
included in HUD's programmatic services. ECHY is administered by the U.S. Department of
Education.
European Federation of Organisations Working with the Homeless (FEANTSA)—
Developed a typology of homelessness and housing exclusion that addressed the idea of "home"
as having three domains: (1) physical, (2) social, and (3) legal
Federally Qualified Health Centers (FQHC)—Centers administered by the U.S. Health
Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC).
FQHCs receive federal grants to fund services to underserved populations. These centers may
receive reimbursement under Medicare and Medicaid (USDHHS, HRSA, BPHC, n.d.).
FQHC Look-A-Likes (FQHCLA)—Centers administered by the Health Resources and Services
Administration (HRSA), Bureau of Primary Health Care (BPHC), which provide services to
underserved populations. FQHCLA sources of funding differ from FQHCs. FQHCLAs do not
receive federal grants to fund services, but may receive reimbursement under Medicare and
Medicaid (USDHHS, HRSA, BPHC, n.d.).
Military Sexual Trauma (MST)—"Sexual assault or repeated, threatening sexual harassment
that occurred while the veteran was in the military. It includes any sexual activity where someone
is involved against his or her will" (U.S. Department of Veterans Affairs, 2012).
Point-in-Time (PIT) Count—As a requirement of HUD funding, CoCs conduct a Point-In-Time
(PIT) count of sheltered homeless people on a single night in late January of every year and
submit this data to HUD. Every other year, the PIT Count
includes sheltered and unsheltered people who are homeless.
United States Conference of Mayors—This organization provides an annual report on hunger
and homelessness in participating major U.S. cities.

Chapter 24
Affordable Care Act (ACA)—health care law offering choices for consumers and provides new
ways to hold insurance companies accountable
agoraphobia—an anxiety disorder characterized by a fear of being in an open, crowded, or
public place, where escape is perceived as difficult or help not available in case of sudden
incapacitation
anorexia nervosa—a disorder of self-starvation characterized by significant weight loss,
amenorrhea, compulsive physical activity, preoccupation with food, and a distorted body image
anosignosia—lack of awareness, lack of insight in illness
anxiety disorders—a group of conditions characterized by feelings of anxiety. Anxiety disorders
may be attributed to genetic makeup and life experiences of the individual. Some of the more
commonly encountered anxiety disorders are generalized anxiety disorder, panic disorder
(sometimes accompanied by agoraphobia), phobias, obsessive-compulsive disorder, and post-
traumatic stress disorder (PTSD) (APA, 2000).
Assertive Community Treatment (ACT)—team treatment approach designed to provide
comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons
with serious and persistent mental illness such as schizophrenia
attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD)—a behavior
disorder characterized by developmentally inappropriate degrees of inattention, impulsiveness,
and hyperactivity
bipolar disorder—a major mental disorder characterized by episodes of mania, depression, or
mixed mood. One or the other phase may be predominant at any given time; one phase may
appear alternately with the other, or elements of both phases may be present simultaneously
Exam 2 Chapter Definitions NUR 496 7
case management (CM)—service to assist clients with serious mental illness and or substance
abuse problems in areas of, but not limited to, housing, finances, social, family, medical,
medication management, transportation
Community Mental Health Centers Act (CMHCA)—1964 legislation providing federal support
for mental health services and measures to implement facilities to care for those who were
mentally retarded and to construct community mental health centers. CMHCA mandated
deinstitutionalization, or a halt to the long-held policy of keeping the severely mentally ill
hospitalized. The intention was to reduce long-term care of seriously mentally ill persons by
transferring treatment to the community
crisis intervention team (CIT)—law enforcement, advocacy, and mental health professional
team programs designed to improve the way law enforcement and the community respond to
people experiencing mental health crises
deinstitutionalization—process of releasing patients from care in psychiatric institutions into the
community
depression—a disorder characterized by an all-pervasive sadness that is present much of the
time
Diagnostic Statistical Manual 5 (DSM 5)—standardized manual published by the American
Psychiatric Association classifying and establishing criteria for all mental health disorders for
both children and adults
generalized anxiety disorder (GAD)—characterized by chronic, unrealistic, and exaggerated
worry and tension about one or more life circumstances lasting 6 months or longer (APA, 2000).
