Chapter 10 And 12 Study Guide

Question 1

What are the seven steps of the communication process?

Answer 1

-Sender

-Message

-Encoding

-Channel

-Decoding

-Receiver

-Feedback loop

Question 2

What is the sender?

Answer 2

-Relaying message to somebody

-Ensure you are sending the right message

-The community health nurse who is serving as the sender has the most control over the sender, the message, and the channel

Question 3

What is the message?

Answer 3

-Whatever you are trying to relay to another person

-Ensure that the message is clear

Question 4

What is encoding?

Answer 4

-The way the sender decides which specific signals or codes you are going to use

-Can use language, words, gestures, and body language

-Relates to how it is determined how that message is getting across

Question 5

What is the channel?

Answer 5

-The way that the message is being delivered

-Can be verbal or nonverbal communication, social networking, or email

Question 6

What is decoding?

Answer 6

The receiver’s interpretation of the message

Question 7

What is the receiver?

Answer 7

-The person that is hearing the message

-Sender has no control over the receiver, decoding the message, the way the receiver interprets the message

Question 8

What is the feedback loop?

Answer 8

-Way the sender and the receiver checks on the success of the transference of the meaning of the message

-If there was any miscommunication there, go back, renegotiate the message to allow for clarity (how can the receiver get it better-may have to reword what was said)

Question 9

What are the barriers to effective communication?

Answer 9

-Selective perception

-Filtering

-Emotional influence

-Language barriers

-Language of nursing

Question 10

What is selective perception?

Answer 10

-Individuals interpret a message through their own perceptions, which are influenced by their own experience, interests, values, motivations, and expectations
1. This perceptual screen leads to possible distortion or misinterpretation of the meaning from the sender’s original intent

-Nurses can overcome this barrier by using the feedback loop to ask clients to voice their understanding of the message they just received from the nurse
1. This enhances clarification and correction of misunderstandings, which is an essential step in the communication process

Question 11

What is filtering?

Answer 11

-Filtering is described as manipulation of information by the sender in order to make it seem more favorable to the receiver

-Clients sometimes use filtering during the assessment process, giving only partial or distorted information because they think this is what health professionals want to hear

-Filtering can also affect community/public health nurses

-Cole, in a classic work, notes that we have “filters” through which we view others—often influenced by culture, ethnicity, and socioeconomic class or even gender—and these can lead to miscommunication

-Cole’s premise is that people from different backgrounds actually view the world differently, thus confounding communication and leading to prejudice and stereotyping

-Community/public health nurses should consider their communication style and those of the people with whom they come in contact

Question 12

What is emotional influence?

Answer 12

-How a person feels at the time a message is sent or received influences the meaning

-Emotions can interfere with rational and objective reasoning, thus blocking communication

-Nurses need to be aware of their own emotions and the emotional status of clients or health professionals with whom they are communicating
1. For example, it is important for community/public health nurses to remain calm and unruffled when dealing with families in crisis

-Family communication may be angry, blaming, and confrontational because of a child’s serious health crisis, for instance

-A calm, firm, reassuring presence can go far in diffusing the situation and promoting clearer and more constructive communication
1. You may say, “I sense that you are feeling upset about Joey’s diagnosis. Are there any questions I can answer for you? How can I be of help to you?”

Question 13

What are language barriers?

Answer 13

-People interpret the meaning of words differently, depending on many variables, such as age, education, cultural background, and primary spoken language
1. For example, an adolescent might understand the term “lit” to mean that something is good or exciting, whereas an 80-year-old person might understand the word refers to lighting

-In the community, nurses work with a wide range of clients and professionals whose disparate ages, education levels, and cultural backgrounds lead to different communication patterns

Question 14

What is the language of nursing?

Answer 14

-The context of health care provides nurses with a unique vocabulary that may not be understood by clients, family, and community members

-The use of scientific terminology or jargon by some health professionals can be confusing to clients

-Communication techniques would be different when educating a new mother on proper breast-feeding techniques than when discussing community health needs with the director of a public health department

Question 15

What are the strategies to overcome communication barriers?

Answer 15

-Community/public health nurses should be aware of the barriers that block effective communication

-Overcoming barriers to effective communication requires the development of sound communication skills, including sending, receiving, and interpersonal skills

Question 16

What is involved with establishing trust and rapport?

Answer 16

-Nurses are considered to be knowledgeable professionals who have standing within the community

-Those working for public health agencies have power and authority as representatives of a government agency

-Clients may feel apprehensive about C/PHNs entering their homes
1. Therefore, it is essential for the nurse to demonstrate respect for the client, especially for those clients who lack self-respect

-Having an appreciation for the dignity and worth of all individuals, being nonjudgmental, and demonstrating empathy (acceptance and acknowledgement of the client’s situation and feelings) are prerequisites for successful communication with clients in the community setting

-Many factors that are often shaped by clients’ cultural background and upbringing influence trust and rapport
1. For many, the societal norm is to agree with someone in a position of authority, such as a community/public health nurse, even if they do not fully understand what that person is communicating
2. This can lead to mistrust and poor client outcomes

-Establishing a trusting relationship can empower clients to accomplish important lifestyle changes
1. However, it is important to keep in mind that although nurses have a good deal of knowledge and education, to be effective they must appreciate the knowledge gained by clients through life experiences and the environments in which they live

-Showing respect is a fundamental behavior that conveys the attitude that clients and others have knowledge, importance, dignity, and worth

-C/PHNs can work with clients in many ways to change their lives for the better, but just like acute care nurses need to “know the patient” in the hospital setting in order to pick up subtle cues that may indicate serious problems, we must begin with what is important to the client rather than our own agenda

-A new nurse making a home visit to a mother who has missed several immunization clinic appointments for her infant may think that the mother needs only information on why immunizations are important for her baby
1. However, the mother may be dealing with an abusive husband who has drug and alcohol problems
2. If the nurse begins the visit with a reminder about the missed appointments and the potential consequences involved, it may end abruptly

-It is best to begin by asking about the client’s concerns so the nurse can gain a deeper understanding of the client’s experiences, fears, and perspectives while communicating a demeanor of understanding and the intention to help

Question 17

What must nurses do to establish trust and rapport?

Answer 17

-Develop a relationship with the client, not just around the public health issues of interest to the nurse but concerning the client’s life and challenges

-Over time, by being consistently trustworthy, reliable, sincere, and truthful with clients

Question 18

What must nurses do to promote trust?

Answer 18

-Commit to develop knowledge and experience of the client and their situation

-Clarify expectations, anticipated behaviors, and boundaries of the nurse–client relationship

-Be aware of attitudes and behaviors that do not promote trust

Question 19

What is involved with active listening?

Answer 19

-An essential skill is active listening, also referred to as reflective listening

-Active listening is the skill of assuming responsibility for and striving to understand the feelings and thoughts in a sender’s message, thus giving importance to the person speaking

-Active listening with nonjudgmental empathy helps to communicate acceptance and increase trust

-It also allows for an accurate understanding of another person’s viewpoint and helps to bring issues and concerns into the open, where they can be more easily resolved
1. However, our own personal beliefs and values may confuse the message

-A critical response to the client’s message by the nurse can cut off communication and cause the client to disengage; therefore, a nonjudgmental approach better supports a therapeutic relationship

Question 20

What are skills that promote active listening?

Answer 20

-Being attentive and mindful:
1. Being focused and engaged in conversation with your client gives insight into the client’s frame of mind, reactions, and body language

-Conveying a nonjudgmental attitude:
1. Keeping an open mind, having interest in what your client is saying, and not arguing help build client self-confidence

-Using reflection:
1. Mirroring the client’s message by occasionally paraphrasing key points demonstrates empathy and shows the client you can view the world through the client’s eyes

-Asking for clarification:
1. By asking probing questions to clear up ambiguity or to expand on the client’s ideas, you check your interpretation of their message, closing the loop and preventing communication breakdowns

-Summarizing:
1. By restating key themes of your conversation, you ensure that you understand the true nature of the message and help the client reflect and focus on issues raised

-Sharing:
1. Explain your ideas, feelings, or messages only after client indicates readiness and you have first fully understood the other person’s views

Question 21

What is involved with communicating clearly?

Answer 21

-The CDC hosts a site that provides valuable resources to augment clear communication, including a clear communication index use guide, index widget, example material, and everyday words for public health communication

-The basic rules for effective verbal or written communication can be summarized in this manner:
1. Use everyday words
2. Use as few words as possible
3. Use active voice
4. Ask for feedback to make certain that the message is understood

Question 22

What is health literacy and health outcomes?

Answer 22

-Health literacy is essential to client autonomy and good client outcomes

-Health literacy is critical to health promotion, and disease prevention encompasses cultural, scientific, media, and technological literacy

-Vulnerable groups such as older adults, recent immigrants, migrants, ethnic minorities, and clients with low levels of education and dominant language proficiency are most affected by low health literacy

-Health information is disseminated in person, in print, and online, so health literacy is relevant to all of these processes

-Clear communication is important to outcomes; one example is the link between the level of health literacy among rural heart failure patients and morbidity and mortality rates

-In addition, adequate health literacy among the nursing population is imperative in addressing the problem

-Low health literacy skills are associated with poorer health status, increased health care costs, and use of emergency care, because patients with low health literacy levels are less knowledgeable about their health conditions and are less likely to seek preventative care, especially in older adults (≥65 years of age)

-Children with caregivers who have low literacy skills have poor health outcomes, because the caregivers are less knowledgeable about their child’s condition and less likely to engage in behaviors to help improve it

-The federal government has set standards to encourage health professionals to consider clients’ health literacy when communicating with them

-The U.S. Department of Health and Human Services (USDHHS) developed the National Action Plan to Improve Health Literacy based on the vision and principles that “(1) everyone has the right to health information that helps them make informed decisions and (2) health services are delivered in ways that are understandable and beneficial to health, longevity, and quality of life”

-To be sure that these goals are being met, the improvement of health literacy and health communication for our population continues to be a priority in the Healthy People 2030 goals

-Health communication includes health literacy, but it also incorporates health messages and campaigns targeted to populations

-Population health promotion is best achieved by health communication that uses multiple communication channels to reach stakeholders, including television, radio, newspapers, Web sites, social media, smartphones/applications, text messaging, educational pamphlets, and nutrition and medication labels

-To manage disease and promote health, we must make sure our patients can understand the health information they see, hear, and read from multiple sources

Question 23

Why do any clients in need of health services or information need health literacy skills?

