Chapter 17 Flashcards
- Which of the following community health improvement projects uses subjective health perspective?
a. Health-promotion project aimed at monitoring an adolescent’s compliance with an asthma treatment regimen
b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program
c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin
d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use
ANS: B : Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program
The subjective life process approach involves taking a holistic view of the person’s total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model.
- An effective community-oriented diabetes program should include:
a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques.
b. care that incorporates the American Diabetes Association treatment guidelines.
c. access to a primary care provider, medication and supplies, and nutritionist consult.
d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.
ANS: D : self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.
From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies).
- The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies?
a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population
b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality
c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged
d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease
ANS: D : Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease
The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models, and strategies to reduce CHD risk. The Alameda County study followed a large sample for 4 years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs.
- A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of:
a. aggregate primary prevention.
b. individual-level primary, secondary, and tertiary prevention.
c. multilevel intervention with a focus on primary, secondary, and tertiary prevention.
d. promotion of optimal health for the individual, family, aggregate, and total community.
ANS: C : multilevel intervention with a focus on primary, secondary, and tertiary prevention.
The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community—individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach.
- In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client:
a. access to care.
b. adjustment of lifestyle.
c. compliance with a prescribed regimen.
d. response to treatment.
ANS: C : compliance with a prescribed regimen.
In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional.
- A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child’s peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices?
a. The family is responsible for the health behaviors of children.
b. The individual is responsible for health behaviors.
c. There is multilevel responsibility for health behaviors.
d. The community has a sense of responsibility for health behaviors.
ANS: C : There is multilevel responsibility for health behaviors.
In the ecological perspective, individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society.
- The local public health nurse (PHN) participates in a town board’s community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be:
a. coalition building.
b. evaluation of outcomes.
c. health-risk assessment.
d. wellness appraisal.
ANS: A : coalition building
The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time
- In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members:
a. are best at determining the health needs and plan interventions for their community.
b. create a passive partnership.
c. provide oversight for the health promotion activities.
d. relieve local service providers of mundane tasks.
ANS: A : . are best at determining the health needs and plan interventions for their community.
The CBPR approach to community assessment allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process. In CBPR, partnerships are active and community members are involved in assessing, planning, implementing, and evaluating change. Both professionals and community residents determine health needs and plan interventions. As residents increase their awareness, they are better able to determine what they want for themselves, their families, and their community and they are more likely to take leadership roles in program development, using health professionals as consultants.
- At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level?
a. Aggregate client system level
b. Environmental level
c. Family client system level
d. Individual client system level
ANS: A : Aggregate client system level
Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention.
- After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change?
a. Preparation
b. Contemplation
c. Action
d. Precontemplation
ANS: A : Preparation
Preparation is the stage where the person intends to do something. Precontemplation is when the person does not plan to change; this may be because the person does not know there is a problem or does not want to do anything about it. In the contemplation stage, the person begins thinking about making a change in the future and examines the pros and cons of doing so. Action occurs when the person actually buys a radon testing kit and uses it in his home.
