Exam 1 - Review Questions Flashcards
(120 cards)
1
Q
The population that best represents the differential vulnerability hypothesis is a group of:
Children with a family history of sickle cell disease and hypertension. Homeless pregnant teens in a substance abuse program. Native Americans at risk for diabetes. Overweight children.
A
Homeless pregnant teens in a substance abuse program. Correct
The differential vulnerability hypothesis states that vulnerable population groups are those that are not only particularly sensitive to risk factors but also have multiple cumulative risk factors. Being at risk for a certain health problem is necessary for the development of that problem, but it is not sufficient. The individual must also possess other characteristics that increase his or her vulnerability before the health problem actually develops. The combination of particular sensitivity to risks and the presence of cumulative causal factors may explain the increased vulnerability of certain populations.
2
Q
In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to:
Assure access to health care for elderly Americans. Build hospitals to care for the medically indigent. Insure children without health insurance. Provide supplementary income for citizens with disabilities.
A
Insure children without health insurance. Correct
Title XXI of the Social Security Act, passed in 1998, established the State Children’s Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.
3
Q
Vulnerability is multidimensional, and one of the primary contributors to vulnerability is:
Gender. Race and ethnicity. Resource limitations. Urban or rural residency.
A
Resource limitations. Correct
Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual’s ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.
4
Q
A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely:
Educate about self-care and the women's rights as employees. Establish a partnership with a community to initiate a community health center. Help identify new cases and ensure that clients receive proper treatment. Teach how to lobby state legislators.
A
Educate about self-care and the women’s rights as employees. Correct
Helping clients understand their rights to protection from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.
5
Q
After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family’s children may qualify for enrollment in the state children’s health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations?
Carrying out primary prevention. Setting family-centered, culturally sensitive goals. Trying to minimize the "hassle factor." Using the MAP-IT approach.
A
Trying to minimize the “hassle factor.” Correct
Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with non-restrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the “hassle factor.”
6
Q
A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as:
Advocacy. Empowerment. Partnership. Social justice.
A
Advocacy. Correct
The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients’ preferences are accommodated.
7
Q
Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual’s or group’s:
Cycle of dependency. Health literacy. Level of income. Race and ethnicity.
A
Health literacy. Correct
A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client’s ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.
8
Q
Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as:
Frail older adults. Low-income families with newborns. Poor clients discharged from acute care. Clients requiring intravenous antibiotics.
A
Frail older adults. Correct
One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act’s more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.
9
Q
An unemployed individual with AIDS develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to:
Barriers to access. Cascade effects. Cumulative risk. Socially based inequity.
A
Cascade effects. Correct
Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contribute to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.
10
Q
ulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics (select all that apply)?
Better access to health care services but poor health outcomes. Greater likelihood of exposure to risk factors. Multiple risk factors but equal health outcomes. Worse health outcomes.
A
Greater likelihood of exposure to risk factors.Correct
Worse health outcomes.Correct
Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, <i>risk</i> is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.
11
Q
One challenge in working with families for healthy outcomes when a following capacity-building practice model occurs when the nurse steps aside in:
Defining the problem. Designing family interventions. Evaluating the plan. Pre-encountering data collection.
A
Designing family interventions. Correct
In a capacity-building model of practice, nurses assume the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates actions for and with the family. When designing family interventions, nurses will be challenged to help families identify the primary problem confronting them (prioritizing) and stepping aside; accepting the family’s priorities as they work in partnership with the family to keep their interventions simple, specific, timely, and realistic.
12
Q
When the community health nurse displays pertinent family information in a family tree format, the family can see the family structure, its members and their relationships over at least three generations and provides a visual source for planning family interventions. This approach also assists the nurse in making clinical judgments relevant to family structure and history. This type of family assessment instrument is referred to as:
Ecomap. Genogram. Family developmental task. Family diagnosis.
A
Genogram. Correct
The last step of Outcome-Present State-Testing is reflection. Reflection involves an examination of the current case and its clusters of evidence, keystone issues, outcomes, and interventions. This allows the nurse to store the details of this case in the nurse’s mental file and engage in self-judgment. By viewing the “whole picture” from outside the action, the nurse can identify increased options for future interventions. This purposeful and deliberate reflection fosters learning and is the critical thinking aspect that paves the way for the nurse to move from novice to expert practitioner.
13
Q
One major challenge in the development of social policies that affect families is related to:
Absence of any federal family policies. Indirect negative effects on families. Attempts at welfare reform. Ongoing debate as to what constitutes a family.
A
Ongoing debate as to what constitutes a family. Correct
The challenges of social policy for families are numerous. Given the ongoing debate as to what constitutes a family, social policy may specify a definition that is inconsistent with the family’s own definition, such as same-sex partnerships and/or marriage, legal definition of a parent, reproductive and fertility issue (surrogacy rights), care of older adults, health care proxy, teen request for confidential services.
14
Q
A nurse is evaluating the outcome of a family with children’s action plan to address the incorporation of caregiving needs of the paternal grandfather. Although evaluation includes many tasks, the critical thinking process includes (select all that apply):
Conducting a summative evaluation meeting. Determining the timeliness of the plan outcome. Identifying changes in the family story. Identifying nurse-related barriers. Making the transition of nurse to family dependence.
A
Determining the timeliness of the plan outcome.Correct
Identifying changes in the family story.Correct
Identifying nurse-related barriers.Correct
Termination, transition, and summative evaluation are tasks of the evaluation process; however, the critical thinking process of evaluation must address whether the plan worked, was it timely, does it need to be revised, whether family barriers or nurse-related barriers existed that interfered with the plan, or figure out if the family story changed. Family barriers include family apathy and indecision. Nurse-related barriers include nurse imposed ideas; negative labeling; overlooking family strengths; and neglecting cultural or gender implications.
15
Q
The nurse working with the family of a child recently diagnosed with juvenile diabetic asks the parents about any changes in their relationship since the child’s diagnosis. This family nursing approach can best be described as treating the family as a:
Client. Component of society. Context. System.
A
System. Correct
When the family is approached as a system, the focus is on the family unit and the family is viewed as an integrated system in which the whole is more than the sum of its parts. The interactions among family members become the target for nursing interventions. The systems approach always assumes that when something happens to one family member, the other members of the family system are affected, and vice versa. This includes interactions among parents and children as well as interactions between parents.
16
Q
Two of the most significant barriers to practicing family nursing are the narrow definition of family used by health care professionals and social policy makers and:
Lack of consensus on what constitutes a healthy family. Medical and nursing diagnosis systems. Nursing's historical ties with the medical model. Lack of exposure of practicing nurses to family concepts.
A
Lack of consensus on what constitutes a healthy family. Correct
Family nursing is practiced in all settings. Family nursing consists of nurses and families working together to improve the success of the family and its members in adapting to normative and situational transitions and responding to health and illness. The diverse and changing definitions of “family” present a challenge to society’s notion of what constitutes healthy families. Healthy and vital families are essential to the world’s future, because families serve as the basic social unit of society.
17
Q
When applying the bioecological systems theory to families, a major assumption of this model is
Families experience disequilibrium when they transition from one stage to another stage. Focusing on the interaction of the system with other systems rather than the individual. Maintaining stability through adaptation to internal and external stressors. What happens outside the family is as equally important as what happens inside the family.
A
What happens outside the family is as equally important as what happens inside the family. Correct
The bioecological systems theory of Bronfenbrenner (1972, 1979, 1997) is designed around the principles of nature and nurture and those principles can be applied to families. The family is at the center of the concentric circles representing microsystems, mesosystems, exosystems, macrosystems, and chronosystems. One assumption of this model is that what happens outside the family is equally as important as what happens inside the family, providing a more holistic view of interactions between family and society but not addressing how families cope or adapt to the interactions with these systems. The other statements apply to family development/lifecycle theory and family systems theory.
18
Q
A community health nurse is working with a single parent with a special needs child and a child with asthma. The maternal grandmother lives with the family and was recently diagnosed with diabetes. The nurse understands the importance of including the grandmother in her assessment and interventions because families are:
Resistant to outside intervention or involvement. Involved in the health care of their members. Unable to manage the stress of complex health needs. Restricted in their ability to identify interventions.