Answer 23

-Access services and information

-Communicate individual needs and preferences

-Internalize the meaning of health information and services available

-Grasp the context, options, and resulting consequences in health settings

-Make choices that are aligned with their preferences and needs

Question 24

How can presenting information in a manner that matches the clients’ health literacy level help address health disparities and empower clients to effectively manage their health?

Answer 24

-Understanding and complying with self-care instructions, including complex daily medical regimens

-Planning and attaining necessary lifestyle adjustments to improve their health

-Making positive, informed health-related decisions

-Knowing when and how to access necessary health care

-Addressing health issues in their community and society by sharing health-promoting activities with others

Question 25

What are the five stages of group development?

Answer 25

-Forming

-Storming

-Norming

-Performing

-Adjourning

Question 26

What is the forming stage?

Answer 26

-Members:
1. Feel awkward and hesitant and depend on the group leader to help them develop mutual trust and give them structure and guidance

-Group leader:
1. Helps members become oriented to each other and to the work

-“Ice-breaker” activities at the first group meeting

-Setting of ground rules (e.g., confidentiality)

-Defining scope of work and timeline for completion

Question 27

What is the storming stage?

Answer 27

-Group begins to work together

-Conflict and competition over different agendas, ideas, and approaches

-Group leader:
1. Guides group in problem-solving and setting goals, models maintenance roles (e.g., encouraging all to participate), and summarizes group feelings

Question 28

What is the norming stage?

Answer 28

-Group shows signs of cohesiveness, trust, openness, shared sense of “belonging”

-Work begins to progress

-Creativity and shared ideas and opinions

-Group leader:
1. Continues to role model good maintenance behaviors

Question 29

What is the performing stage?

Answer 29

-May not occur with all groups

-Members:
1. Can work as a total group, in subgroups, or independently

-Most productive stage, as group members are motivated and able to handle the decision-making process in a competent and autonomous manner

-High level of team satisfaction

Question 30

What is the adjourning stage?

Answer 30

-Emphasis is on wrapping up the project

-Withdrawal from both task and relationship or maintenance activities

-Members
1. Often feel happy to have accomplished goal but sad about the loss or disbanding of the group

Question 31

What is mobile health (mHealth)?

Answer 31

-The rapid expansion of mobile technology provides an opportunity for nurses and other clinicians to improve health and health care through forms of interactive mobile health (mHealth), referred to as mHealth service

-mHealth includes the use of wireless technologies, such as smartphones, tablets, and notebooks for improving health

-mHealth offers great opportunities for improving global health, safety, and preparedness

-The potential of mobile technology’s impact on sharing health information and collecting disease/health data is tremendous due to its portability, affordability, and availability; it also has the potential to save billions of dollars in health care costs

-The potential of mHealth will be further established as patients’ experiences with technology and clinical/psychosocial outcomes are evaluated

-mHealth is extending health care to underserved and hard to reach areas

-Technology puts health care providers in a position to change how health care is delivered, the quality of the patient experience, and the cost of health care

-Advantages include management of chronic disease, empowering the elderly and expectant mothers, reminding people to take medication, serving underserved areas, and improving health outcomes and medical system efficiency

-A report cited common uses for mHealth globally that included call centers, reminders, and telemedicine
1. Mobile medical applications and wearable medical devices were projected to be growth areas for mHealth

Question 32

What are the three current mHealth trends that have been identified?

Answer 32

-The trends include mHealth technology that is interactive, integrated, and multimedia

-Interactive strategies enable “two-way flow of information that engages patients more actively” in their health management

-Integrative strategies use multiple “self-management applications to share health information between patients and providers through text messages, centralized web-based” tracking and management programs, and mobile monitoring (such as glucose monitoring)

-Multimedia use “games and quizzes” to communicate preventive messages and motivate behavior change

Question 33

How are mobile phones beneficial?

Answer 33

-Text messaging and the use of applications and other mHealth interventions can reduce geographic and economic barriers to health information and services
1. These interventions have the potential to reduce health disparities and leverage a profound effect on health

-A recent study found Black and Hispanic participants used mobile digital devices to access patient portals more often than White participants, who relied more on computers

-Another study found that “racial/ethnic minorities and patients living in poorer neighborhoods” most often checked personal health records exclusively by means of a mobile device

-Optimizing Web sites for mobile devices could be helpful in reaching diverse populations and would enable a wide audience to test and review apps in development

-Mobile phone technologies offer promising opportunities for nurses working in the community setting

-Connected health offers the patient the opportunity to feel constantly connected to the health delivery system and offers the system a just-in-time messaging opportunity that can be motivating, educational, and caring

-A disadvantage is that mobile or cellular phones are less reliable than landlines, with users sometimes citing spotty service, dropped calls, and text messages delayed or lost in cyberspace

-Reminder and educational text messages have the ability to be disseminated widely and broadly, reaching mass number of recipients quickly and inexpensively

-Tailored, user-friendly interventions delivered by mobile phone may be a better fit with many individuals’ lifestyles than traditional treatment and an attractive option for both clinicians and patients or clients

-Mobile phones have a broad range of uses, diverse functions, and the ability to intercede in “real time”

-Text messaging can overcome barriers of time and access to reach even high-risk populations

-Text messaging is used globally to communicate and to motivate individuals to engage in healthy or healthier behaviors, deliver public health messages, and alert populations about available resources or disasters

-In some cases, other digital solutions may be more effective
1. A systematic review of research studies using texting, video-observed therapy (VOT), or medication monitors in tuberculosis care found that text messaging did not significantly affect completion of treatment, whereas VOT rates of treatment completion were comparable to the much more expensive directly observed treatment (DOT) option
2. Groups using medication monitors demonstrated statistically significant reductions in missed doses over those using standard care measures

-Nurses and other clinicians may use texting to assist patients and caregivers with management of chronic conditions and disease prevention

-Text messaging provides a venue to deliver information to hard-to-reach populations and the opportunity to have a positive influence on health knowledge and behaviors, as evidenced by clinical outcomes in a recent study among college students

Question 34

Why are text messages beneficial?

Answer 34

-Text messages are the initial, simplest, and most common type of mobile data service and are becoming a vital tool for the delivery of health information and engaging users to improve their health

-Text messaging is a way of connecting quickly with a large population

-The use of text messaging has been advocated in HIV testing as a means of improving health quality and preventing complications

-Marcolino et al. (2018) conducted a systematic review of text messaging and the implications in health care and noted that this is growing in use and popularity
1. Given the widespread use of mobile phone text message reminders among different patient groups, it may have the potential to improve adherence to medication and attendance at clinical appointments globally

-Text messaging is simple, low cost, and ubiquitous

-It continues to increase as a form of communication

-Text messaging is considered more private and less intrusive than a phone call

-Pictures, video, and text reminders can also be sent

-Text messaging allows for automatic contact with groups of clients without the sender having to send an individual message to each intended recipient

-Response may be real time or at the leisure of the recipient

-Text messages are less expensive than phone calls and less prone to spam than e-mail

-Texts may be stored and revisited, and all languages are supported

-The benefits of text messages and social media are numerous
1. However, health literacy and cultural appropriateness for diverse populations must be considered when using text messages

-Much research in public health has found that it is possible to use text messages to help deliver health-related information and to aid people in disease management (e.g., diabetes) and make better health decisions such as smoking less and exercising more

-Text message interventions promote healthy lifestyle behaviors, have become widely integrated into routine daily life, and are simple, low cost, and nonlabor intensive

-Use of text messaging to deliver information about more sensitive topics, such as sexual health and reducing risky behaviors, seems promising

-Opt-in features, which allow choice for the recipient, can also be used
1. These are helpful for immunization reminders, encouraging healthy behaviors, and more

-Text messages may be used for simple reminders to have blood pressure checked, to notify individuals about an upcoming appointment, or to pick up prescriptions

Question 35

What are the characteristics of collaborative partnerships in community/public health nursing?

Answer 35

-To explore the meaning of collaboration in the context of C/PHN, this section examines five characteristics that distinguish collaboration from other types of interaction:
1. Shared goals
2. Mutual participation
3. Maximized resources
4. Clear responsibilities
5. Set boundaries

Question 36

What is shared goals?

Answer 36

-First, collaboration in C/PHN is goal directed

-The nurse, clients, and others involved in the collaborative effort or partnership recognize specific reasons for entering into the relationship
1. For example, a lumber company with 150 employees seeks to develop a wellness program
2. The interdisciplinary health team will work together to develop specific physical and mental health goals
3. The team enters into the collaborative relationship with broad needs or purposes to be met and specific objectives to accomplish

Question 37

What is mutual participation?

Answer 37

-Second, in C/PHN, collaboration involves mutual participation; all team members contribute and are mutually benefited

-Collaboration involves a reciprocal exchange, in which individual team players discuss their intended involvement and contribution, and all members of a team should feel equally valued—no hierarchies should exist

-In interdisciplinary teams, physicians, nurses, lay community health workers, clients, outside agency personnel, and others must be able to effectively share ideas and frustrations on an equal, reciprocal basis

Question 38

What is maximized use of resources?

Answer 38

-A third characteristic of collaboration is that it maximizes the use of community assets

-That is, the collaborative partnership is designed to draw on the expertise of those who are most knowledgeable and in the best positions to influence a favorable outcome

-In this age of dwindling resources, it is now common for public health agencies to seek additional funding assistance from other agencies to support new community/public health programs or to provide educational information or interventions

-Being able to demonstrate fiscal responsibility and evidence-based outcomes will assist nurses in sustaining health promotion efforts on a long-term basis through collaborative partnerships

Question 39

What is clear responsibilities?

Answer 39

-Fourth, the collaborating team members work in partnership and assume clearly defined responsibilities

-Each member in the partnership plays a specific role with related tasks

-Effective collaboration clearly designates what each member will do to accomplish the identified goals

-Each member of the team develops an understanding of individual responsibilities based on realistic and honest expectations

-This understanding comes through effective communication

-The collaborating partners explore necessary resources, assess their capabilities, and determine their willingness to assume tasks

Question 40

What are boundaries?

