9 - Population-Based Public Health Nursing Practice: The Intervention Wheel

Question 1

A PHN is conducting a community assessment. Which of the following is the best example of this action?

a. ) Visiting an elderly person at home to assess and evaluate safety and fall risk
b. ) Developing diagnoses to identify nursing interventions at a health clinic
c. ) Evaluating services at an immunization clinic where a translator provides services
d. ) Compiling recent data from the county health department on child abuse cases

Answer 1

d.) Compiling recent data from the county health department on child abuse cases

Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

Question 2

A PHN is using collaboration, coalition building, and community organizing to develop a new program in the community. Which of the following strategies is the nurse most likely using?

a. ) Providing case management, referral, and follow-up services with individuals
b. ) Carrying out collective action at the systems or community levels of practice
c. ) Conducting a community assessment
d. ) Implementing primary and secondary prevention strategies

Answer 2

b.) Carrying out collective action at the systems or community levels of practice

Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention.

Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment.

Question 3

A PHN is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse most likely use?

a. ) A 50-year-old woman receives annual mammograms
b. ) School absences in a community decline
c. ) Teachers have increased awareness of health problems
d. ) Those in poverty utilize the free mammogram program

Answer 3

a.) A 50-year-old woman receives annual mammograms

Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening.

The other examples do not look at population health as an outcome or are not occurring at the individual level.

Question 4

A PHN utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished?

a. ) Including specific goals for community health nurses
b. ) Developing an accurate nursing diagnosis
c. ) Analyzing the needs of the community, systems, individuals, and families
d. ) Utilizing primary, secondary, and tertiary prevention

Answer 4

c.) Analyzing the needs of the community, systems, individuals, and families

PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice.

The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

Question 5

What is the purpose of the color-coded wedges on the Intervention Wheel?

a. ) The interventions are grouped together in related wedges.
b. ) The wedges consist of referral information for each wedge.
c. ) The element of health teaching is the predominant feature of each wedge.
d. ) Coalition building must be implemented with each wedge.

Answer 5

a.) The interventions are grouped together in related wedges.

Each wedge consists of related interventions. The other answers describe some of the individual wedges.

Question 6

A PHN uses Assumption 2, “Public health nursing practice focuses on populations,” to guide practice. Which of the following would be considered a population of interest?

a. ) Healthy school children
b. ) Homeless individuals
c. ) A person recently diagnosed with diabetes
d. ) Teenage parents

Answer 6

a.) Healthy school children

A population is a collection of individuals who have one or more personal or environmental characteristics in common.

Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children.

Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

Question 7

The cornerstones of public health nursing practice include which of the following? (Select all that apply.)

a. ) Focus on the health of the entire population
b. ) Reflect community priorities and needs
c. ) Promote health through strategies driven by epidemiological evidence
d. ) Are grounded in an ethic of collaboration.
e. ) Provide a framework for ethical decision making

Answer 7

a.) Focus on the health of the entire population

b.) Reflect community priorities and needs

c.) Promote health through strategies driven by epidemiological evidence

Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring.

Question 8

A PHN is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse?

a. ) Involve the entire community in solving the health problem
b. ) Identify health problems in the community
c. ) Change laws, policies, and practices that influence population-based issues
d. ) Provide outreach services to populations at risk

Answer 8

c.) Change laws, policies, and practices that influence population-based issues

Systems level practice consists of changing laws, policies, and practices that influence population-based issues.

The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach.

Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

Question 9

A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented?

a. ) Collaboration
b. ) Surveillance
c. ) Health teaching
d. ) Screening

Answer 9

c.) Health teaching

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities.

Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health.

Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data.

Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

Question 10

A PHN is conducting an assessment of the community’s health. Which of the following is being accomplished through this activity?

a. ) Define one problem that will be the focus for a year
b. ) Assess a social network of interacting individuals usually in a defined territory
c. ) Minimize the effects of health risks and hazards
d. ) Intervene at the population level by changing laws and regulations

Answer 10

b.) Assess a social network of interacting individuals usually in a defined territory

A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

Question 11

PHNs utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented?

a. ) Systems
b. ) Community
c. ) Policy
d. ) Individual

Answer 11

d.) Individual

The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals.

Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors.

Systems level interventions change organizations, policies, laws, and power structures within communities.

Policy is not a level of intervention described by “The Wheel.”

Question 12

A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented?

a. ) Health teaching
b. ) Coalition building
c. ) Surveillance
d. ) Referral and follow-up

Answer 12

b.) Coalition building

One example of coalition building is promoting alliances among organizations for a common purpose.

Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns.

Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data.

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

Question 13

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated?’

a. ) Individual
b. ) Systems
c. ) Community
d. ) Government

Answer 13

c.) Community

Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals.

Systems level interventions change organizations, policies, laws, and power structures within communities.

Government is not a level of intervention described by “The Wheel.”

Question 14

The levels of practice encompassed by the Intervention Wheel are:

a. ) communities, individuals and families, and systems.
b. ) assessment, diagnosis, and evaluation.
c. ) primary, secondary, and tertiary.
d. ) communities, populations, and aggregates.

Answer 14

a.) communities, individuals and families, and systems.

Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice.

Question 15

Public health interventions are implemented with:

a. ) legislators, policy makers, and community leaders.
b. ) individuals and families, communities, and systems.
c. ) children, adolescents, and adults.
d. ) health departments, public health agencies, and visiting nurses associations.

Answer 15

b.) individuals and families, communities, and systems.

It is important to know that PHNs work with individuals and families, communities, and systems.

The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening.

Question 16

A PHN is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse?

a. ) Participating in the “Great American Smokeout”
b. ) Working with a local employer to provide smoking cessation education
c. ) Providing one-on-one counseling to smokers
d. ) Advocating for increased taxes on tobacco products

Answer 16

b.) Working with a local employer to provide smoking cessation education

Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice.

Participating in the “Great American Smokeout” occurs at the community level and is not health teaching.

Providing one-on-one counseling to smokers is health teaching at the individual level of practice.

Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching.

Question 17

A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied?

a. ) Screening
b. ) Referral and follow-up
c. ) Surveillance
d. ) Health teaching

Answer 17

a.) Screening

Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns.

Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data.

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

Question 18

Which statement is true about the origins of the Intervention Wheel?

a. ) A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel.
b. ) It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan.
c. ) It was a result of a qualitative analysis carried out by the State Boards of Nursing.
d. ) It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

Answer 18

d.) It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components.

It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

Question 19

Since the Intervention Wheel was first published in 1998, it has:

a. ) guided national policy.
b. ) been used as a tool in deciding licensure issues for State Boards of Nursing.
c. ) been incorporated into the public health curricula of many nursing programs.
d. ) gained wide acceptance internationally.

Answer 19

c.) been incorporated into the public health curricula of many nursing programs.

Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice.

It serves as a model for practice in many state and local health departments. It has been presented internationally, but is not used widely at the international level.

Question 20

PHNs across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used?

a. ) Describe the proper order of implementation
b. ) Emphasize surveillance as the main focus of public health practice
c. ) Guide practice and generate agency protocols
d. ) Improve the health status of communities, systems, individuals, and families

Answer 20

d.) Improve the health status of communities, systems, individuals, and families

Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation.

Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

Question 21

Which statement about the Intervention Wheel is true?

a. ) It provides a graphic illustration of population-based public health practice.
b. ) It describes in detail the components of public health nursing.
c. ) It demonstrates the practice of community health nurses for policy and lawmakers.
d. ) It is a framework used by all health departments in the United States.

Answer 21

a.) It provides a graphic illustration of population-based public health practice.

The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all.

Question 22

A PHN is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use?

a. ) Alteration in nutrition: More than body requirements
b. ) Need for increased knowledge of proper nutrition
c. ) Families at risk for obesity because of inactivity
d. ) Overweight child related to poor dietary habits

Answer 22

c.) Families at risk for obesity because of inactivity

Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention.

The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

Question 23

An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented?

a. ) Individual
b. ) Systems
c. ) Community
d. ) Government

Answer 23

b.) Systems

Systems level of practice consists of changing laws, policies, and practices that influence population-based issues.

The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals.

Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors.

Government is not a level of intervention described by “The Wheel.”