A
Involved in the health care of their members. Correct
Health care decisions are made within the family, the basic social unit of society. Families are involved in the health care of their members and therefore are significant participants in the health care team, because they are an ever-present force over the lifetime of care.
19
Q
More than 50% of divorced people remarry, and for middle-aged families this results in more blended families This trend has increased challenges for these families in the area of:
Childcare. Family size. Family stability. Financial survival.
A
Childcare. Correct
Remarried middle-aged couples with families are often creating more complex blended families that create family challenges for childcare (custody arrangements, visitation rights). However on the positive side, remarriages contracted by adults older than 40 years of age may be more stable than first marriages. Nurses need to keep up to date on demographic trends pertaining to families in order to identify high-risk populations and plan for the implication of such trends on community service needs.
20
Q
Family health can be defined as a dynamic relative state of well-being that involves the biological, psychological, sociological, cultural, and spiritual aspects of the family system. This approach to family health is consistent with which of the following principles (select all that apply)?
Assessment of the individual's health does not reveal the overall family system's health. Family functioning affects the health of individuals. Family system assessment specifically addresses the individual's health. The individual's health affects the family's functioning. Individual family members and the family system as a whole are assessed simultaneously.
A
amily functioning affects the health of individuals.Correct
he individual’s health affects the family’s functioning.Correct
Individual family members and the family system as a whole are assessed simultaneously.Correct
The biological/psychological/sociological/spiritual approach to family health considers individual members as well as the family unit as a whole. An individual’s health (along a wellness-illness continuum) affects the functioning of the entire family, and, in turn, the family’s functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.
21
Q
In nursing centers, research questions emerge from the essential organizational practice of:
Academic affiliation. Creation of educational opportunities. Program evaluation. Strategic planning.
A
Program evaluation. Correct
Program evaluation, a systematic approach to improving and accounting for public health and primary care actions, is an essential organizational practice in nursing centers. Evaluation is thoroughly integrated into routine program operations; drives community-focused strategies; allows for process improvements; and identifies the need for additional services. Program evaluation separates what is working from what is not working and enables clinicians, faculty, and students to ask different questions and deal with pressing challenges. Therefore, research questions emerge from program evaluation.
22
Q
When a business plan for a nursing center is being developed, the essential elements to include are a forecast for minimum startup funding, projected income for 1 to 3 years out, and:
Breakeven analysis. Community assessment. Feasibility study. Managed care contracts.
A
Breakeven analysis. Correct
The business plan provides information that forecasts the minimum funding necessary to create a nursing center and projects income 1 to 3 years from inception. A breakeven analysis is essential. The business plan must be modified in accordance with changing managed care reimbursement in a particular locale, as well as the state’s reimbursement parameters for nurse practitioners.
23
Q
The health and wellness center is a type of nursing center that focuses on:
Health-promotion, disease-prevention, and disease-management programs. Programs affiliated with major for-profit health corporations. Programs for special populations and specific health conditions. Public health programs.
A
Health-promotion, disease-prevention, and disease-management programs. Correct
The health and wellness center is specific type of nursing center service model. The focus of the health and wellness center is health promotion, disease prevention, and disease management programs. The centers are generally supported by service contracts and public health departments, grants, fees for services, voluntary contributions, and shared resources from affiliated organizations. They may provide such services as outreach, public awareness programs, health education, immunizations, family assessment and screening, home visiting, social support, and enabling services. They complement existing primary care services.
24
Q
Effective quality improvement programs for nursing centers should choose quality indicators that are priority indicators and measures for nursing centers and later add other measures after careful consideration. The best examples of priority indicators for nursing centers are:
Billing data, client account data, and provider productivity data. Epidemiologic data, billing data, and client satisfaction and utilization data. Demographic and disease-tracking data for the specific subpopulations being served. Data on prevention, utilization, client satisfaction, and functional status.
A
Data on prevention, utilization, client satisfaction, and functional status. Correct
Evidence-based practice is the clinical application of particular interventions and documentation of client and population outcome data. Mechanisms for collecting and analyzing the findings (evidence) and timelines for sharing the evidence in appropriate forums need to be in place. Quality indicators and related performance measures are priority indicators in any type of nursing center, because these data will be presented to the nursing center’s board, funders, and the community at large and document the center’s contributions to the health and welfare of the community. Center staff must carefully consider and determine what outcome measures and quality indicators are worthy and have meaning for the community and health care system. It is prudent to begin with particular indicators and measures and incrementally add more. The Quality Task Force of the National Nursing Centers Consortium has developed guidelines for quality management for nursing centers that include standards for community nursing centers. Use of these standards and selected indicators and associated processes will enable a nursing center to document evidence-based practice in contributing to the health and welfare of the community. Examples of quality indicators for nursing centers include measures of prevention, utilization, client satisfaction, and functional status.
25
To identify the strengths and limitations of an organization and the community, and their capacity to support the establishment of a nursing center and maintain its viability, which of the following should be completed?
Business plan
Community assessment
Feasibility study
Strategic plan
Feasibility study Correct
A feasibility study reveals the strengths and limitations of a given organization and community, and examines their ability to support the establishment of a nursing center and maintain its viability. Performing a feasibility study requires interviewing key individuals, conducting surveys and other data collection, and organizing focus groups and community forums. Epidemiologic, environmental, and other community assessments and data from public health agencies should be considered. The study should also take into account legal and regulatory policies. The overall process supports the emergence of business plans, strategic plans, and timelines.
26
A comprehensive primary health care center housed on the campus of the local high school in a predominately urban African-American community provides 24-hour/5-day-a-week access to physical and behavioral health care services for community residents of all ages. The center is measuring outcomes related to the use of services; immunization rates; use of alcohol, tobacco, and other drugs; weight; functionality; and responsible sexual behavior. These indices best identify a systematic approach to:
Achieving Healthy People 2020 objectives.
Addressing the World Health Organization (WHO) common nursing research agenda.
Achieving designation as a federally qualified health center.
Qualifying for insurance reimbursement as a safety net provider.
Achieving Healthy People 2020 objectives. Correct
The Healthy People initiative has framed the nation's health promotion and disease prevention agenda since 1980. Healthy People 2020 goals are to increase quality and years of healthy life and to eliminate health disparities, and these goals take into consideration demographic changes in the nation, with its more racially and culturally diverse and older population; escalating global influences on personal and national health status; and anticipated changes in the health care system. Healthy People 2020 is a systematic approach to improving the health status of the nation. The health indices noted above are part of the leading health indicators that pertain to nursing centers.
27
A community-oriented nurse has noted that pediatric clients diagnosed with HIV/AIDS do not have ready access to services that focus on the specific needs of this population. The nurse begins working with community stakeholders to develop a nursing center. The most appropriate model to consider for this nursing center would be:
Comprehensive primary care center.
Federally qualified health center.
Health and wellness center.
Special care center.
Special care center. Correct
Nursing centers that focus on a particular demographic group or those with special health needs are special care centers. Services are responsive to the characteristics and needs of a particular group and provide specialized health knowledge and skills to the population. These centers are adjuncts to comprehensive primary care centers and may focus on the needs of populations such as those with diabetes or HIV/AIDS, adolescent mothers, the frail elderly, or people with cancer.
28
The nursing center director, in collaboration with key stakeholders, is identifying a research agenda for the nursing center. The research agenda incorporates World Health Organization (WHO) priorities for a common nursing research agenda, so it will include, at a minimum, which of the following (select all that apply)?
Cost analysis and documentation of cost-effectiveness.
Demonstration of effective interventions that produce appropriate outcomes.
Description of nursing interventions and linkages with consumer needs and resources.
Identification and clarification of client needs, particularly those not engaged.
Welfare-to-work transitions that influence access and use patterns.
Cost analysis and documentation of cost-effectiveness.Correct
Demonstration of effective interventions that produce appropriate outcomes.Correct
Description of nursing interventions and linkages with consumer needs and resources.Correct
Identification and clarification of client needs, particularly those not engaged.Correct
A research agenda is needed by every nursing center. The WHO has set priorities for a common nursing research agenda that include identification and clarification of client needs, particularly those not engaged; description of nursing interventions and linkages with consumer needs and resources; demonstration of effective interventions that produce appropriate outcomes; and cost analysis and documentation of cost-effectiveness. However, more than descriptive studies are needed. For instance, the psychosocial aspects of nursing practice are important. These include nurses' ability to listen to, support, and interpret information to clients; client perception of the perceived value of nursing center services; accessibility, acceptability, and affordability of services; and environmental conditions that influence health care access and use patterns, such as transportation, criminal activities, and welfare-to-work transitions.