Answer 40

-Fifth, collaboration in community/public health practice has set boundaries, with a beginning and an end, that fall within the goals of the partnership

-An important part of defining collaboration is determining the conditions under which it occurs and when it will be terminated

-The temporal boundaries sometimes are determined by progress toward the goal, sometimes by the number of team member contacts, and often by setting a time limit

-Once the purpose for the collaboration has been accomplished, the group as a formal entity can be terminated

-In some settings, the partnership may desire to continue to work on other, mutually agreed-on activities

-Some partnerships are ongoing
1. For example, a university department of nursing might use a neighborhood community center for clinical experiences for their students

-When people collaborate and work together in partnership, many possibilities exist

Question 41

What are electronic health records?

Answer 41

-Electronic health records (EHRs) are, at their simplest, digital (computerized) versions of patients’ paper charts

-The contemporary EHR is a complex piece of software with multiple functions and capabilities that enables a health care provider to record patient progress in free text, place prescription orders, receive decision-support alerts and reminders, order laboratory tests, receive and review results electronically, message patients or fellow providers, and perform a variety of other documentation and clinical tasks

-It may contain lab and x-ray results and medications and medical history, along with administrative and billing information

-The use of EHRs in community/public health has followed a slower progression than in hospitals

-Reporting (e.g., communicable disease, immunizations) has moved from paper to unidirectional electronic reporting in many areas

-In public health, EHRs have been shown to improve efficiency, productivity, quality of care, cost reduction, and data management, although drawbacks include missing data, complex technology, and the learning curve

-Agencies may find EHRs helpful in areas such as epidemiology, large-scale planning, budgets, and grant writing
1. For example, an agency may search for specific characteristics and target vulnerable populations to best determine more effective planning and targeted interventions (e.g., clients with specific chronic diseases, current smokers)

-Individuals may also gain access to their own health information, and this is especially helpful in the case of immunization records

-Health technology incorporates large information systems and the use of electronic health records (EHRs)

-One of the most significant problems encountered is discrete EHR systems within departments in the same hospital or system

-One of the most beneficial advantages of using EHRs is the ability to enter data once and reuse them multiple times

Question 42

What is communication?

Answer 42

-Communication provides a two-way flow of information that nourishes nurse–client and nurse–professional relationships

-For communication to take place, client and professional messages are sent and received

-As participants in the communication process, community/public health nurses play both roles: sender and receiver

-The nurse must be able to elicit ideas as well as contribute to the planning process by speaking and acting in ways that promote information sharing

-Nurses working in community/public health must be skilled in effective communication to be able to maintain relationships with individual clients, families, the community, members of the health care team, and community partners

-The lack of effective communication can lead to misunderstanding, poor performance, interpersonal conflict, ineffective program development, and medical mistakes, all resulting in poorer health outcomes

-Whereas ineffective communication is one of the major causes of preventable adverse events in acute care settings, effective communication skills empower community/public health nurses to
1. Provide quality health care and health education that improves patient outcomes
2. Advocate effectively for clients, families, and populations
3. Enhance professional collaboration and organizational commitment
4. Initiate public health policy
5. Implement programs designed to meet the needs of clients despite societal, organizational, and individual obstacles

-Successful nurses must use both sound clinical skills and good communication skills

-dNecessary communication skills include soliciting input from others and listening to others in a nonjudgmental way

Question 43

What is documentation?

Question 44

What is the geographic information systems (GIS)?

Answer 44

-A geographic information system (GIS) is a computer-based information system designed to capture, store, manipulate, analyze, manage, and present all types of spatial (relating to space) or geographical data

-Mapping programs that can be used along with data to analyze and interpret relationships between a location and a disease or condition (e.g., area of a city and diabetes rates)

-GIS allows the user to visualize, question, analyze, and interpret data to understand relationships, patterns, and trends

-Spatial or mappable data are integrated with conventional data

-GIS can be thought of as a two-dimensional Google earth map
1. Google earth allows you to zoom in and out and pan around, and GIS additionally allows users to select a feature on the map and, in return, will be provided with any information in the database associated with that feature

-Much of community/public health is spatially related, so the use of GIS can provide information about demographic, epidemiological, and logistical issues and emerging trends. GIS output is location-based information

-Sharing, comparing, and integrating GIS data will eliminate silos and result in better outcomes providing additional information to identify health disparities

-There is great potential for GIS to inform C/PHN

-Nurses can play an important role in demonstrating how various data sources come together to enable informed decisions for populations and individuals

-Understanding of GIS may be considered an fit health care delivery is being realized

-Both public and private organizations are developing innovative ways to use GIS, from public health departments and public health policy and research organizations to hospitals, medical centers, and health insurance organizations

-Public health uses of GIS include tracking child immunizations, evaluating the spread and clustering of diseases, conducting health policy research, and establishing service areas and districts

-Both telehealth and GIS have great potential for public health, as access barriers can be eliminated and disease patterns can be more closely studied and addressed

-An example of how GIS has been used to benefit health care delivery is the research by DeGuzman
1. The purpose of their study was to use GIS and other mapping to identify local and regional access gaps of children with special health care needs (CSHCN), with the aim of pinpointing and reducing disparities
2. This collaborative group of academic and practice researchers recognized that access to necessary services for families of CSHCN is less convenient for rural populations due to distance and travel required
3. Public health departments often serve as safety net providers in these areas but sometimes need to refer clients to specialized programs at child development centers (CDCs)
4. In the state of Virginia, there were only five CDCs helping children with motor/physical disorders, speech/developmental delays, attention-deficit hyperactivity disorder, or autism spectrum disorder
5. Researchers “layered individual-level data over county-level socioeconomic data” to bring the sociodemographic environment into focus
6. A chloropeth map (i.e., color progression from lighter to darker areas) indicated the number of uninsured CSHCN children at the county level
7. Darker red and orange areas have a greater number of uninsured children
8. You can easily discern larger cities (groupings of dots) and rural areas (scattered dots) as well as the distance of the child from the nearest CDC
9. At a quick glance, it is evident that many children live in rural areas, and many of them are uninsured
10. One of the significant limitations of this chloropeth map is that it cannot include the unknown number of unserved children who never made contact with a CDC

Question 45

What is used in the communication process?

Answer 45

-Communicate clearly

-Use everyday words

-Use as few words as possible

-Use active voice

-Ask for feedback to ensure understanding

Question 46

How do you communicate with groups?

Answer 46

-Problems may arise when group members:
1. Lack independent knowledge (“group think”)
2. Are too similar in background and experiences
3. Adapt to each other’s knowledge too quickly (“herd mentality”)
4. Comply out of a desire to fit into the group
5. Ignore their own instincts and follow others
6. Brainstorming

-Techniques for enhancing group decision making
1. Motivating
2. Nominal group technique
*Group sharing after working alone initially
*Silent ranking after discussion
3. Group-teaching methods
4. Public speaking

Question 47

What are the value and characteristics of contracting?

Answer 47

-Partnership developed, with agreement about purpose of relationship and conditions under which it will be carried out

-Self-health promotion and increased motivation

-Focus on unique needs

-Client participation in decision-making

-Clients’ autonomy and self-esteem enhanced with learning self-care

-More efficient and cost-effective nursing service

-Characteristics:
1. Partnership and mutuality
2. Commitment
3. Format
*Responsibilities
*Timeline
4. Negotiation

Question 48

What are the process and levels of contracting?

Answer 48

-Assessment: explore needs

-Nursing diagnosis/goal setting

-Plan/intervention: explore resources; develop a plan; divide responsibilities; agree on time frame

-Evaluation: evaluation; renegotiation or termination

-Levels:
1. Formal
2. Informal

Question 49

What is collaboration?

Answer 49

-Essential element: interprofessional and interdisciplinary collaboration

-Purposeful interaction between nurses, clients, other professionals, and community members based on shared values, mutual participation, and joint effort

-Two basic features
1. Goal: benefit public’s health
2. Involvement of several parties assisting one another to achieve goal

-Characteristics
1. Shared goals
2. Mutual participation
3. Maximized use of resources
4. Clear responsibilities
5. Set boundaries

Question 50

What are barriers to effective collaboration?

Answer 50

-Communication barriers

-Miscommunication

-Misconceptions about others’ knowledge and motives

-Stereotypes

-Perception of unequal power and authority

-Structural factors: inadequate time, resources, or agency support

Question 51

What is big data?

Answer 51

-Include very large and complex data sets that are analyzed to uncover trends, associations, and patterns

-This is very helpful in public health agencies in the areas of disease surveillance, population health management, and immunization trends

Question 52

What is involved with identifying group or community health problems?

Answer 52

-Student nurses are educated in the care of individuals, families, and communities, yet nurses most often practice at the individual and family levels
1. When is it appropriate for a nurse to expand his or her practice to the community level?
2. Perhaps the most natural time is when a nurse identifies an ongoing issue that does not change with traditional interventions

-Examples include the following:
1. Overuse of the emergency room for pain medication prescriptions
2. Recurrent hospitalization of the elderly from several nursing homes for dehydration, sepsis, and malnutrition
3. Hospitalization of unvaccinated children with vaccine-preventable diseases

-These types of recurrent problems might lead nurses to investigate the feasibility of community-based interventions

-Includes:
1. National and state health objectives and initiatives
2. Local health priorities and initiatives
3. Using data to conform needs
4. Target groups and neighborhoods
5. Collaborating with other health care professionals
6. Engaging the target population
7. Understanding the target population
8. Using evidence to guide interventions
9. Community action model
10. Advisory groups
11. Delineating the problem(s)
12. Rating the important and changeability of identified behavioral factors
13. Factors that influence behavior change: predisposing, reinforcing, and enabling factors

Question 53

What are the national and state health objectives and initiatives?

Answer 53

-Individually or in a group, identify a possible issue to explore—one you believe is leading to poor health outcomes in your community

-How do you know if this problem is widespread or if others also find it to be a problem?

-Several methods can be used to validate the importance of the issue
1. One method would be to consider Healthy People 2030 objectives for the nation

-What are the major areas of concern for improving health outcomes in the United States?

-What are the priorities of the state in which you live?

