Chapter 9 Flashcards
- The three components of the Intervention Wheel are:
a. communities, systems, and individuals/families.
b. interventions, color wedges, and levels of practice.
c. population base, levels of practice, and public health interventions.
d. populations at risk, populations of interest, and levels of practice.
ANS: C : population base, levels of practice, and public health interventions.
The components of the Intervention Wheel include population base, three levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges
- Public health nursing practice is guided by the community’s priorities as identified by community:
a. assessment.
b. diagnosis.
c. interventions.
d. planning.
ANS: A : assessment.
Assessing the health status of the populations that make up a community requires ongoing collection and analysis of relevant qualitative and quantitative data. Community assessment includes a comprehensive evaluation of the determinants of health. Data analysis identifies deviations from expected or acceptable rates of disease, injury, death, or disability, as well as risk and protective factors. Community assessment generally results in a lengthy list of community problems and issues. However, communities rarely possess sufficient resources to address the entire list, and priorities must be set after assessing the community’s beliefs, attitudes, and opinions, as well as the community’s readiness for change.
- Collaboration is an intervention that would be located where in the Intervention Wheel?
a. Red wedge at the individual/family level of practice
b. Blue wedge at the community level of practice
c. Orange wedge at the community level of practice
d. Green wedge at the systems level of practice
ANS: C : Orange wedge at the community level of practice
The public health interventions are grouped with related interventions, and these wedges are color coordinated. The red wedge includes five interventions: surveillance, disease and health investigation, screening, outreach activities, and case finding. They typically occur in pairs or in sequence, although all can occur independently. The green wedge consists of three interventions: referral and follow-up, case management, and delegated functions; these are often implemented together. Similarly, the blue wedge includes three interventions—health teaching, counseling, and consultation—that are often implemented together. The orange wedge combines three interventions—collaboration, coalition building, and community organizing—which are all types of collective action that are usually carried out at the systems or community level of practice. Similarly, the three yellow wedge interventions—advocacy, social marketing, and policy development and enforcement—are often interrelated when implemented. Interventions in the orange and yellow wedges are typically used at the systems and community levels of practice, whereas those in the red, blue, and green wedges are usually carried out at the individual/family level of practice and to a lesser degree at the community and system levels of practice. Collaboration is a collective action and therefore, must be in an orange wedge.
- The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as:
a. advocacy.
b. coalition building.
c. consultation.
d. social marketing
ANS: D : social marketing
Social marketing utilizes commercial marketing principles and technologies in programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Recent examples of the use of these techniques are antismoking campaigns, campaigns for refunding of the State Children’s Health Insurance Program, and campaigns to address the needs of uninsured/underinsured populations.
- Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of:
a. community-level practice.
b. family-level practice.
c. individual-level practice.
d. systems-level practice.
ANS: D : systems-level practice.
The goal of systems-level practice is to change the laws, policies, and practices that influence immunization rates, such as promoting the creation of population-based immunization registries and improving clinic and provider practices.
- When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses (PHNs) conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of:
a. community-level practice.
b. family-level practice.
c. individual-level practice.
d. systems-level practice.
ANS: A : community-level practice.
The goal of community-level practice is to improve the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized. These strategies lead to an increase in the percentage of people who obtain recommended immunizations for themselves and their children.
- A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention.
a. individual/family, secondary
b. community, primary
c. community, secondary
d. individual/family, primary
ANS: A : individual/family, secondary
Based on this nursing diagnosis, one could assume that the level of practice is at the individual/family level (young child who is being parented by a primary parent who is experiencing mental health problems) and at the secondary level of prevention (because the family has an existing identified risk, i.e., a mental health problem).
- After consulting with the health department director, a PHN collaborates with a housing advocate service and legal counsel on behalf of the nurse’s clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice.
a. evaluation, systems
b. assessment, community
c. implementation, systems
d. diagnosis, community
ANS: C : implementation, systems
Collaboration and advocacy are often collective actions applied at a community or systems level of practice. In this case, the identification of the community problem probably emerged out of practice, rather than from a formal community assessment. The nurse’s goals were to enforce the tenant’s legal rights and improve their living conditions. The nurse sought advice from a housing advocate service and connected the clients with legal counsel. The nurse also sought political support by consulting with health department officials before implementing the nursing plan.
- A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements.
a. evaluate the effectiveness of
b. assess the expansion needs of
c. identify problems with
d. implement the expansion of
ANS: A : evaluate the effectiveness of
The evaluation phase of a community-level intervention attempts to determine the effectiveness of the intervention in meeting the desired outcome (decreased social isolation for the elder community population) and in establishing new healthier practices (increased social networking and increased involvement in other community activities) while identifying any emerging barriers (problems) that may interfere with the desired outcome. Very often this can be achieved through a repeat assessment such as a survey of the population receiving the intervention to measure change in attitudes, beliefs, and behaviors.
- Factors related to the determinants of health identified in Healthy People 2020 include which of the following? (Select all that apply.)
a. Education and literacy
b. Genetic endowment
c. Gender
d. Culture
e. Social status
ANS: A, B, C, D, E
The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.