29
One of the most significant challenges and threats to the survival of nursing centers is:
Consumers' perception that nurses are less desirable health care providers.
Decreased numbers of advanced practice nurses available to work in nursing centers.
Increased numbers of uninsured and nurses' ineligibility for insurance reimbursement.
Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events.
Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events. Correct
Threats to the survival of nursing centers include the economics of the marketplace, such as increased numbers of uninsured, decreased availability of funding, and declining nursing workforce. There are increasing numbers of trained advanced practice nurses every year. Evidence-based analysis has shown that consumer satisfaction with nursing centers is high and nursing centers improve health outcomes. Although nursing centers represent a distinctive and innovative approach to the delivery of health care services, there will be an ongoing need for nursing centers to address policy and political issues that influence this model of health care, such as any existing insurance or program participation barriers, the public's increasing disenchantment with managed care, double-digit increases in the proportion of the gross national product spent on health care, fiscal sustainability, and the national emphasis on achieving Healthy People 2020 goals and objectives despite the absence of universal health insurance.
30
Stakeholders facilitate or undermine a community's efforts to address critical needs, solve problems, and improve health. A major barrier to collaboration is:
Limited resources.
Shared risks.
Professional agendas.
Time.
Professional agendas. Correct
The objectives of Healthy People 2020 will be achieved through community collaboration over time, because communities have the potential to change. Productive collaboration requires staff expertise and commitment to change communication patterns and professional agendas, and to develop a common voice to generate positive community transformation through changes in policy, legislation, and funding that improve the health status of many. Collaboration takes time, effort, and resources, and requires the nurturing and support of relationships that evolve into a collective willingness to work together toward a common purpose, with sharing of risks, responsibilities, resources, and rewards along the way. The collaborative process itself will address time requirements, limited resources, and inevitable risks. Without the development of a collective willingness and the placing aside of professional or other agendas, a common purpose cannot be achieved.
31
The Healthy Communities and Cities movement can best be described as which of the following?
Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community.
Movement that began in the United States in 1986 that targets health promotion in community practice.
Movement that focuses on the effective development and utilization of public policy as the primary means for improving health in communities worldwide.
Program that uses the principles of primary, secondary, and tertiary prevention in communities throughout the world in an effort to mobilize citizens to improve the health of their communities.
Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community. Correct
The Healthy Cities movement began in Europe in 1986 and has since spread worldwide. The Healthy Communities and Cities movement incorporates principles and concepts that focus on mobilizing local political, professional, and community members to improve the health of the community. The principles of health promotion and primary health care prevention guide the movement. The model was adopted and modified in the United States in 1988 and has been applied to rural and metropolitan areas to engage local residents in action for health.
32
A nurse has decided to use a bottom-up approach of Healthy Communities and Cities (HCC) to meet Healthy People 2020 goals for the community setting. Which would be the most appropriate intervention?
Design and implement a health promotion activity that can be scheduled at a senior center.
Organize a community meeting of local politicians, clinicians, and community members to prioritize needs and plan for the purchase of equipment needed to better treat elderly clients with diabetes.
Recruit the mayor and city council to designate an annual Elder Health day.
Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults.
Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults. Correct
Healthy People 2020 goals include establishment of educational and community-based programs that focus on disease prevention and health promotion. Goals for community settings and select populations include culturally appropriate community health promotion and disease prevention programs. Increasing the proportion of older adults participating in organized health promotion activities is also a goal. Following the implementation steps of the Community Health Improvement Model: Development of Community Structure for Health Promotion, the nurse working to achieve Healthy People 2020 goals should mobilize local political, health professional, and community members, including members of the target population, to prioritize, design, and implement culturally appropriate health promotion activities for seniors in the community.
33
The Healthy Communities and Cities model process relies on a problem-solving approach to achieve goals. The best example of this approach is:
Community activists lobbying their state legislature to mandate increased primary care access.
Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change.
Health care professionals working independently to determine priorities for their community and then educating their community about the health promotion needs they have prioritized.
Teachers using health promotion curricula to reduce teenage smoking in their community.
Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change. Correct
The goal of the Community Health Improvement Model is to encourage community members to take responsibility for the changes they wish to see happen. The model focuses on community involvement in every step of the process. Health care providers can best act as facilitators, educators, and promoters of the model, not "experts" who dictate solutions to the community.
34
An example of tertiary prevention related to Healthy Communities and Cities is:
Assessing the need for programs to treat alcohol addiction.
Assessing the strengths of local schools' adolescent pregnancy prevention programs.
Initiating an evaluation of a program to address endemic hepatitis A in a community.
Organizing a community forum to explore health promotion priorities.
Initiating an evaluation of a program to address endemic hepatitis A in a community. Correct
Tertiary prevention includes initiation of community action when problems have occurred, and evaluation of progress and effectiveness of programs and policies.
35
Nurses working with communities to implement the Community Health Promotion Model (CHPM) are most effective when they:
Begin where the community is and then work to facilitate implementation of all nine steps.
Serve in the role of expert, spearheading the community's work.
Teach basic community and public health concepts before beginning to explain and teach the Health Communities Model.
Work with community leaders to begin with step one and progress through step nine of the model.
Begin where the community is and then work to facilitate implementation of all nine steps. Correct
Nurses should begin where the community is. Nurses help facilitate implementation of the model, coaching community leaders so they understand and implement all steps of the model. Nurses are most effective when they serve as facilitators and coaches-not seeking to be "bosses" but instead sharing leadership and enhancing the skill development of those involved by "being on tap, not on top."
36
Instrumental in the development of Healthy Communities and Cities is the concept of primary health care, which refers to meeting the basic health needs of a community by providing readily accessible health services. Primary health care seeks to provide affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns. This is the primary health care principle of:
Affordable technology.
Community participation.
Equity.
Multisectoral participation.
Affordable technology. Correct
The principles of primary health care and the Ottawa Charter for Health Promotion were influential in the development of the Healthy Communities and Cities movement. The principles of primary health care include equity, health promotion, community participation, multisectoral cooperation, appropriate technology, and international cooperation. Appropriate technology refers to the provision of affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns.
37
The Ottawa Charter adopted by the Healthy Communities and Cities movement defined health promotion as the process of enabling people to take control over and to improve their health by enabling community members to increase control over and assume more responsibility for health; mediating among public, private, voluntary, and community sectors; and advocating on behalf of people who are powerless to make the changes necessary to promote health. The charter identified the most effective health promotion action as:
Creating supportive environments.
Developing health-promoting public policy.
Reorienting health services.
Strengthening community action.
Developing health-promoting public policy. Correct
The Ottawa Charter for Health Promotion (World Health Organization, 1986) lays the foundation for the Healthy Communities and Cities movement definition of health promotion. In order of priority, the Ottawa Charter identifies developing health-promoting public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services as the key strategic health promotion action for achieving health for all. Health-promoting public policy supports health in a broad ecological sense that includes environmental, physical, social, and mental well-being. Although efforts to change individual behavior are important, the contributions of policies that affect the broader environment are thought to be more effective in achieving social change. Good examples of such impacts are statewide seat belt laws, helmet laws, and local nonsmoking ordinances.
38
The Community Health Improvement Model: Step 3-Development of the Community Structure for Health Promotion supports the development of local collaborative partnerships to enhance the objectives of Healthy Communities and Cities. The collaborative partnership best practice of "identifying specific community and system changes to be sought to effect widespread behavior change and community health improvement" would best apply to which concept of the Ottawa Charter for Health Promotion strategic framework?
Creating supportive environments.
Establishing health-promoting public policy.
Reorienting health services.
Strengthening community action
Strengthening community action. Correct
The Ottawa Charter for Health Promotion identified the strengthening of community action as a priority health promotion action. The strengthening of community action refers to promoting the community's capacity, ability, and opportunity to take appropriate action to protect and improve the health of the community.