-Take some time to review federal agency Web sites to identify programs that are being developed to meet the Healthy People 2030 goals and objectives

-Your state or local health department may also publish Healthy People 2030 objectives on its Web site, highlighting those issues that are high priorities in your region

-You can monitor progress on meeting the Healthy People 2020 objective targets by searching for current results for national- and state-level data on the Healthy People 2020 widget

Question 54

What are local health priorities and initiatives?

Answer 54

-Community agencies and organizations frequently network to establish community-wide goals, with the local health department spearheading the effort

-It may also be organized by community-based health agencies and volunteer organizations

-Improved outcomes for individuals who have diabetes or asthma is an example of a goal a local community might want to set
1. Another topic of concern may be adolescent suicide

-Nurses can work collaboratively with these special interest groups to find solutions for affected individuals and families

-As a specific problem is identified, it is crucial to analyze the scope of the problem within the community

-It is a poor use of resources to set up a program if the condition or situation is rare
1. For example, it would be a waste of resources to establish a program on diabetes and pregnancy for a local homeless shelter that only serves 35 women a year
2. Of those 35 women, none may be pregnant, and only 5.6% of pregnant women develop gestational diabetes, so it may be several years before an eligible client is found
3. A better use of resources would be to target a community with a high proportion of individuals at risk for diabetes during pregnancy, such as a community with a large population of non-Hispanic Asian mothers, among whom the prevalence of gestational diabetes is higher (11.1%) than other racial/ethnic groups
4. Another target group may be pregnant women age 40 years or older, who are also at increased risk of gestational diabetes

Question 55

How is data used to confirm needs?

Answer 55

-There are many ways a nurse can determine whether a problem affects enough of the population to warrant intervention

-The best way to start is to review the local, state, and national data available through government repositories
1. This can be done by going to a university library for assistance, asking for specific data from local health and social service agencies, police and judicial departments, and local school districts, or by searching the Internet

-The National Center for Health Statistics (NCHS) offers public-use data files through the file server of the Centers for Disease Control and Prevention (CDC)

-The NCHS data collection systems include the following:
1. Population surveys, such as the National Health and Nutrition Examination Survey and National Survey of Family Growth
2. Vital records, such as the National Death Index
3. Provider surveys, such as the National Hospital Care Survey and other national health care surveys
4. Historical surveys, which provide an overview of surveys and programs administered by the NCHS that have been completed

-The U.S. Department of Health and Human Services (USDHHS) makes high-value health data accessible to the public via HealthData.gov

-The data are collected from agencies within the USDHHS as well as its state partners and include U.S. data on:
1. Environmental health
2. Medical devices
3. Social services
4. Community health
5. Mental health
6. Substance abuse
7. Medicare and Medicaid

-Hospital discharge data are also reported to state agencies, and this information is sometimes available at the local level

Question 56

What are target groups and neighborhoods?

Answer 56

-As nurses and community groups narrow their focus, they can identify target groups and neighborhoods by using geographic information system (GIS) technology

-Many organizations use GIS to identify target groups by race, age, and family status

-GIS data can be found through a variety of federal sources, including the CDC, the National Cancer Institute, the Center for Mental Health Services, the National Library of Medicine, the Environmental Protection Agency, and the NCHS, which maintains GIS maps on the major causes of mortality in the United States

-GIS mapping can depict deaths by regions or in clusters, such as one depicting drug overdose mortality

-Earthquake seismic hazard maps may be helpful in disaster planning

-National and state maps are available

Question 57

What is involved with collaborating with other health care professionals?

Answer 57

-Talking about the problems you have identified in your community with other nurses and health care professionals may help you identify resources and solutions as you brainstorm ideas about the problem and what should be done to alleviate it

-Find out what has been tried in the past and why those interventions may have failed
1. A very helpful source of information is the Community Preventive Services Task Force (CPSTF)

-The CPSTF developed a federally sponsored resource, the Guide to Community Preventive Services: What Works to Promote Health—now known as The Community Guide
1. Originally published in 2005, The Community Guide is an online collection of evidence-based findings and other resources that C/PHNs can use to select and implement interventions to improve health and prevent disease within communities or at state and national levels

-The interventions with limited evidence may be very effective but need to be confirmed by further research; perhaps your idea is among those listed
1. For example, as a means of increasing community demand for vaccinations, client reminder and recall systems are recommended, yet there is not enough evidence to support client or family incentives, or the use of patient-held medical records
2. If a C/PHN develops a program to implement these interventions, the additional step of publishing the program results would add to the body of evidence that determines the value of such a program

Question 58

What is involved with engaging the target population?

Answer 58

-The next step is the most important of all, as it will determine whether your interventions succeed or fail

-A nurse may think, “I know what the problem is—now I will think up an intervention to alleviate it!”
1. This is a well-intentioned, but doomed, approach

-At this point, only part of the assessment is complete; the most important component of the assessment is to find out the views of the target population about the identified problem
1. What do they think are the causes? What ideas do they have about solving it? Which approaches do they think will work?

-It is crucial to hear and respect the views of the target population

-Anthropologists talk about a concept called authoritative knowledge
1. This is based not on whose knowledge may be right but rather on what is accepted as substantial and legitimate because it comes from authoritative sources, such as health care providers

-Nurses may think they know more about a topic (e.g., diabetes) than their target population and therefore conclude that their solutions must also be superior

-Members of the target population may hold just as strongly to their own beliefs
1. If nurses don’t learn about the target population’s beliefs and only consider their own, they will not be able to work out an acceptable and appropriate solution

-Interventions that fail to engage the target population will likely be unsuccessful

-It is imperative that positive working relationships be established with high-risk target communities and that chosen interventions involve effective use of health resources

Question 59

What is involved with understanding the target population?

Answer 59

-When working with target groups, it’s important to get as much information about the population as possible

-Start by asking those you know, as colleagues and as patients/clients, about their local community
1. What are their thoughts about the problem of interest? What do they think about the quality of services currently available? What do they see as barriers to services? What about barriers to adherence to treatment and other health care recommendations?

-Nurse interactions with the community is an essential first consideration in promoting community health

-Which Web sites do they visit when seeking health information?
1. The answers to these questions will provide insight into factors influencing the health problem and will also help you understand how to reach out to the target population

-Mobilizing Action through Planning and Partnerships (MAPP) is one of many tools that begin with this community mobilization step

-As you gain insight into relevant environmental and social factors, you are also building interest among the community members about the issue

-As you participate in discussions with others, be open to their input

-Your original ideas will likely change in response to feedback from members of the target and service communities

-For example, an experienced C/PHN was involved in a project developed to serve Hispanic women with gestational diabetes
1. When interviewed, the Spanish-speaking women expressed concern that they were told to go on a diabetic “diet” and were then chastised for not eating enough
2. To these women, going on a “diet” meant they should eat less
3. They were also told that if they followed the diabetic diet, they wouldn’t have such “big babies”
4. They thought a “big” baby was a healthy baby and couldn’t understand why they were being told to avoid having a larger baby
5. These were simple issues to fix but required knowledge of how the “diabetic teaching plan” was interpreted by the target audience
6. Another key factor was that the clinic was a family event; thus, all of the children were brought along
7. The clinic staff had been irritated by the presence of large groups of children but learned they should alter the clinic setup and resources to accommodate their clients’ expectations
8. Modifications were made based on dialogue with members of the target population that contributed to the eventual success of the clinic’s program

-This example demonstrates how use of local knowledge can increase the effectiveness of a community-based intervention
1. Working with community partners is a technique that has been used in providing services within developing countries
2. This type of approach ensures community buy-in for an intervention
3. It also builds networks that increase the capacity of communities to resolve other health care issues, both current and emerging

Question 60

What are the additional issues that need to be explored to understand the target population?

Answer 60

-Who else can provide insights about this problem?

-Who are key people with whom you should build relationships?

-What are their customs regarding health care?

-Who are the leaders within families?

-What is the best way to form collaborations and linkages within this community?

-Who are their formal and informal leaders?

-What types of events bring them together?

-What are the roles of family, church, and health care providers within their community?

-Should you approach church groups, school groups, or other organizations?

-What radio stations do they listen to, and what television stations are they most likely to watch?

Question 61

What is involved when using evidence to guide interventions?

Answer 61

-The search for evidence-based guidelines and interventions is important to program success

-It is essential to review literature regarding health problems, factors influencing the outcomes of interventions, and the role of families and communities in adhering to interventions

-The literature review can offer insights that may shape interviews with community members

-How does the target group compare to other target groups? Are there issues that should be addressed that are not found in the literature?

-Consider this situation: A C/PHN wanted to know why parents were using emergency rooms for after-hours urgent care
1. A literature review found studies focusing heavily on the “misuse” of emergency rooms by parents to treat urgent ambulatory care health problems, such as otitis media
2. Based on input from an emergency room nurse, the C/PHN decided to go directly to the source and asked families what their doctors had told them to do if their child became ill at night
3. The families said they were told to take their children to the emergency room!
4. None of the literature addressed what the families had been told to do for after-hours care
5. This is an example of how being open to information from a variety of sources (in this case, the emergency room nurse) enhanced the C/PHN’s understanding of the problem beyond what could be learned by solely relying on the literature

Question 62

What is the community action model?

Answer 62

-Facilitating community action is most effective when using participatory action research approaches

-One such approach is known as the Community Action Model, which aims to identify actions that are achievable and sustainable and propels changes for the well-being of all

-This model builds on concepts presented in the planned-change process and includes a cyclical five-step process

-The C/PHN educator can use this model to facilitate community participation and ownership of change that improves the community’s health

-An example of a successful application of the Community Action Model is Pennsylvania’s School Nutrition Policy Initiative, targeted to combat obesity in 4th to 6th graders
1. About 48 hours of interactive nutrition lessons are presented in classrooms yearly, with participation from families and local community partners
2. Incentives are offered to students who choose healthier snacks
3. Program evaluation revealed a 50% reduction in the number of students who were overweight
4. Other successful programs incorporate farm-fresh foods into school lunches and snacks or aim to reduce consumption of soda

Question 63

What are the five steps of the community action model?

Answer 63

-Step 1:
1. Train participants (develop skills, increase knowledge, build capacity)
2. Name the issue
3. Choose area of focus

-Step 2:
1. Define, design and do community diagnosis

-Step 3:
1. Analyze results of community diagnosis

-Step 4:
1. Select action or activity and implement

-Step 5:
1. Maintain and enforce action or activity

-Repeat process

Question 64

What is an action according to the community action model?