Symptoms of GAD include trembling, twitching, muscle tension, headaches, irritability, sweating
or hot flashes, dyspnea, and nausea. Periods of increasing symptoms are usually associated
with life stressors or impending difficulties.
mental health consumer—person who is under treatment for a psychiatric illness or disorder
mental health disparity—disparities in access, availability, and use of mental health services
are well-established by race/ethnicity, geography, and socioeconomic status
Mental Health Parity and Addiction Equity Act 2008—law requires health insurance to cover
treatment for mental illness on the same terms and conditions as physical illness
mental health—absence of mental disorders and the ability for social and occupational
functioning
mental illness—includes all diagnosable mental disorders, those health conditions
characterized by alterations in thinking, mood, or behavior associated with distress and/or
impaired functioning
obsessive-compulsive disorder (OCD)—an anxiety disorder characterized by recurrent and
persistent thoughts, ideas, and feelings of obsessions or compulsions sufficiently severe to
cause marked distress, consume considerable time, or significantly interfere with the patient's
occupational, social, or interpersonal functioning
post-traumatic stress disorder (PTSD)—an anxiety disorder with set characteristic signs and
symptoms that occur after a person is exposed to, or is the victim of, a traumatic event
psychosocial rehabilitation service (PSR)—a program in which participants learn specific
skills that foster rehabilitation and mental health recovery
psychotropic/psychotherapeutic medications—sometimes called psychoactive drugs; affect
the central nervous system and can cause a variety of changes in behavior or perception
schizophrenia—presents with (1) positive symptoms including hallucinations, delusions,
disorganized thinking and speech, and bizarre behavior and (2) negative symptoms, such as flat
affect, poor attention, lack of motivation, apathy, lack of pleasure, and lack of energy. Onset
typically occurs during late adolescence and early adulthood in males and somewhat later in
females. There is an increased risk for alcohol use, depression, suicide, and diabetes among
persons with schizophrenia.
Exam 2 Chapter Definitions NUR 496 8
severe emotional disorders (SED)—specific disorders children and adolescents whose
emotional and mental disturbance severely limits their development and welfare over a
significant period of time and that required a comprehensive and coordinated system of care in
order to meet their needs
severe mental illness (SMI)—current or at any time during the past year having a diagnosable
mental, behavioral, or emotional disorder with moderate, severe, or extreme functional behavior
in specific areas of lifestyle
stigma—associating negative qualities with having a mental illness

Chapter 25
acquired immunity—derived from actual exposure to the specific infectious agent, toxin, or
appropriate vaccine
active immunity—the body produces its own antibodies against an antigen, either from infection
with the pathogen or introduction of the pathogen in a vaccine
agent—causative factor invading a susceptible host through an environment favorable to
produce disease, such as biological or chemical agent
antigenicity carriers—stimulates an immune response in the host
case—an episode of illness or injury
cold chain—a system used to ensure that vaccines are kept at a designated temperature from
the time they are manufactured until they are used for vaccination
communicable disease—a disease of human or animal origin caused by an infectious agent
and resulting from transmission of that agent from an infected person, animal, or inanimate
source to a susceptible host. Infectious disease may be communicable or noncommunicable
(e.g., tetanus is infectious but noncommunicable).
communicable period—communicability follows latency and begins with shedding of the agent.