39
A nurse expands a community exercise program to include a senior exercise program targeted at strength and balance training in response to the Healthy Communities and Cities initiative to address the needs of free-living elders in the local community. The nurse is most likely applying the Ottawa Charter for Health Promotion priority health promotion activity of:
Developing personal skills.
Establishing health-promoting public policy.
Reorienting health services.
Strengthening community.
Reorienting health services. Correct
Nurses participating in a Community Health Promotion Model collaborative partnership can redirect community health services toward local priorities and plans based on the Healthy Communities and Cities committee's desired actions for health. This redirecting of community health services is an example of "reorienting health services," a priority health promotion action of the Ottawa Charter for Health Promotion.
40
The Healthy Communities and Cities (HCC) movement emphasizes a bottom-up approach to community practice. The Community Health Promotion Model is a bottom-up community practice model that includes multisectoral planning and action for health, which is consistent with a locality development model (bottom-up approach). The aspects of the locality development model that have been integrated can best be described as which of the following (select all that apply)?
Emphasizing consensus and cooperation.
Building a sense of community.
Using a rational-empirical approach.
Producing fundamental social change.
Rational-empirical problem solving by outside experts.
Emphasizing consensus and cooperation.Correct
Building a sense of community.Correct
Different models of community practice exist. The locality development model is a process-oriented model that emphasizes consensus, cooperation, and building of group identity and a sense of community. The social planning (top-down approach) model stresses rational-empirical problem solving, usually by outside professional experts. Social planning does not focus on building community capacity or fostering fundamental social change. The social action model concentrates on increasing the problem-solving ability of the community through concrete actions that attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. The Community Health Improvement Model aims at creating partnerships within the community and focuses on community leadership development for health while using a bottom-up approach like the locality development model. This multisectoral cooperation (primary health care principle) by all parties in a community, from local government officials to grassroots community members, creates a stronger foundation for health-promoting public policy development, the highest-priority health promotion action identified for producing sustainable community health change.
41
In 1988 the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as:
What public-private partnerships do to treat vulnerable populations.
What the government does to ensure that vital programs are in place.
What the U.S. Public Health Service does to prevent disease, promote health, and deliver services.
What society does collectively to ensure the conditions in which people can be healthy.
What society does collectively to ensure the conditions in which people can be healthy. Correct
In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.
42
A registered nurse is seeking a position as a public health nurse. In reviewing the job description the nurse would expect to find a description of a position that focused on functions such as:
Monitoring pregnant teenagers for symptoms of complications of pregnancy.
Offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members.
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders.
Preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. Correct
The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.
43
A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to:
Agency colleagues' push for nurses to focus on population initiatives.
Costs associated with staff training and revision of documents.
Lack of support from the agency's funding sources.
Opinions that nursing should focus on the provision of direct client care and services.
Opinions that nursing should focus on the provision of direct client care and services. Correct
Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology; biostatistics; community development; service administration; and policy formation.
44
The role and goals of the community health nursing practice can best be described as:
Community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes.
Education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs.
Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole.
Activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies
Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Correct
Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.
45
A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of:
Assessment.
Assurance.
Policy development.
Research.
Assessment. Correct
Assessment is a core function of public health and refers systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.
46
The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is:
Assurance.
Policy development.
Primary prevention.
Public transportation.
Assurance. Correct
The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.
47
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:
Community-oriented care.
Community-based care.
Secondary care.
Tertiary care.
Community-oriented care. Correct
Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.
48
A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of:
Clinical community health practice.
Community-based practice.
Population-focused practice.
Public health nursing.
Clinical community health practice. Correct
Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.
49
Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is:
Operator of a nurse practitioner-run urgent care center in a major retail location.
Director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system.
Clinical director of a home health agency.
School nurse position in the local high school.
Director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. Correct
The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.
50
Public health nursing specialists are interested in which of the following topic(s)? Select all that apply.
Educational materials for individuals with HIV/AIDS.
Evaluation of an outreach program for at-risk pregnant teenagers.
Community subpopulations with high rates of type 2 diabetes.
New technologies to monitor diabetes.
Prevalence of hypertension among various age, race, and gender groups.
Evaluation of an outreach program for at-risk pregnant teenagers.Correct
Community subpopulations with high rates of type 2 diabetes.Correct
Prevalence of hypertension among various age, race, and gender groups.Correct
Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.
51
In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period (select all that apply)?
Establishment of state health departments and local health boards in every town.
Promotion of environmental sanitation and collection of vital statistics.
Steps to decrease preventable disease and control smoking and alcohol use.
Targeting of efforts solely on environmental hazards.
Provision of supplemental food to low-income persons.
Establishment of state health departments and local health boards in every town.Correct
Promotion of environmental sanitation and collection of vital statistics.Correct
Steps to decrease preventable disease and control smoking and alcohol use.Correct
The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of public health nurses.
52
During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by:
Decrease in focus on the community as the unit of service.
Increase in the scope of fundamental services.
Increase in field experience.
Decrease in the need for training and supervision.
Decrease in focus on the community as the unit of service. Correct
Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health; but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision.
53
The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was:
Establishment of a frontier nursing service.
Provision of funding to support employment and education.
Provision of funding for research and investigation of disease.
Institution of a district nursing model.
Provision of funding to support employment and education. Correct
Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses. More than 1000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of public health nurses with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease.
54
The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives (select all that apply)?
Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home.
Established public health nursing programs for military outposts in World War I.
Provided matching funds to establish maternal and child health divisions in state health departments.
Responded to the 1918 worldwide influenza pandemic in the United States.
Supported nurse employment through increased grants-in-aid for state programs of home medical care.
Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home.Correct
Established public health nursing programs for military outposts in World War I.Correct
Responded to the 1918 worldwide influenza pandemic in the United States.Correct
The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.
55
The most important contribution made by Florence Nightingale to community-oriented nursing was:
Development of the settlement house concept as a strategy to improve urban health standards.
Expansion of the role of nursing to include health-promotion practices.
Founding of the first district nursing association in England.
Introduction of professional schools of nursing in the United States.
Expansion of the role of nursing to include health-promotion practices. Correct
Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness.
56
In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of:
Enforcing the department of health's rules and regulations.
Excluding infectious children from the school environment.
Providing and obtaining medical treatment for absent students.
Providing shoes and clothing for students.
Providing and obtaining medical treatment for absent students. Correct
In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide followup care to children absent from school.
57
The Association of Community Health Nurse Educators has called for increased graduate programs to educate public health nurse leaders, educators and researchers to address unmet community and neighborhood needs in such areas as (select all that apply):
```
Immigrant and migrant health.
Natural and human-made disasters.
Potential bioterrorism.
Student health.
Rural health.
Chronic disease management.
```
The Association of Community Health Nurse Educators has called for increased graduate programs to educate public health nurse leaders, educators and researchers to address unmet community and neighborhood needs in such areas as (select all that apply):
```
Immigrant and migrant health.Correct
Natural and human-made disasters.Correct
Potential bioterrorism.Correct
Student health.Correct
Rural health.Correct
Chronic disease management.
```
Nurse-managed health centers have provided a range of innovative nursing services, including health promotion and disease/injury prevention to vulnerable populations that lack access to such services when existing organizations have been unable to meet their needs. New populations in communities continue to challenge schools of nursing, health departments, rural health clinics, and migrant health services. Although transfer of official public health services to private control has sometimes reduced professional flexibility and service delivery, in times of workforce shortages having a fully prepared workforce of graduate educated nurses can supplement the public system's ability to respond effectively and meet societal challenges of the time. Well-prepared nurses can seek successful strategies to meet the complex needs of today's vulnerable populations and public health challenges of the future, looking to history for inspiration, explanation, and prediction.
58
In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was:
Establishment of the Federal Emergency Relief Administration.
Introduction of the first nurse-midwifery training.
Introduction of the nursing process.
Introduction of occupational health nursing
Introduction of the first nurse-midwifery training. Correct
The unique pioneering spirit of the FNS influenced the development of public health programs to improve the health care of rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckenridge, the founder of the FNS, introduced the first nurse-midwives into the United States.