Answer 64

-Is achievable

-Is long-term or sustainable

-Compels another entities to do something to change the environment (place people live) for the well being of all

Question 65

What is an activity according to the community action model?

Answer 65

Is an education intervention that leads up to an supports an action

Question 66

What are advisory groups?

Answer 66

-As nurses work with community members to identify factors contributing to a health problem, individuals will begin to stand out because of their knowledge, networking capabilities, and interest in the subject

-A key factor for ensuring the success of any intervention is to appoint an advisory group that includes representatives from the target and service communities

-Findings from interviews, literature reviews, and data analyses should be reviewed with this advisory group

-To ensure success of the advisory group, all meetings should be carefully planned, so that they are well organized, punctual, and efficient

-Strategies to encourage input from the advisory group should be employed; meetings should focus on getting the advisory group to interpret findings and community feedback and to develop possible solutions

-Contributions from each member should be sought and valued equally

-Depending on the size of the group, it may be most effective to hold breakout sessions as well as larger group sessions

-Every member should do an evaluation at the conclusion of each meeting, so that any problems can be addressed before the next meeting

-Maintaining a record of these meetings—in the form of minutes or a brief written overview—is also very helpful

-Be certain to also keep a record of attendees

-Maintaining a paper trail is always important

Question 67

What is involved with delineating the problem(s)?

Answer 67

-With the help of the advisory group, it’s important to define the problem or problems to be addressed

-The process of determining the real or perceived needs of a defined community is called community assessment

-There are a variety of assessment tools and methods that help nurses delineate community health problems by collecting, analyzing, and interpreting information

-For example: A group of school nurses identified teenage use of e-cigarettes (“vaping” or “JUULing”) as a problem
1. Input from community members, as well as a review of data, demonstrated a high rate of teen vaping in a local high school
2. Although the original plan made by the school nurses was to establish a special educational presentation for all high school students, input from members of the service and target community indicated significant problems with this approach:
*Many of the high school students began using e-cigarettes in middle school
*There was a widespread belief in the community that vaping was a safer alternative to tobacco use
*The e-cigarette users were predominantly male, and the nurses did not understand the association between gender and vaping within the targeted community
3. The use of an advisory group helped the nurses first identify what behavioral factors contributed to vaping in the target population; these behavioral factors included the following:
*There was a high rate of tobacco use among adults in the community, and vaping was becoming increasingly popular
*Smoking cessation programs in the area promoted the idea that vaping was less harmful than smoking, which supported a common belief that vaping was not risky
*A high proportion of high school students began vaping during middle school
*Teenagers in the target population were attracted to the flavors available with e-cigarettes, such as fruit, mint, and chocolate
*Although the legal age to purchase e-cigarettes was 18, local vendors were lax in enforcing the restrictions and vaping products were easily accessible online
*Teenagers in the target group indicated they enjoyed vaping with their friends as an after-school activity
*Many males in the target group were high school athletes who used e-cigarettes to appear “cool” without the risks of smoking

-What nursing diagnoses can you identify from these behavioral factors? Would you begin with deficient knowledge or risk for injury? Are family relationships or self-concept involved?

-Although you may be most familiar using nursing diagnoses with individual clients, nursing diagnoses can be advanced for aggregate clients or populations, especially in conjunction with community assessments, and may be helpful guides in proposing interventions and outcomes

Question 68

What is involved with rating the importance an changeability of identified behavioral factors?

Answer 68

-To achieve success, community health programs must narrow their focus to a limited number of health behaviors that can be addressed successfully within a specific time frame

-To prioritize which behaviors to address, the authors suggest rating them in terms of importance and changeability

-The final list should include problems that are both important and easy to change

-Importance is determined by the frequency of the identified behavior and how strongly it is linked to a health problem

-The advisory group for teen vaping, mentioned previously, ranked the importance of the identified behaviors
1. The attractiveness of e-cigarette flavors was rated highly important because the advisory group learned that flavors are the primary reason youth begin using e-cigarettes
2. The widespread use of tobacco among adults in the community, which modeled unhealthy practices for the youth, was not rated very highly by the advisory group because the members felt the influence of peers was a more important factor

-The advisory group was then asked to rate the changeability of the behaviors

-Green and Kreuter indicate that behaviors that are easiest to change:
1. Are usually still developing
2. Are more recently adopted
3. Do not have deep roots in culture or lifestyle
4. Have been attempted before with some success

-In this round of assessments, the advisory group believed that the smoking cessation programs’ promotion of inaccurate information about vaping could potentially be changed
1. This rating was based on the fact that the smoking cessation program leaders were well-intentioned, but misinformed, and could easily change the program content
2. The program leaders could, in fact, become valuable allies in disseminating accurate information about the risks of vaping
3. The advisory group also determined that it may be more effective to target middle school rather than, or in addition to, high school students, because they had not yet begun using e-cigarettes or had vaping habits that were not yet deeply ingrained

-After rating the identified problems based on changeability and importance, the nurses and advisory group sought to narrow their focus to specific goals
1. Ranking the behaviors in a simple table is suggested
2. This effort yielded a table with the problems categorized in four groups: more important/more changeable, less important/more changeable, more important/less changeable, and less important/less changeable
3. One issue seen as most important and changeable was the use of e-cigarettes among male athletes, who represented the subpopulation most likely to vape (high school males) and who were influential among other male teens
4. This had support from coaches, so there was greater motivation to abandon unhealthy behaviors

-The use of this grid enabled the advisory group to focus on more changeable and important issues
1. They wrote behavioral objectives for each identified factor they hoped to change
2. These objectives identified who was targeted, what they hoped would change or what action would be taken, how the change would be measured, and what the time frame was for achieving the expected outcome; the following are their behavioral objectives:
*By the end of the fall semester, all local smoking cessation programs will discontinue the promotion of vaping as a safer alternative to tobacco
*By the end of the fall semester, 90% of all high school athletes will sign a “no-vaping” contract as a condition of participation in high school sports
*By the end of the school year, 90% of 6th through 12th grade students will attend a presentation aimed at preventing or discontinuing participation in vaping

Question 69

What are the factors that influence behavior change: predisposing, reinforcing, and enabling factors?

Answer 69

-Three categories of factors affecting individual behavior can contribute or create barriers to successful behavioral change

-The advisory group followed the PRECEDE–PROCEED model and identified the predisposing, enabling, and reinforcing factors that affected each behavioral objective

-For the behavioral objective:
1. By the end of the fall semester, 90% of high school athletes will sign a “no-vaping” contract as a condition of participation in sports
2. A predisposing factor seemed to be the athletes’ belief that vaping would help them look “cool” among their peers
3. Reinforcing factors included the common use of tobacco and e-cigarettes among adults in the community, as well as the belief that e-cigarettes were a relatively safe alternative to tobacco
4. An enabling factor that promoted the change was the support of high school athletics coaches who agreed to monitor the conduct of the athletes while at school and enforce the no-vaping contract
5. On the other hand, the apathy of local vendors in enforcing restrictions on the sale of vaping products to children under the age of 18 was seen as inhibiting change

-In addition to the vaping education presentations, the advisory group decided to establish a peer-mentoring program, in which student leaders would work with the advisory group and provide mentoring and support to students who wanted to quit vaping
1. The advisory group had teachers nominate students for this intervention
2. The principal allowed the nominated students to attend educational classes conducted by the nurses to increase their knowledge about vaping cessation
3. The nurses worked collaboratively with the students to ensure that their mentoring and support approaches were effective
4. Student peer mentors suggested rewards that the students could work for that would encourage them to persist
5. One of the rewards that students felt should be offered is sports equipment for student use during recess and lunch periods
6. One local community-based organization offered to sponsor a fund-raising event that would allow them to purchase sports equipment for the school

-Working with the advisory group, the nurses developed a program that outlined activities for each objective, as well as the individual responsible for the activity, the date by which the activities were to be accomplished, and how outcomes would be documented
1. This allowed the group to stay focused, share responsibilities, and monitor outcomes
2. For instance, student mentors were asked to meet with their assigned students to evaluate their progress and provide support at least once a week
3. The nurses were tasked with meeting each week with the student leaders to provide peer-mentoring training

-Working with the advisory group allowed the nurses to contextualize the problem of teen vaping within the target community
1. The advisory group ensured that the nurses identified solutions that were culturally acceptable, appropriate, and ultimately effective
2. This process also helped them develop outcome measures that were consistent with the concerns of the community
3. As data were gathered, findings could be interpreted with input from the advisory group
4. This approach grounded the findings and ensured that interpretations were culturally consistent with the target population
5. Evaluation was facilitated by clearly defined goals that could be measured against actual results

Question 70

Per the PRECEDE-PROCEED model, what are predisposing factors?

Answer 70

-Provide the rationale or motivation for subsequent behavior

-Factors that categorize various behavioral influences:
1. Knowledge
2. Beliefs
3. Values
4. Attitudes
5. Confidence

Question 71

Per the PRECEDE-PROCEED model, what are reinforcing factors?

Answer 71

-Provide a continued motivation to repeat or persist in the behavior

-Factors that categorize various behavioral influences:
1. Family, peers, teachers
2. Employers
3. Health care providers
4. Community leaders
5. Decision makers

Question 72

Per the PRECEDE-PROCEED model, what are enabling factors?

Answer 72

-Promote or facilitate the behavior based upon availability

-Factors that categorize various behavioral influences:
1. Health resources (availability and accessibility)
2. Community/government (priority, laws, and commitment to health)
3. Health-related skills

Question 73

What is involved with planning community health programs?

Answer 73

-In the classic writings of Ottoson and Green, public health education programs are defined as interventions “designed to inform, elicit, facilitate, and maintain positive health practices in large numbers of people”

-Likewise, the American Nurses Association’s Public Health Nursing: Scope and Standards of Practice focuses on the role of the nurse in planning, implementing, and evaluating population-focused health promotion/health education programs
1. Standard 5B calls on the PHN to “employ multiple strategies to promote health, and a safe environment,” through programs and services that include appropriate teaching–learning methods, that are culturally and age appropriate, and that also include an evaluation component
2. Advanced PHNs plan “evidence-based health promotion programs and services” and engage with consumers and advocacy groups in promoting health and modifying programs

-With so much emphasis on planning and developing health education/health promotion programs, the process can seem overwhelming to the new C/PHN or even to the acute care nurse who is involved in some aspect of health initiative development

-In your nursing program, you may have been tasked with developing a health program, working on an existing community program, or simulating the process in a written assignment
1. Whatever your experience level, the essential elements are the same.