Frequently, the communicable period begins before symptoms are present.
control—the reduction of incidence or prevalence of a given disease to a locally acceptable level
as a result of deliberate efforts
direct transmission—the immediate transfer of an infectious agent from an infected host or
reservoir to an appropriate portal of entry in the human host through physical contact
elimination—controlling a disease within a specified geographical area, such as a single
country, an island, or a continent, and reducing the prevalence and incidence to eventual
eradication
endemic—the constant presence of an infectious disease within a specific geographic area
Exam 2 Chapter Definitions NUR 496 9
environment—the accumulation of physical, social, cultural, economic, and political conditions
that influence the lives of communities (Chapter 14); that which surrounds the human host and
where transmission of an infectious agent is occurring
epidemic—the occurrence of an infectious agent or disease within a specific geographic area in
greater numbers than would normally be expected
eradication—reducing the incidence of a disease worldwide to zero as a function of deliberate
efforts, with no need for further control measures
fomites—any inanimate object, material, or substance that acts as a transport agent for a
microbe (e.g., water, a telephone, or a contaminated tissue)
herd immunity—a state in which those not immune to an infectious agent will be safe if at least
80% of the population has been vaccinated or is otherwise immune
host—a living human or animal organism in which an infectious agent can exist under natural
conditions
immunity—the body's ability to protect itself from infection
immunization—process of introducing a vaccine or toxoid to produce active or passive immunity
in the recipient
incidence—in epidemiology, the number of new cases of infection or disease that occur in a
defined population in a specified period of time
incubation period—the time from invasion to the time when disease symptoms first appear
indirect transmission—the spread of infection through vehicle fomites, animals, and vectors
that carry a parasite or pathogen to a suitable portal of entry in the human host
infection—the entry and multiplication of an infectious agent in a host
infectious disease—any communicable disease, or one that can be transmitted from one
human being to another or from animal to human by direct or indirect contact
infectivity—the power to invade and infect large numbers of people
isolation—the separation of a seriously ill patient from others to prevent the spread of an
infection or to protect the patient from irritating environmental factors
latency—the period of replication before shedding
multicausation—principle that emphasizes that an infectious agent alone is not sufficient to
cause disease; the agent must be transmitted within a conducive environment to a susceptible
host
natural immunity—an innate resistance to a specific antigen or toxin
notifiable infectious diseases—infectious diseases that are designated by the Centers for
Disease Control and Prevention as "nationally notifiable." Health care providers who encounter
these diseases must report them to the local or regional health department.
outbreak—refers to the unexpected occurrence of an infectious disease in a limited geographic
area during a limited period of time
pandemic—a worldwide outbreak of an epidemic disease (Chapter 2); a steady occurrence of a
disease over a large geographic area or worldwide, such as malaria in Africa
passive immunity—the temporary resistance that has been donated to the host through
transfusions of plasma proteins, immunoglobulins, and antitoxins, or from mother to neonate
transplacentally
pathogenicity—the power of an organism to produce disease
portal of entry—the route by which an infectious agent enters the body, such as through
nonintact skin
Exam 2 Chapter Definitions NUR 496 10
portal of exit—the route by which an infectious agent leaves the body, such as through
respiratory secretions, saliva, or blood
primary vaccine failure—the failure of a vaccine to contribute any level of immunogenicity; can
be caused by improper storage that may render the vaccines ineffective, improper administration
route, or light-sensitive vaccines exposed to light
quarantine—isolation of people with communicable disease or those exposed to communicable
disease during the contagious period in an attempt to prevent spread of the illness
reservoir—the site where the agent (organism) is naturally found. A carrier can serve as a
reservoir.
resistance—the ability of an organism to remain unaffected when exposed to an infectious
agent
secondary vaccine failure—the waning of immunogenicity after eliciting an initial immune
response that fades over time
subclinical infection—an infection that is so mild it produces no symptoms
susceptible—at risk for contracting an infection or developing an infectious disease
toxigenicity—that which produces a toxin
universal precautions—set of guidelines, developed by the Centers for Disease Control and
Prevention in the 1980s to prevent transmission of diseases found in blood and body fluids
vaccination—the administration of a vaccine or toxoid that confers active immunity by
stimulating the body to produce antibodies
Vaccine Adverse Events Reporting System (VAERS)—a program that takes reports of
specific postvaccination "adverse events" in order to monitor actual and potential vaccine-related
problems
vectors—nonhuman organisms, often an insect, that either mechanically or biologically play a
role in the transmission of an infectious agent from source to host
virulence—a term used to assess the strength of an organism

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