59
The poor environmental conditions experienced by immigrants in tenement houses and sweatshops were familiar features of urban life across the northeastern United States and the upper Midwest. Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of the times (select all that apply)?
Community health's focus on teaching and prevention
Establishment of settlement houses
Establishment of the town and country nursing services in large cities
Lack of public interest in limiting disease
Middle and upper class fear of diseases
Community health's focus on teaching and preventionCorrect
Establishment of settlement housesCorrect
Middle and upper class fear of diseasesCorrect
In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities.
60
From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as:
Adoption of 2-year associate degree nursing programs.
Exclusion of home-based care from health insurance coverage.
National preference service model that neglects emerging problems.
Rise in hospital-based care.
National preference service model that neglects emerging problems. Correct
The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only.
61
A community-oriented nurse understands that the most important use of the principles for effective advocacy is to:
Act as a friend and advocate for the target population served to promote research and data gathering.
Act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality.
Ensure that public funds are spent only for the priorities stated in the legislation that authorized program funding and promote regulations and legislation.
Give more priority to the opinions and feelings of key community leaders than to data when determining program priorities.
Act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. Correct
The six principles of effective advocacy include acting in the community's best interest, acting in accordance with the community's wishes, keeping the community informed, acting with diligence, maintaining impartiality, and maintaining confidentiality. Bateman's practical framework for advocacy places the advocate's core skills within the context of the six principles of effective advocacy.
62
The new director of a local public health unit reviews the personnel records of the unit staff and notes that none of the assigned public health nurses has academic training in community and public health nursing. The director's next step should be to:
Recognize that staff members have learned on the job through years of experience and that they will be able to teach their new director basic community and public health principles.
Make arrangements to hire new staff with appropriate formal training.
Realize that with the current nursing shortage the unit should be grateful to have long-term staff.
Review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.
Review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training. Correct
Both the American Nurses Association (ANA) Code of Ethics and the Public Health Code of Ethics state that the professional competency of all public health employees must be assured and address issues of the nurse's accountability to ensure competency in delivery of services to individuals, families, or populations.
63
A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using fragranced candles. The most appropriate intervention for the nurse is to apply the principle of:
Autonomy, in which the nurse leaves the matches and candles accessible to the client.
Beneficence, in which the nurse maintains the client's dignity and reinforces to the client how pleasant it is to use scented candles.
Nonmaleficence, in which the nurse counsels the client regarding the dangers of the use of candles and matches by someone with low vision.
Respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet.
Respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet. Correct
The nurse applies the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others.
64
A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.)
```
Autonomy of the professional.
Confidentiality, when possible.
Funding.
Advocacy for disenfranchised persons.
Respect of only community rights.
```
Confidentiality, when possible.Correct
Advocacy for disenfranchised persons.Correct
The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; maintaining trustworthiness; and advocating for disenfranchised persons within the community.
65
A nurse has worked for years in an intensive care unit and decides to take a position as a community health nurse directing a local public health unit. Her first assignment is to perform an assessment of the community's migrant farmworker population. The nurse's most appropriate next step is to:
Begin the community assessment using a survey tool proven effective in previous public health unit assessments.
Perform a literature review to study assessment data for similar populations.
Enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques.
Form a relationship with the farmworkers' community leaders and other key informants.
Enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. Correct
Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population.
66
Caring and the ethic of care are core values of community health nursing. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in the health care sciences and the desire of nurses to:
Apply gender-related voices to moral judgment.
Apply principles of utilitarianism.
Differentiate distributive justice from beneficence.
Differentiate nursing practice from medical practice.
Differentiate nursing practice from medical practice. Correct
The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics.
67
Although nursing has a strong implicit heritage of ethical values and morality, it was not until the 1960s that several seminal events significantly shifted the focus to ethical decision-making processes. One of those seminal events was the emergence of the field of bioethics and the other event was:
Adoption of the American Nurses Association (ANA)'s Code for Professional Nurses .
Adoption of the American Public Health Association's Public Health Code of Ethics .
Adoption of the International Council of Nurses' Code of Ethics for Nursing .
Issuance of the ANA's position statement on nursing education in institutions of higher education.
Issuance of the ANA's position statement on nursing education in institutions of higher education. Correct
In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values to the explicit study of ethics and ethical decision-making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs.
68
One step in the ethical decision-making framework is to place an ethical issue within a meaningful context. The rationale for this step is that:
Multiple factors affect the formulation and justification of ethical issues and dilemmas.
The nature of ethical issues and dilemmas determine the specific ethical approach used.
People cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas.
Professionals cannot avoid choice and action in applied ethics.
Multiple factors affect the formulation and justification of ethical issues and dilemmas. Correct
The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified.
69
Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to:
Character development.
Consequentialism.
Distributive justice.
Egalitarianism.
Character development. Correct
The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness.
70
The community oriented nurse best exemplifies the application of feminist ethics when the nurse:
Designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community.
Designs health care programs for women that respect their dignity and autonomy.
Ensures that male providers do not use sexist terms when counseling clients and their spouses and when dealing with female colleagues.
Participates in political action committees that focus on women's rights and status in the community.
Designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. Correct
Whereas feminism rejects the devaluing of women and their experiences, believes that the oppression of women is morally wrong, and demands social justice and political action, feminist ethics holds a broader worldview advocating just relationships for both men and women, adopts a feminist perspective that facilitates critical thought, and focuses on broad issues such as power, gender, and socioeconomic structures.
71
The three components of the Intervention Wheel are:
Communities, systems, and individuals/families.
Interventions, color wedges, and levels of practice.
Population base, levels of practice, and public health interventions.
Populations at risk, populations of interest, and levels of practice.
Population base, levels of practice, and public health interventions. Correct
The components of the Intervention Wheel include population base, 3 levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges.
72
Public health nursing practice is guided by the community's priorities as identified by community:
Assessment.
Diagnosis.
Interventions.
Planning.
Assessment. Correct
Assessing the health status of the populations that make up a community requires ongoing collection and analysis of relevant qualitative and qualitative data. Community assessment includes a comprehensive evaluation of the determinants of health. Data analysis identifies deviations from expected or acceptable rates of disease, injury, death, or disability, as well as risk and protective factors. Community assessment generally results in a lengthy list of community problems and issues. However, communities rarely posses sufficient resources to address the entire list, and priorities must be set after assessing the community's beliefs, attitudes, and opinions, as well as the community's readiness for change.
73
Collaboration is an intervention that would be located where in the Intervention Wheel?
Red wedge at the individual/family level of practice.
Blue wedge at the community level of practice.
Orange wedge at the community level of practice.
Green wedge at the systems level of practice.
Orange wedge at the community level of practice. Correct
The public health interventions are grouped with related interventions, and these wedges are color coordinated. The red wedge includes five interventions: surveillance, disease and health investigation, screening, outreach activities, and case finding. They typically occur in pairs or in sequence, although all can occur independently. The green wedge consists of three interventions: referral and followup, case management, and delegated functions; these are often implemented together. Similarly, the blue wedge includes three interventions-health teaching, counseling, and consultation-that are often implemented together. The orange wedge combines three interventions-collaboration, coalition building, and community organizing-which are all types of collective action that are usually carried out at the systems or community level of practice. Similarly, the three yellow wedge interventions-advocacy, social marketing, and policy development and enforcement-are often interrelated when implemented. Interventions in the orange and yellow wedges are typically used at the systems and community levels of practice, whereas those in the red, blue, and green wedges are usually carried out at the individual/family level of practice and to a lesser degree at the community and system levels of practice. Collaboration is a collective action and therefore must be in an orange wedge.
74
The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as:
Advocacy.
Coalition building.
Consultation.
Social marketing.
Social marketing. Correct
Social marketing utilizes commercial marketing principles and technologies in programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Recent examples of the use of these techniques are antismoking campaigns, campaigns for refunding of the State Children's Health Insurance Program, and campaigns to address the needs of uninsured/underinsured populations.
75
Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of:
Community-level practice.
Family-level practice.
Individual-level practice.
Systems-level practice.
Systems-level practice. Correct
The goal of systems-level practice is to change the laws, policies, and practices that influence immunization rates, such as promoting the creation of population-based immunization registries and improving clinic and provider practices.