-Think about your past experiences, such as taking blood pressures at a local health fair or developing a pamphlet on the need for prostate screening for non–English-speaking residents
1. Did these actions have the impact you hoped for?

-Successful health promotion programs do not occur by accident; they take skill, time, patience, and most of all listening to and understanding the needs and opinions of the individuals who are the focus of your program (the target population)

Question 74

How do you evaluate the outcomes of a health program?

Answer 74

-Although the scope of the effort to address outcome evaluation is understandably broader, the concepts are essentially the same as program planning, implementation, and evaluation as they relate to a small health program

-According to the CDC, “Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate”

-The CDC proposes a framework and standards for program evaluation in public health, which includes six steps, usually taken in order

-There are several approaches and tools for evaluating health care agencies, programs, and outcomes

-Includes:
1. Accreditation
2. Logic models
3. Setting measurable goals and objectives
4. Quality indicators and benchmarks
5. The nurse’s role in quality assurance and improvement
6. Program evaluation: concepts and tools

Question 75

What is accreditation?

Answer 75

-The Institute of Medicine (IOM) report, The Future of the Public’s Health in the 21st Century (IOM, 2002), called for examining the benefits that accreditation of governmental public health departments might bring

-The Public Health Accreditation Board (PHAB) is a nonprofit entity that is the independent accrediting body
1. With support from the CDC, Office for State, Tribal, Local, and Territorial Support, and the Robert Wood Johnson Foundation, the PHAB was launched in 2011
2. By August of 2019, PHAB accredited or re-accredited a total of 275 U.S. health departments, which included 36 state, 3 tribal, and 236 local health departments
3. Eighty percent of the U.S. population is now served by a PHAB-accredited health department
4. The National Association of County and City Health Officials and PHAB offer resources that assist health departments to assess the feasibility of becoming accredited and tools to further support a successful accreditation process if departments choose to seek accreditation

-Of the 12 domains in Standards and Measures version 1.5 for accreditation, 3 are particularly applicable to program development and outcome measurement:
1. Domain 4: Engage with the community to identify and address health problems
2. Domain 9: Evaluate and continually improve health department processes, programs, and interventions
3. Domain 10: Contribute to and apply the evidence base of public health

-A review of the impact of the accreditation process suggests that one of the leading benefits is strengthening health departments’ quality improvement efforts

-As more agencies seek accreditation, there will likely be increased pressure to achieve this status at all levels (local, county, or state) to demonstrate excellence

-Accreditation promotes the provision of high-quality services to the public and commitment to meeting the specific needs of communities

-It also supports the need for community/public health nursing services to meet those challenges

-The accreditation initiative has raised the issue of demonstrating in real and objective terms the outcomes resulting from health promotion programs provided through public health agencies

-The principles discussed have relevance in many community settings and should be considered whenever health promotion programs and services are provided

-PHNs at local, state, and global levels are instrumental to many of the health promotion programs and services offered through health departments; their expertise with and understanding of the communities served are invaluable in assuring ongoing quality assurance and outcome evaluation

Question 76

What are logic models?

Answer 76

-An important step in evaluating any program entails constructing a clear model of what the program is meant to achieve

-Logic models, or pathway logic models, are often used to articulate the causal relationship between planned program activities and the expected outcome

-While community problems may be easy to recognize, it is harder to determine which strategies offer the highest likelihood for successful change and, more importantly, what evidence will indicate progress or success

-It is important to develop a framework for change and use it as a road map in planning and implementing individual and community change

-Based on change theory, logic models offer a clear picture of the desired outcome, the changes that must be realized in order to achieve the outcome, the activities and outputs that will affect the change, and the inputs necessary to carry out the planned activities
1. In other words, logic models provide a process for planning backward in order to implement forward

-In developing a causal framework or pathway, you are able to map out what will be done to produce a desired effect

-It demonstrates how inputs (e.g., community resources), outputs (e.g., potential interventions), impact (e.g., initial results of intervention), and outcomes (e.g., improvement in behaviors or population statistics) are interrelated

-A visual roadmap can be examined by starting with intended outcomes and “walking back” through the steps that are needed to produce the intended result

-A logic model is a type of flow chart and usually takes up one page or less
1. The left side deals with process and the right side with outcomes

-To be effective, a logic model should:
1. Logically link activities and effects
2. Demonstrate appropriate level of detail about the program (enough to clearly understand but not too much to overwhelm)
3. Be thought-provoking and visually engaging
4. Include the known forces needed to promote program outcomes

Question 77

What is involved with setting measurable goals and objectives?

Answer 77

-Using the logic model as a guide, planned programs should have specific goals to help identify who the program is supposed to serve, what services are provided, the length of time the services are to be provided, and the resources that are needed
1. Then, measurable objectives are developed that describe the expected outcomes

-Use of selected verbs indicates the expected level of achievement, such as “clients will be able to demonstrate safe administration of insulin after three home visits” or “parents will have their infants’ recommended immunizations up to date by 24 months of age”

-Goal setting is imperative when developing an educational program for an entire health program or service

-These statements of measurable goals are then examined during the program evaluation

-Without such statements, accurate evaluations cannot be conducted

-Consider the overarching goal of your program, what you plan to accomplish, as well as why this program is important
1. The timeline and personnel resources must be considered, along with which actions must be taken to achieve your intended results

-One helpful acronym, SMART is frequently used in developing outcome measures
1. The general consensus is that SMART stands for Specific, Measurable, Attainable, Relevant, and Time Bound, and may include Evaluate and Reevaluate—SMARTER when added

-In evaluating programs and care, outcomes must be measured against certain standards

-Standards are generic guidelines of expected functioning
1. They can focus on the client, the caregiver, or the organization (finances)
2. All care and services must also be measured against these guidelines

-The core standards of care, practice, and finance must be integrated and compatible if they are to ensure quality care

Question 78

What are quality indicators and benchmarks(quality indicators)?

Answer 78

-Quality indicators of client outcomes are the quantitative measures of a client’s response to care

-Defining and quantifying client outcomes from these indicators are worthwhile processes that enable the nursing staff to evaluate the results of the care they provide

-The goal of care in the community is successful client outcomes

-By starting with measurable indicators, successful outcomes can be demonstrated in quantifiable terms

-When client care meets the standards set, client satisfaction—another quality outcome indicator—is greater

-Quality indicators are part of the broader quality management program and are used to determine goal achievement

-Chart auditing is a useful method by which to measure the frequency of quality indicator occurrence
1. For example, an agency may have a quality indicator such as “all infants younger than 6 months of age are weighed on each home visit”
2. Every fifth chart of infants visited in March, June, September, and December during a designated year is audited for documentation of the number of home visits and the number of infant weights recorded
3. A sampling of charts is sufficient to measure goal achievement and specific quality indicators
4. It is generally accepted that a review of a random selection of 10% of eligible cases, with a minimum sample of 20, will provide useful information

-Indicators are necessary when setting standards in order to measure the success and quality of programs at home or in the community

-The same types of indicators are used in acute care settings, with the focus appropriate to that population

-If the standards are being met, but client outcomes are unacceptable, the process indicators are explored for possible areas of weakness
1. Such areas may need further study to identify the cause of the poor client outcomes
2. For example, a process such as the catheter-care protocol used by an agency, or the communication between hospital and health department or home health nurses, may be examined to determine why there is a high incidence of catheter-associated urinary tract infections among home care patients
3. In addition, Medicaid and Medicare regulations in some states mandate that a percentage of records be audited each year

Question 79

What are quality indicators and benchmarks (benchmarks)?

Answer 79

-While striving for excellence and best practices, agencies may use the benchmarking process

-Continuous, collaborative, systematic processes for measuring and examining internal programs’ strengths and weaknesses; also studying another’s processes to improve own

-Benchmarking compares the performance of an individual practice, department, or agency with an external standard

-In quality improvement, a benchmark is considered achievable because it has already been achieved by another agency or institution

-Internal benchmarking occurs within organizations, between departments or programs

-External benchmarking occurs between similar agencies providing like services
1. Good sources for external benchmarks include local quality collaboratives where several practices or agencies collect and compare similar performance data among themselves
2. Other sources include data reports from federal agencies such as the Health Resources and Services Administration’s Uniform Data System, which evaluate services or interventions aimed at improving the health of vulnerable populations and underserved communities
3. In this way, an agency identifies what is achievable while comparing and contrasting how others provide quality services

-Benchmarking is a key feature of the Quality and Safety Education for Nurses (QSEN) project

Question 80

What is the nurse’s role in quality assurance and improvement?

Answer 80

-Some quality improvement activities for C/PHNs include daily prioritizing of care needs for a caseload of clients, seeking supervision or skills development for a difficult case, systematizing charting so that needed documentation is efficiently completed, proposing better ways to organize care of chronically ill clients, and establishing new agency procedures
1. Any activities to realize goals contribute to the quality management program

-Staff meetings, peer review, and case conferences are common settings for nurses to bring the lessons of their practices to the larger group for examination and potential adoption

-In particular, nursing peer review shows promise as a means to improve quality and safety in health care

-It is the role of nursing administration to develop a formalized quality management program that includes a three-pronged focus, based on a classic approach to quality management: (1) review organizational structure, personnel, and environment; (2) focus on nursing care standards and delivery methods (process); and (3) focus on the outcomes of that care

-In its essential competencies for health care quality professionals, the National Association for Healthcare Quality (NAHQ) identifies six key components of a robust quality management program, which are as follows:
1. Performance and process improvement
2. Population health and care transitions
3. Health data and analytics
4. Patient safety
5. Regulatory and accreditation
6. Quality review and accountability

-The issue of quality and safety has more recently been addressed through the QSEN project
1. The QSEN competencies are consistent with the Donabedian approach to quality improvement and provide a framework for nursing education
2. They also form a sound basis for community health program evaluation, especially as it relates to quality

-Nurses should recognize the value of quality improvement efforts and the importance of their role in ensuring that quality care is delivered

-Direct service providers are the best judges of care problems and potential solutions
1. For this reason, it is critical that quality assurance reviews and other quality improvement activities focus on issues relevant to staff and client concerns and are structured to be accomplished quickly and with minimal effort
2. When these activities are clear, concise, and well-integrated into daily routines, they become less time-consuming, and staff members may recognize the positive client outcomes as rewards for their efforts
3. Moreover, when health care providers have the opportunity to systematically examine the care they provide, they can identify problems and generate potential solutions sooner

Question 81

What is involved with program evaluation (concepts and tools)?