76
When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of:
Community-level practice.
Family-level practice.
Individual-level practice.
Systems-level practice.
Community-level practice. Correct
The goal of community-level practice is to improve the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized. These strategies lead to an increase in the percentage of people who obtain recommended immunizations for themselves and their children.
77
A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention.
Individual/family + secondary.
Community + primary.
Community + secondary.
Individual/family + primary.
Individual/family + secondary. Correct
Based on this nursing diagnosis, one could assume that the level of practice is at the individual/family level (young child who is being parented by a primary parent who is experiencing mental health problems) and at the secondary level of prevention (because the family has an existing identified risk, i.e., a mental health problem).
78
After consulting with the health department director, a public health nurse collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice.
Evaluation + systems.
Assessment + community.
Implementation + systems.
Diagnosis + community.
Implementation + systems. Correct
Collaboration and advocacy are often collective actions applied at a community or systems level of practice. In this case, the identification of the community problem probably emerged out of practice, rather than from a formal community assessment. The nurse's goals were to enforce the tenant's legal rights and improve their living conditions. The nurse sought advice from a housing advocate service and connected the clients with legal counsel. The nurse also sought political support by consulting with health department officials before implementing the nursing plan.
79
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A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements.
Evaluate the effectiveness of.
Assess the expansion needs of.
Identify problems with.
Implement the expansion of.
```
Evaluate the effectiveness of. Correct
The evaluation phase of a community-level intervention attempts to determine the effectiveness of the intervention in meeting the desired outcome (decreased social isolation for the elder community population) and in establishing new healthier practices (increased social networking and increased involvement in other community activities) while identifying any emerging barriers (problems) that may interfere with the desired outcome. Very often this can be achieved through a repeat assessment such as a survey of the population receiving the intervention to measure change in attitudes, beliefs, and behaviors.
80
Factors related to the determinants of health identified in Healthy People 2020 include which of the following (select all that apply)?
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Education and literacy.
Genetic endowment.
Gender.
Culture.
Social status.
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Factors related to the determinants of health identified in Healthy People 2020 include which of the following (select all that apply)?
```
Education and literacy.Correct
Genetic endowment.Correct
Gender.Correct
Culture.Correct
Social status.
The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.
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81
Today, an evidence-based nursing practice can best be defined as which of the following?
Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served.
Concept developed by acute care nurses to ensure the quality of care of hospitalized clients and to challenge managed-care decisions.
Concept developed in the early twentieth century to help nurses document the scientific basis of their nursing practice.
Framework supporting the use of traditional research as the only basis for making clinical decisions in practice.
Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served. Correct
Evidence-based practice (EBP) was originally adopted by physicians as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients. Evidence-based public health is a public health endeavor in which there is informed, explicit, and judicious use of evidence that has been derived using any of a variety of scientific and social science research and evaluation methods. In 2005, Sigma Theta Tau International defined evidence-based nursing as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served. External evidence includes research and other evidence while internal evidence includes the nurse's clinical experiences and client's preferences.
82
Community-oriented nurses use evidence-based practice (EBP) most effectively when they:
Base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied.
Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice.
Make client care decisions using the latest nursing research findings.
Work with physicians to design client care guidelines for community clinics
Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. Correct
EBP uses interventions based on the best available evidence from a variety of sources, including research studies, evidence from nursing experiences and expertise, and evidence from community leaders. EBP also addresses client preferences and values, including clients in decisions, and focuses on developing true partnerships in which power and decision making are shared between health care providers and the community to make culturally and financially appropriate interventions.
83
A community-oriented nurse seeks to implement evidence-based practice (EBP) in the community clinic's programs. The best model for the nurse to apply is:
Action research and review.
Community development.
Community research utilization.
EBP.
Community development. Correct
Nurses have an important role to play in developing and using clinical guidelines for community practices. The use of a community development model will ensure that the community's perspective is included. Nurses active in the EBP movement should devote attention to understanding how best to incorporate clinical practice guidelines into a community-oriented practice. Nurses must use caution in adopting EBP in a prescriptive manner in different community environments. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues or distinctions and thus may not be acceptable to the community. Ethical practice in communities requires attention to community differences.
84
A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of:
Meta-analysis of research evidence.
Primary prevention using evidence-based practice (EBP).
Secondary prevention using EBP.
Tertiary prevention using EBP.
Primary prevention using evidence-based practice (EBP). Correct
Using resources such as the Healthy People 2020 information access objectives, nurses can identify evidence-based prevention strategies to implement at the community level in their nursing practice and improve clients' understanding of EBP by fostering access to these electronic personal health tools.
85
When nurses work with communities, "best practices"-the application of the best available evidence to improve practice-must also be:
Accessible and diverse.
Competent and compliant.
Culturally and financially appropriate.
Reasonable and deliverable in a timely fashion.
Culturally and financially appropriate. Correct
Nurse in community-oriented practice need to identify culturally and financially appropriate interventions when implementing evidence-based practice (EBP) in work with communities. The use of evidence to determine appropriate interventions that are both culturally sensitive and cost-effective is a necessity to ensure acceptance by the community and appropriate allocation of limited resources.
86
Although the definitions of evidence-based practice (EBP) in the literature vary widely, their common thread across all health care disciplines is:
Application of the best available evidence to improve practice.
Definition of what counts as evidence.
Reliance on principles of pathophysiology.
Method of transforming research into practice.
Application of the best available evidence to improve practice. Correct
The definition of EBP has evolved over the years and across health professions. The current understanding of EBP has identified this term as an approach to integrating all health professions. The underlying principle is that high-quality care is based on evidence rather than on tradition or intuition. Although definitions of EBP vary widely in the literature, the common thread across disciplines is the application of the best available evidence to improve practice.
87
Examples of the application of evidence-based practice (EBP) to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with:
Agency on Healthcare Research and Quality.
Cochrane Database of Systematic Reviews.
The Intervention Wheel.
U.S. Preventive Services Task Force.
The Intervention Wheel. Correct
A systematic review of the literature was conducted on the 3 levels of practice and 17 interventions identified in the Intervention Wheel. The sources were rated by members of a practitioner panel and consensus was achieved on the outcomes of the review. These findings were field tested and subsequently critiqued by a national panel of experts providing examined evidence for the use of the model and its relationship to the core functions and essential services of public health.
88
When a public health nurse uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of:
Assessment.
Assurance.
Policy development.
Research.
Assurance. Correct
The core public health functions of assessment, assurance, and policy development can be addressed through evidence-based practice (EBP) interventions. The core function of assurance can be carried out by monitoring health status to identify community health problems, enforcing laws and regulations that protect health and ensure safety, ensuring the provision of health care that is otherwise unavailable, ensuring a competent public health and personal health workforce, and utilizing EBP to evaluate effectiveness. To successfully implement an EBP, nurses must be knowledgeable about the research and current evidence; have the ability to interpret the meaning of the evidence; be willing to change personal viewpoints about quality and credibility of evidence; and the practice environment must be willing to embrace EBP.
89
Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of:
Blinded studies.
Case-control studies.
Expert opinion.
Research synthesis.
Case-control studies. Correct
What counts as evidence has been argued in the public health literature. Randomized controlled trials, the gold standard in other areas of evidence-based practice (EBP), is often inappropriate for evaluating public health interventions because subjects cannot be randomly assigned to treatment and control groups. In public health, a case-control study is most appropriate.
90
A community health nurse is revising the agency's nursing protocols to incorporate current evidence-based practice (EBP) clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following (select all that apply)?
Disempowerment of nurses in their ability to make clinical decisions.
Experienced nurses' challenging of the need to change long-accepted practices.
Lack of knowledge of how to conduct a systematic review of the research literature.
Unwillingness of clients to accept changes in familiar agency programs.
Urban agency setting with restricted computer resources.
A community health nurse is revising the agency's nursing protocols to incorporate current evidence-based practice (EBP) clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following (select all that apply)?
Disempowerment of nurses in their ability to make clinical decisions.Correct
Experienced nurses' challenging of the need to change long-accepted practices.Correct
Unwillingness of clients to accept changes in familiar agency programs.Correct
Urban agency setting with restricted computer resources.
Barriers to adopting EBP in the community setting can include miscommunication among nursing leaders about the implementation process; inferior quality of available research or other types of evidence; inability to assess and use evidence; unwillingness of organizations to fund research and make decisions based on research or other evidence; the nurse's ability to make clinical decisions; and certain realities of the practice setting, such as lack of resources for implementation in the setting (time, funding, computer resources, and knowledge), reluctance to accept findings, and resistance to changing long-standing practices. The use of EBP clinical guidelines is one way for nurses to provide evidence-based nursing care in an efficient manner. Clinical practice guidelines usually are developed by groups of experts in the field who have reviewed the evidence (systematic review) and made recommendations based on the best available evidence. This overcomes the need for knowledge on the part of those in practice setting on how to conduct a systematic review of the research literature.
91
A group of six nurses is charged by the nurses' manager with evaluating current unit policies. One month later, the manager determines that the group is ineffective because of lack of cohesiveness. Which of the following group concerns or behaviors would be indicative of lack of cohesion (select all that apply)?
Complaints about the degree of member participation.
Dissatisfaction about demands on their schedules.
Complaints about lack of administrative support.
Lack of a work plan for accomplishing the task.
Vying for leadership.
Complaints about the degree of member participation.Correct
Dissatisfaction about demands on their schedules.Correct
Complaints about lack of administrative support.Correct
Lack of a work plan for accomplishing the task.Correct
Vying for leadership.Correct
Cohesion is the attraction between individual group members and between each member and the group that allows them to identify themselves as a unit and work toward common goals, endure frustration for the sake of the group, and defend the group against outside criticism. This attraction increases when members feel accepted and liked by others, see similar qualities in one another, and share similar attitudes and values. Members of a highly cohesive group work toward their common goal, identifying with the group, being willing to endure frustration to meet their goals, and recognizing the needs of individual members.
92
A nurse diabetic educator who recently returned from a professional conference decides to present current best practices and research findings at a gathering of newly diagnosed diabetic clients. In adopting this approach, the nurse may fail to provide health education effectively. This failure would relate to which domain of learning?
Affective.
Cognitive.
Psychomotor.
Practice.
Cognitive. Correct
The domains of learning are the cognitive, affective, and psychomotor domains. For health education to be effective, the community-oriented nurse must first assess the cognitive abilities of the learner, so that the nurse's expectations and plans are directed to the correct level. Teaching above or below the client's level of understanding may lead to frustration and discouragement.
93
A nurse integrates a structured exercise into her classroom presentation on effective handwashing that assists students in demonstrating and modeling good handwashing techniques. The principle followed by an effective educator that is best demonstrated by this approach is:
Create the best learning environment.
Encourage participatory learning.
Organize the learning experience.
Select the learning format.
Encourage participatory learning. Correct
There are six principles that guide the effective educator: send a clear message, select the learning environment, create the best learning experience, organize the learning experience, encourage participatory learning, and provide evaluation and feedback. People learn better when they are actively involved in the learning process. Participation increases motivation, flexibility, and the learning rate.
94
The nurse recommends Parents Without Partners to a colleague who is experiencing the challenges of single parenthood in raising a teenager. The nurse is demonstrating an understanding of the group elements of:
Cohesion and task functioning.
Leadership and role structure.
Member interaction and group purpose.
Norms and maintenance.
Member interaction and group purpose. Correct
Health-promoting groups may form when people meet in community and health care settings and discover common challenges to their physical and mental well-being. People often make changes with the support of a group that they are unable to make independently. Health-promoting groups like Alcoholics Anonymous and Parents Without Partners improve members' health and deal with specific threats to health.
95
Which objective includes all of the critical elements of an educational objective?
After attending the diabetic education class, the client will prepare a meal plan.
At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines.
The diabetic client will prepare a list of the five food groups and the number of servings from each group that are necessary for an 1800-calorie diet following ADA guidelines.
The client and his wife will attend all of the diabetic education classes to learn to prepare meals consistent with ADA diet guidelines.
At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines. Correct
Objectives are specific, short-term criteria that need to be met as steps toward achieving a long-term goal. Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by the client. They must be stated clearly and defined in measurable terms. Objectives are different from goals, which are broad, long-term, expected outcomes.
96
A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby and presents the material. In terms of the sequencing of instruction, what should the nurse do next?
Ask the mother about her previous experience with breastfeeding.
Demonstrate how to position the baby for breastfeeding.
Have the mother demonstrate breastfeeding.
Show the mother a video about breastfeeding.
Have the mother demonstrate breastfeeding. Correct
To facilitate skill learning, the nurse should teach and demonstrate the skill. The educator should allow learners to practice and immediately correct any errors in performing the skill. The basic sequence of instruction includes nine steps: gain attention, inform the learner of the objectives, stimulate recall of prior learning, present the material, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention and transfer of knowledge.
97
A group's culture is created by the combination of its norms. The nurse supports helpful rules, attitudes, and behaviors in the group because group norms do which of the following (select all that apply)?
Challenge the cohesiveness of the group.
Ensure movement toward the group's purpose and tasks.
Identify message pathways and member participation.
Influence members' perceptions and interpretation of reality.
Maintain the group through various supports to members.
Ensure movement toward the group's purpose and tasks.Correct
Influence members' perceptions and interpretation of reality.Correct
Maintain the group through various supports to members.Correct
Group norms set the standards for group members' behaviors, attitudes, and perceptions. All groups have norms and mechanisms to accomplish conformity. Group norms serve three functions: they ensure movement toward the group's purpose and tasks (task norms), they maintain the group through various supports to members (maintenance norms), and they influence members' perceptions and interpretations of reality (reality norms). Group norms combine to create group culture. Nurses working with groups should not dictate norms but support helpful rules, attitudes, and behaviors within the group. The role of the nurse becomes one of providing accurate information, confirming the possibility/attainability of the group's goals, and encouraging different/positive perspectives.
98
A clinic-based public health nurse has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level?
Analysis of the immunization clinic appointment rate over the next few months.
Analysis of the trend in childhood immunization rates for the health district.
Assessment of the immunization status of each child who visits the clinic.
Determination of the budgetary impact of the media campaign on the clinic's operations.
Analysis of the trend in childhood immunization rates for the health district. Correct
The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs.
99
A nurse is working with an established group of parents of children with special needs. Several parents continually express frustration with the health care system and feelings of powerlessness to address their needs. The nurse uses group techniques to validate their experiences and explore options for action. The nurse reacts in this way to conflict within the group because conflict:
Means the group leader must ask the persons causing the conflict to excuse themselves from future meetings.
Means those with the dissenting opinion will change their stand to be more in line with the rest of the group.
Should be avoided.
Supports individual and group growth and change.
Supports individual and group growth and change. Correct
The groups to which people belong influence health behavior. Through participation with others, meaning is confirmed, confounded, contradicted, or compromised. This is how social reality is created. Nurses frequently use groups to help individuals within a community. When conflict occurs in a group, the resulting tension can help move the group toward its goals. Group members are most effective and productive when conflict is acknowledged and individual concerns are expressed in a manner that respects other members of the group. Effective groups promote collaboration and support expression and resolution of conflict.
100
A nurse helping to form a group to deal with ongoing industrial pollution within a community understands that effective groups:
Are larger and comprised of recognized community leaders.
Can be small and yet be influential in changing the larger community.
Must include members of all involved parties, including political, corporate, health, and environmental leaders.
Should be small with informal leadership and relationships within the group.
Can be small and yet be influential in changing the larger community. Correct
Small groups can influence and change the larger social community. Citizens use focal concern groups to address perceived threats to community well-being. Focal concern groups provide a context through which people influence and are influenced by the community. Wider social systems often depend on small groups for direction and guidance. Effective small groups are purposeful, organized, and respectful of group members and the communities they represent.
101
A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices?
The family is responsible for the health behaviors of children.
The individual is responsible for health behaviors.
There is multilevel responsibility for health behaviors.
The community has a sense of responsibility for health behaviors
There is multilevel responsibility for health behaviors. Correct
In the ecological perspective individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society.
102
In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client:
Access to care.
Adjustment of lifestyle.
Compliance with a prescribed regimen.