Answer 81

-Studies of community health programs suggest that they are often successful in changing community policies and individual behavior but may not have a significant impact on health outcomes over time
1. This may have more to do with the complex causes of health-related issues, involving both “proximal risk factors as well as upstream determinants of health”

-Whether small or large, health care agencies are complex organizations with many interrelated components

-Assuring they provide services that protect or promote health can be an equally complex task

-Avedis Donabedian, a physician credentialed in public health, offered a conceptual framework for evaluating health care, which is foundational to 21st century quality initiatives
1. The concepts of structure, process, and outcome offer the basis for his own and related models of care evaluation

Question 82

According to structure, process, and outcomes, what is structure?

Answer 82

-The organizational structure should:
1. Fulfill its mission statement or philosophy

2. Be client-focused, with enough resources to maintain present services and introduce additional services as needed
3. Operate efficiently and within budget, maintaining financial stability and promoting trust and confidence among stakeholders
4. Have a well-developed system of acquiring additional funding for new services through grants and contract expansion if needed
5. Attract and retain clients and qualified, highly motivated staff

Question 83

According to structure, process, and outcomes, what are processes?

Answer 83

-The agency should integrate processes which:
1. Provide client services in a manner that is safe, effective, client-centered, timely, efficient, and equitable

2. Maintain standards set by the professional staff that comply with or surpass those recommended by relevant accrediting bodies
3. Encourage staff to contribute to the evaluation and revision of standards
4. Assure that staff members maintain current skills and knowledge pertinent to their job requirements
5. Foster a collaborative work environment in which quality of care is continuously monitored and improved using a variety of participative management tools (e.g., audit instruments, peer review, incident reporting systems)
6. Minimize staff turnover by providing a supportive work environment in which administration and staff have compatible working relationships
7. Assure that employee values are compatible with the goals of the agency and that the conduct of all employees is consistent with organizational values
8. Maintain effective feedback mechanisms for clients to share their perceptions about the care and services received (e.g., questionnaires, surveys, interviews)
9. Act upon suggestions and opportunities for improvement that are identified by clients

Question 84

According to structure, process, and outcomes, what are outcomes?

Answer 84

-The client health outcomes reflect the impact of the services provided by the agency

-Outcomes are the result of numerous factors, including structure and processes, and others that are often beyond the agency’s control

-Examples include the following:
1. Review the charts of hospitalized clients to identify any opportunities for improvement in the agency’s teaching or care that could have prevented hospitalization

2. Review clinic or home visit records when poor client outcomes are reported to determine whether any aspect of the clinic’s or home visit care might have prevented these occurrences
3. Focus on outcomes among commonly served high-risk populations in order to optimize care delivery as well as to benefit high-risk clients
4. Review national, state, and local health care initiatives and objectives (discussed earlier in this chapter) to identify priority health indicators or outcomes in the agency’s client population
5. Develop SMART goals (discussed earlier in this chapter) focusing on the priority health indicators and outcomes in the client population
6. Develop aim statements—the tactics to achieve the SMART goals—which are outcome-focused
7. Enlist individuals with health care analytics skills, within or outside the agency, who can offer expertise in measuring and analyzing outcomes
8. Identify the metrics, or measures, that will show the agency has achieved its goals for client outcomes.
   Develop and implement strategies to improve and monitor client outcomes
9. Modify and improve structure and/or processes when client outcome targets are not met

Question 85

What models are useful in program evaluation?

Answer 85

-Donabedian model

-Omaha system

-Quality and safety education for nurses

Question 86

What is the donabedian model?

Answer 86

-As previously mentioned, Donabedian (2003) was the original proponent of using the concepts of structure, process, and outcome in evaluating quality of care

-The Donabedian model is:
1. Essentially linear in form, suggesting that structure influences processes which, in turn, produce outcomes
2. Recognized as a simplistic and basic method of measuring quality
3. Widely used as the framework for more elaborate models
4. Relevant to common domains of nursing

Question 87

What were included with structure, process, and outcome in the Donabedian Model?

Answer 87

-Structure:
1. Facility resources
2. Personnel mix and skills
3. Philosophy, policies
4. Client mix

-Process:
1. Standards
2. Attitudes
3. Nursing care plans
4. Effectiveness

-Outcomes:
1. Client health care goals met
2. Efficiency and effectiveness of services
3. Client satisfaction

Question 88

What is the Omaha system?

Answer 88

-The Omaha System includes measurement approaches that make it a useful model for evaluating the quality of nursing care provided to individuals, families, and communities

-Evaluation focuses on process indicators, client outcome measures, and satisfaction with care

-The model is currently used in “home care, public health, and school health practice settings, nurse-managed center staff, hospital-based and managed care case managers, educators and students, occupational health nurses, faith community staff, acute care and rehabilitation hospital/long-term care staff, researchers, members of various disciplines, and computer software vendors”

-The evaluation components of the Omaha System include the following:
1. Outcomes that are rated in terms of knowledge (what the client knows), behavior (what the client does), and status (how the client is)
2. Quantification of outcomes in a range of severity, as well as on a continuum toward or away from optimal health
3. Ongoing monitoring of individual, family, or community health to assess the quality of nursing interventions

Question 89

What is the quality and safety education for nurses?

Answer 89

-The QSEN project arose from the groundbreaking IOM report on medical errors and the subsequent 2004 report focusing on nursing quality and safety
1. This recognition prompted funding from the Robert Wood Johnson Foundation for what would become known as the QSEN project

-The purpose of the project is “preparing future nurses who will have the QSEN competencies (knowledge, skills, and attitudes, or ‘KSAs’) necessary to continuously improve the quality and safety of the health care systems within which they work”

-Some have called for these competencies to move beyond the individual to systems of care, bringing it more in line with the population-based focus of public health

-The KSAs can be used across all settings where a nurse may be employed, whether hospital, outpatient center, home care, hospice, or community/public health nursing services

-The KSAs are similar to the Omaha System outcome measures of knowledge, behavior, and status

-The QSEN competencies are significant in community/public health nursing because they provide a method of evaluating both individual nurse performance and the use of aggregated data to assess programmatic outcomes

-The CDC’s model for continuous program improvement cycle or its National Public Health Improvement Initiative is other example of quality improvement methods for public health

Question 90

What is involved with securing grants to fund community health programs?

Answer 90

-Public health departments and other community agencies often require outside funding to develop new health intervention programs

-A common practice is to seek grant funding

-A grant is, very simply, one individual or group providing another individual or group with the support (i.e., money) for a specified purpose

-In health promotion and education, grants offer a source of funding for program development or project support

-These types of grants fall into the following common categories:
1. Planning grants (i.e., initial project development)
2. Start-up grants (i.e., seed money)
3. Management or technical assistance grants (e.g., for fund raising or marketing)
4. Research grants
5. Facilities or equipment grants

-Grants are a reality in public health efforts, similar to a new program or research proposal

-They are not easy to locate, secure, or manage (once you have one), but they are vital in providing a wide range of programs and services to a community
1. Highly competitive

-Grants are available from government sources, private philanthropic sources, and corporations

-Private organizations often have sections on their Web sites with information on available grant funding

-Grant money is not typically paid back; however, it is a contractual agreement, and the terms and conditions are usually clearly delineated

Question 91

What are federal grants?

Answer 91

-Federal grants award government funds to implement projects that provide public service and stimulate the economy and are available from 26 grant-making agencies

-The funding categories most applicable to community health include the following:
1. Community development
2. Disaster preparation and relief
3. Food and nutrition
4. Health

-Federal grants are available to a wide variety of groups, but typically, health-related grants are available to state or local governments, which include public health departments, public housing organizations, educational organizations, and nonprofit organizations

-Nonprofit means the organization was not established to earn a profit
1. This does not mean it doesn’t generate income, but only that there are restrictions on how its funds can be used

-Of particular importance to the discussion of grants is the term 501c3
1. This is a designation that refers to the Internal Revenue Service (IRS) tax-exempt status granted to certain nonprofit organizations
2. To be granted this designation, an entity must be organized and operated exclusively for specific purposes, which include charity, science, education, or the prevention of cruelty to children or animals
3. Some grants are only available to 501c3 organizations, and the funders will request proof of this in the grant application
4. Only corporations, community chests, funds, or foundations can receive this designation; individuals or partnerships do not qualify
5. Essentially, the 501c3 organization can be the provider of the grant funding or the organization seeking the funding

Question 92

What is the grant process?

Answer 92

-The grant process, although arduous, provides the opportunity to focus clearly on what you intend to accomplish, why it is needed, and what part you will play in the successful outcome of the project

-It is wise to seek the help of an experienced mentor—someone who has been successful in grant writing—as they can critique your proposal and offer suggestions prior to submission

-In grant funding, experience counts!
1. A proven record in securing grants and completing the requirements, means you or your organization will have an easier time securing additional funding
2. For the new grant seeker, this can be discouraging

-So, where to begin? Don’t start with complicated grants
1. Begin building your reputation with small local grants
2. Work with partners
3. A school of nursing could partner with a home health agency to write a grant to provide worksite wellness programs for uninsured agricultural workers
4. Or several faith-community groups could partner in a grant application to provide free health screenings for uninsured adults in their area

-Finally, be certain that the grant will allow you to meet the mission and goals of your program

-With limited funds available, funders are looking for proof of the sustainability of your program after their support ends
1. For instance, a breast-feeding support program sought funding in a high-risk area where there was a clear need
2. Although the need was demonstrated, the agency had no plan for continuing the program after the funding ended, so they did not receive funding

-Grant support is often seen as funding to get programs started—not to provide for long-term operations

-Many courses are available on how to successfully locate and write grants
1. A wide variety of information is available online
2. Helpful Web sites are included in the Internet resources found on thePoint

Question 93

What are the steps in the grant process?