Response to treatment.
Compliance with a prescribed regimen. Correct
In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional.
103
At the request of a local housing authority, a public health nurse conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The public health nurse, the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level?
Aggregate client system level.
Environmental level.
Family client system level.
Individual client system level.
Aggregate client system level. Correct
Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention.
104
Which of the following community health improvement projects uses subjective health perspective?
Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen.
Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program.
Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin.
Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use.
Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program. Correct
The subjective life process approach involves taking a holistic view of the person's total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model.
105
The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies?
Both focus on urban health risks and interventions to reduce the impact of those risks on the local population.
Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality.
Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged.
Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease.
Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease. Correct
The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models and strategies to reduce CHD risk. The Alameda County study followed a large sample for four years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs.
106
The local public health nurse participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be:
Coalition building.
Evaluation of outcomes.
Health-risk assessment.
Wellness appraisal.
Coalition building. Correct
The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time.
107
A community-oriented nurse wants to design the most effective intervention to reduce coronary heart disease (CHD) morbidity and mortality in a rural area. The program approach should incorporate the strategies of:
Aggregate primary prevention.
Individual-level primary, secondary, and tertiary prevention.
Multilevel intervention with a focus on primary, secondary, and tertiary prevention.
Promotion of optimal health for the individual, family, aggregate, and total community.
Multilevel intervention with a focus on primary, secondary, and tertiary prevention. Correct
The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community-individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach.
108
An effective community-oriented diabetes program should include:
Access to a certified diabetes educator to teach the client self-management strategies and proper techniques.
Care that incorporates the American Diabetes Association treatment guidelines.
Access to a primary care provider, medication and supplies, and nutritionist consult.
Self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies
Self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies. Correct
From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies).
109
The use of volunteer community health advisors (CHAs) to promote health within the community is an effective community-level intervention because CHAs:
Build community capacity to address individual and community health needs.
Create a passive partnership.
Provide oversight for the health promotion activities.
Relieve local service providers of mundane tasks.
Build community capacity to address individual and community health needs. Correct
The CHA program is a health promotion program that builds community capacity through volunteer CHAs. This program identifies natural helpers and trains them to improve the health of individuals and their communities. Through this training, CHAs are linked with local service providers and community leaders, which can lead to an increased awareness of and responsiveness to community health needs and create a more active partnership in assessing, planning, implementing, and evaluating change.
110
Health-risk appraisal instruments, although useful, have which of the following disadvantages (select all that apply)?
Lack of cultural sensitivity.
Lack of a holistic focus, with emphasis on physical health over other aspects of health.
High-cost and high-time requirements.
Overemphasis on personal lifestyle factors without consideration for the quality of health care provided to the consumer.
Variable validity and reliability, failure to address access to care and other environmental issues.
Lack of cultural sensitivity.Correct
Variable validity and reliability, failure to address access to care and other environmental issues.Correct
Health-risk appraisal instruments, although quite useful, have limitations. These include variable validity and reliability outside their targeted populations, emphasis on personal client responsibility without consideration of environmental factors, and lack of cultural sensitivity.
111
Which action by the community-oriented nurse best illustrates a partnership for health?
Assisting a school nurse in conducting vision screening of elementary school children.
Developing a volunteer program for teaching parenting skills.
Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions.
Informing a neighborhood council that smoking is its major community health problem.
Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions. Correct
Healthy People 2020 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term.
112
A rural public health nurse is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency?
County public health department.
National Centers for Disease Control and Prevention.
State vital statistics bureau.
U.S. Census Bureau.
State vital statistics bureau. Correct
Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus.
113
Which community attribute is an indicator of a community's health status?
Mean educational level.
Location of health facilities within the community.
Ratio of police to citizens.
Suicide rate.
Suicide rate. Correct
Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes includes morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios.
114
A community-oriented nurse leader is working with a community partnership to improve access to services for the underserved by planning an expansion of the local community health clinic. This nursing intervention strategy is focused on which of the following community health dimensions?
Environment.
Health status.
Process.
Structure.
Structure. Correct
The nursing intervention strategy is a component of the nursing process applied at the community level through community partnership. The intervention strategy is part of the planning phase. The intervention identified would relate to the structure dimension of community health. Structure is the dimension of community health defined in terms of services and resources.
115
The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse is evaluating the community health dimension of process and seeks to determine the community's:
Commitment to prioritizing and solving health problems.
Crime rate and school absenteeism rate.
Educational level.
Local client-to-provider ratio.
Commitment to prioritizing and solving health problems. Correct
The process dimension of community health includes the concept of community competence; that is, the ability of the parts of a community-organizations, groups, and aggregates-to collaborate effectively in identifying the problems and needs of the community, to achieve a working consensus on goals and objectives, to agree on the ways and means to implement the agreed-upon goals, and to collaborate effectively in the required actions. Community competence has eight essential conditions, including commitment to solving a given problem. It directs the study of community health to identify community action to address community problems and guides and influences the nurse's chosen role in the partnership. This indicates the importance of assessment in determining the strategies that can and should be used in community partnership approaches.
116
The most important aspect of the nursing community assessment phase can best be described as:
Analyzing and synthesizing data.
Collecting and gathering data.
Formulating a community nursing diagnosis.
Identifying problem correlates.
Formulating a community nursing diagnosis. Correct
Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____."
117
A rural community health nurse has made sure that male and female lay advisors are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be:
People who are influential in approving or vetoing new ideas.
Medical professionals within the migrant community.
Natural healers within their community.
Translators to help overcome language barriers.
People who are influential in approving or vetoing new ideas. Correct
Lay advisors are people who are influential in approving or vetoing new ideas and from whom others seek advice and information about new ideas. They often perform a function similar to that of early adopters (diffusion of innovation).
118
The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation?
Evaluation should start in the planning phase of the nursing process.
Evaluation can have unintended consequences.
Effectiveness is the only true measure of worthiness.
The power to design, judge, or institute change is important.
Evaluation can have unintended consequences. Correct
Evaluation of community health interventions can provide valuable information about an intervention's effectiveness and efficiency in obtaining the desired measurable outcome or its progress to date in reaching that desired outcome. Factors related to costs in money and time should also be addressed to determine if the intervention was worth carrying out. This is especially true given the fact that health care operates in a political environment in which competition for limited resources is a reality. The nurse must also recognize when selecting measurable outcomes in the planning phase that unintended outcomes may result from the intervention that may become evident upon evaluation. The success or failure of the intervention may carry unintended consequences. It may uncover new trends in the community. Finally, the evaluation process should identify whether the intervention was adequate and acceptable to the community. In this case, the change in the outcome measure was not sufficient to be acceptable, and the community's expectations were greater than the results delivered. The community decided to invest its limited resources elsewhere. The issue was not the power to design, judge, or institute change. The results of the intervention were not good enough in the community's eyes. Some of these challenges could have been addressed in the planning stages by exploring alternative approaches that would have ensured a better return on the dollar. This would have built community confidence in health interventions and fed success into the initiative. It may be harder to propose new initiatives when past initiatives produced such unintended consequences.
119
If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about:
Boundaries, parts, and dynamic processes of the client community.
Community health status and structure.
Community problems and problem correlates.
Role of the nurse and lay advisors in the community partnership.
Boundaries, parts, and dynamic processes of the client community. Correct
In most definitions, the community includes three factors: people, place, and function. The people are the community members or residents. Place refers to both the geographic and time dimensions, and function refers to the aims and activities of the community. The parts of a community are interdependent, and their function is to meet a wide variety of collective needs. Therefore, the definition of community should also recognize the interaction among systems within the community.
120
Which of the following are the best argument(s) for supporting community-as-client nursing (select all that apply)?
Change for the benefit of the community-client must often occur at several levels.
Changes in the health of individuals will affect the health of their communities.
The idea of providing health-related care within the community is not new.
The impact of the environment on health has long been established.
Direct hands-on nursing care delivered to individuals or families in community settings is important.
Change for the benefit of the community-client must often occur at several levels.Correct
Changes in the health of individuals will affect the health of their communities.Correct
The idea of providing health-related care within the community is not new.Correct
The impact of the environment on health has long been established.Correct
The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, public health nurses, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall.