Answer 93

-Select a funder that is a good match for your organization and your program/project
1. For instance, applying to a faith-based organization that supports abstinence-only educational programs would not be a good fit for your program that seeks to provide contraceptive information in an after-school program for teens

-Be prepared to provide proof of interdisciplinary or community involvement; many grant funders favor or require grant applications that show collaboration with other

-Submit a letter of inquiry; this may be by invitation-only or be part of the original advertisement of the grant funding
1. This letter is brief, yet clearly lays out your plan

-Read the request for proposal (RFP) carefully and write a clear, well-prepared grant proposal that carefully follows the guidelines; failure to submit all required items prior to the deadline means your grant application is unlikely to be reviewed or funded

-If your grant is not selected, contact the funder to request a review of your submission; this is common with government-sponsored grants
1. Understanding what hampered your selection puts you in a better position to be successful in future submissions to this or other funding sources

Question 94

What is the nurse’s role in grant applications and management?

Answer 94

-Many health departments see grants as an integral part of their service delivery, even hiring grant writers and managers in some cases

-For the small nonprofit organization seeking funding, one effective approach is to partner with a local university, which allows for more access to grant-locating programs, as well as the expertise offered on the campuses (e.g., content area experts, experienced researchers, statisticians, business plan experts)

-For most health agencies, the task of locating grant funds, writing the grant application, and doing the work stipulated by the grant falls on the nurses and other professionals within those agencies

-On the positive side, it provides an opportunity for C/PHNs to explain to others what they can provide in terms of services and programs targeting the community’s health

-The following tips may be helpful as you begin the process of seeking grant funding:
1. Gain a sound understanding of the grant and specific criteria required, ensuring your interests and intentions are in line with the grantor agency
2. Seek input from the community the services are intended to benefit
3. Compile all required documents, such as articles of information, tax exemption certification, etc
4. Conform the proposal to the RFP requirements
*The order of contents may vary but usually include a proposal summary, problem statement, project goal and objectives, project methods or design, project evaluation, and budget
5. Review, proofread, and ensure all requirements are met prior to submitting your proposal
6. Submit the proposal prior to the deadline

-Even if you are never required to write a grant, you will likely be involved in some part of a programmatic grant at some point in your career, either in the delivery of services stipulated by the grant (product) or in evaluating the outcomes of the services provided (e.g., satisfaction surveys)

-You may even be asked to provide ideas for services to be included in the grant application
1. Take advantage of these opportunities
2. The experience you gain will enhance your knowledge of the process and prepare you for future opportunities

Question 95

What is the social marketing of community health programs?

Answer 95

-The term social marketing refers to using marketing principles to influence or advance “the voluntary behavior of target audiences”

-You may have seen brief examples on television (or in print) of the CDC’s Tips from Former Smokers campaign

-An example of a very successful social marketing campaign was the ALS Association’s “Ice Bucket Challenge,” which raised over $115 million during an 8-week period in 2014 for amyotrophic lateral sclerosis (ALS) research

-The objective of social marketing in public health is to improve society’s health by influencing changes in individual health behaviors (e.g., healthy eating) and implementing policies that improve health behaviors of populations (e.g., seat belt laws)

-The integration of marketing with public health is seen as a means to enhance the effectiveness of public health practitioners; nevertheless, this has yet to be confirmed by substantial research

Question 96

What are the social marketing concepts?

Answer 96

-Concepts that are important in marketing are also applicable to social marketing as noted in a seminal book by Resnick and Siegel

-These principles seem rather straightforward, yet public health practitioners are often at a disadvantage when attempting to implement social marketing campaigns

-They may lack training in the necessary skills, be outspent by the competition (e.g., the fast-food industry), or have limited options for distributing their message (e.g., public service announcements)

-Another example of a very successful social marketing campaign is the Go Red for Women initiative begun in 2004 by the American Heart Association
1. Using a red dress as the symbol of the program, the initiative seeks to raise awareness of heart disease among women
1. Both of these health issues are equally important (heart disease, ALS), but one has a more broadly recognized campaign; the other was humorous but not necessarily educational

-Ultimately, the issues are whether public health practitioners will take full advantage of social marketing to promote community or population health and whether behaviors and health outcomes will improve as a result

-Zahid and Reicks reported on a quantitative study of messaging that promotes healthy beverage intake among children
1. The study evaluated the effectiveness of gain-framed messaging (outcomes framed in positive light), on parenting practices that affect child intake of sugar-sweetened beverages (SSBs)
2. Gain-framed messaging aimed to support parental motivation for reducing child SSB intake, as opposed to loss-framed messaging (outcomes framed in negative terms), which aimed to undermine it
3. Parents completed a survey after viewing gain- and loss-framed messages
4. The gain-framed messages were associated with higher parental motivation to decrease child intake of SSBs
5. This study exemplifies the importance of framing health-related messages in a manner that is appealing, relevant to the situation, and acceptable to the audience

Question 97

What are the key social marketing concepts?

Answer 97

-Exchange:
1. Individuals give something to get something; they weigh the costs and perceived benefits

-Self-interest:
1. People act in their own best interests in most cases

-Behavior change:
1. Change in behavior is the focus; thoughts and ideas may also need to change but are not the ultimate goal

-Competition:
1. Selecting one option (or action) inherently involves giving up another option (or action)

-Consumer orientation:
1. Problem-solving process is directed at the target—the consumer (this could be an individual, group, or organization)

-Four Ps (product, price, place, and promotion):
1. Also called the marketing mix; each can be altered to increase market share

-Partners and policy:
1. Organizations with similar interests may form partnerships to achieve mutual objectives; identification of policy changes necessary for behavioral change, those supportive of the change, and those that the organization could help influence

Question 98

What is social media?

Answer 98

-In 2017, the National Institute for Health and Care Excellence (NICE) in the United Kingdom became the first major public health agency to use Snapchat to educate them on a health topic—antibiotic resistance
1. The cost? $500!

-There is, as yet, a lack of evidence confirming the effectiveness of social media in promoting public health programs; nevertheless, there is no doubt that social media can be very cost-effective and has the capacity to reach vast populations

-In 2017, over 2.7 billion people—37% of the world’s population—were considered active social media users

-In 2019, approximately 72% of Americans used social networking tools, such as Facebook, Snapchat, Instagram, Twitter, and YouTube

-The capacity of social media to reach individuals with strategic and effective health messages is immense and must be harnessed

-A thematic analysis of research on the use of social media in public health and medicine suggests that patients, health care professionals, and the general public are already using social media for a variety of health-related purposes including behavioral change support and disease surveillance, prevention, and management

-When planning and beginning development of a social marketing approach, there are many resources available to the C/PHN and other public health professionals
1. The CDC offers an excellent Web site, Gateway to Health Communications and Social Marketing, that includes links to a wide variety of resources
*For instance, one of the social marketing resources, Social Media at CDC, offers guidelines and best practices, including a social media toolkit and a guide to writing for social media
2. The European Centers for Disease Prevention and Control offers a comprehensive Social Marketing Guide for Public Health Programme Managers and Practitioners
*Another very helpful publication What Works: Health Communication and Social Marketing—Evidence-Based Interventions for Your Community
3. Social Media Toolkit: A Primer for Local Health Department PIOs and Communications Professionals provides information on the importance of social media tools to “reinforce and personalize messages, reach new audiences, and build a communication infrastructure based on open information exchange”
*However, there are also downsides to this approach

Question 99

What are the ethical issues in social marketing?

Answer 99

-The plethora of social marketing campaigns have raised a spotlight on ethical issues that must be carefully considered when designing, implementing, and evaluating social marketing programs for good causes

-The International Union for Health Promotion and Education is dedicated to seeing optimum health and well-being globally

-Their values highlight the importance of ethics in this arena:
1. Respect—for the innate dignity of all people, for cultural identity, for cultural diversity, and for natural resources and the environment
2. Inclusion and involvement of people in making the decisions that shape their lives and impact upon their health and well-being
3. Equity in health, social, and economic outcomes for all people
4. Accountability and transparency—within governments, organizations, and communities
5. Sustainability
6. Social justice for all people
7. Compassion and empowerment

-Social media platforms, which are potent social marketing tools, are powerful but often unreliable sources of information
1. It may be difficult for consumers to discern truth from fiction in social media posts about health and wellness, many (or perhaps, most) of which may originate from sources that are not authoritative or credible

-Social media platforms are also vulnerable to nefarious uses such as hacking and fraud, which also makes them potent sources of misinformation

-In 2019, Facebook and Twitter took action against China for using hundreds of fake accounts to sow political discord during protests in Hong Kong

-As Olson points out, social marketers should resist the temptation to use questionable tactics, even when it might seem justified from their perspective about “the greater good”

-Social marketing is not a panacea, but it does provide techniques that can support health education and promotion programs

-The method can be very expensive and elaborate, or it can provide simple, straightforward messages

-The point is that well-presented marketing can prompt behavior change

-Media messages are not a replacement for a sound health promotion program; but they are a tool that can be used for great impact

Question 100

What is the nurse’s role and structure?

Answer 100

-Client focus
1. Knowing that the population or client is the center of care is needed to assess the competency of the nursing student or community health nurse

-Sufficient resources
1. Program will fall apart without proper, sufficient, or don’t know the resources needed

-Budgeting and system for acquiring additional funding
1. Know what it will cost and where it is going; always have a backup; reach out to multiple/different organization or resources

-Private agencies and profit
1. Reach out to see what type of funding you can get from them, if any

Question 101

What is the nurse’s role and process?

Answer 101

-Daily prioritizing of care needs for a caseload of clients

-Seeking supervision or skills development for a difficult case

-Systematizing charting so that needed documentation is efficiently completed

-Proposing better ways to organize care of chronically ill clients

-Establishing new agency procedures

-Conducting staff meetings, peer review, and case conferences

Question 102

What is the nurse’s role and outcomes?

Answer 102

-Periodic review of standards and ability to meet needs of population

-Staff implementation of standards

-Nursing services used most frequently