Community health FDU Flashcards
What woman started using concepts of epidemiology and focused on correcting unsanitary conditions? And she also set the foundation for visiting nurses-health promotion?
Florence Nightingale
She also said nursing is a call to service and the moral character of persons entering nursing is important
- she set up the school of nursing
- she had a population based approach that Lead to improvements in environmental conditions
What are ways to measure community health?
- infant mortality
- morbidity and mortality rates
- life expectancy
- cancer incidence rates
*fewer resources equals increased infant mortality
The steps in the ethical decision making process are similar to steps of:
The nursing process
Which ethical principle means to do no harm?
Non -maleficence
According to Leininger and Watson the moral idea of nursing is? A. Caring B. Advocacy C. Responsibility D. Accountability
A. Caring
Rationale: the conceptual i action occurred as a response to the technological advances in healthcare science and the desire of nurses to differentiate nursing practice from medical practice
3 elements Ethics involve?
Morality
Values
Code of ethics
Morality is
To do right and wrong based on societal norms
Values is
Beliefs about importance about what is right
Code of ethics is
Moral standards for professional practice
What is a branch of ethics that examines ethical issues in healthcare?
Medical ethics/bioethics
Ethical principals are?
1) non-malificence
2) beneficence
3) social justice
4) health disparities
* autonomy is one an is allowing a person to make decisions in their care (directives)
Beneficence means?
Obligation to do the best for the patient and population
Social justice means?
Equality of distribution of healthcare services
-fair distribution of benefits among members of society
Health disparities are?
Unequal access to healthcare and poorer outcomes in certain groups
Examples: race, gender, ethnicity, disability status, identity
Examples of Health disparities?
1) Environment
- access to healthcare, socioeconomic factors, geographical and political factors
2) Sociocultural
- cultural factors, social factors, psychological factors
3) Behavioral factors
- coping factors, health behaviors, psychosocial (risk and resilience)
4) Biological
- genetics, cell function
* poorer, race, ethnicity, culture, and healthcare access are the most common
What is the order for making ethical decisions (the decision-making process)?
- identify issues
- gather facts related to issues
- reformulate ethical issues if needed
- consider appropriate actions/options
- make decisions and act–> the right action provides the greatest good for all people
- Evaluate the decision
What are the 3 core functions of Community Health?
- Assessment
- wrong assessments lead to wrong interventions - Policy development
- you need to be more concerned with the population needs than your own needs - Assurance
- need to make sure essential services are available to people who need services
What are social determinants of health?
they are the social conditions in which people live, their income, gender, culture and literacy, home and work environment, support network, social status, and availability of health services (access to care)
- these conditions have an impact on the extent to which a person or community possesses the physical, social, or personal resources necessary to maintain and attain health
Patient-centered care considers individuals?
- cultural traditions
- personal preferences
- values
- families
- lifestyles
A nurse is caring for an older adult patient who is struggling to manage her type 2 diabetes. The nurse should recognize which social determinants of the patient’s health (select all that apply)?
a. low- income
b. the reading level of 3rd grader
c. medication ineffective due to error in prescription
d. originally from Sudan
e. No family in the area
A, B, D, E
income, literacy, coming from another country and no family support all lead to poor determinants of health
What is it called when it involves active participation in one’s own health through education and lifestyle changes?
Personal responsibility of health
This is active in U.S communities and works collectively to improve collective community health ?
public health
She was from Scotland and traveled on horseback in rural areas to improve child mortality in those areas where access to care was scarce. Her purpose was to reduce pregnancy complications, reduce maternal mortality, reduce stillbirths, reduce infant mortality, and improve health in rural populations.
- She was a frontier nurse in kentucky and led to the profession of nurse-midwifery
Mary Breckinridge
Public health nursing looks at what part of the population?
the whole
rationale: the primary focus is promoting the health of the population using knowledge from nursing, social, and public health sciences
What are the main areas of practice in public health nursing?
health promotion
health maintenance
- increased health maintenance and increased healthy behaviors = decreased illness and complications
What is the goal of public health nursing?
reduce disease through prevention and improve health in the community, both nationally and internationally
- to promote physical and mental health and prevent disease, injury, and disability
What is the definition of health?
illness, health, and peak wellness on a continuum, it is fluid and changing
- within a social environment, the state of health depends on goals, potentials, and performance of individuals, families, communities, and societies
She formed the henry street settlement -> which is the visiting nurse association in NYC
- she looked at social determinants of health in a community
- she worked with politicians to promote clean environments that were unsanitary
- she worked with community members and educated them on cleanliness within the home and community
- she noticed poor health conditions in the schools and led to having a nurse in the schools, which then there was a decline in sick children
- she assessed communities
- she focused on public health nursing and promoted public understanding through education
Lilian Wald (founder of public health nursing)
*district nursing was formed in the late 1800s
What is a nurse who provides to people in their homes and provides to several people at a time?
a visiting nurse
Community is?
a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging
What determines the health status of a community?
- access to healthcare
- economic conditions
- social issues
- environmental issues
- cultural practices
What are some environmental issues that affect a community?
air quality drinking water contamination housing problems high crime rates community issues
What happens to infant mortality when resources decline?
they increase
* the people are usually poorer and less educated
How is public health supported?
tax-supported and have county health departments
What are some barriers to healthcare access?
health literacy transportation mental health and substance abuse living in rural areas (being far away) workforce shortages Job doesn't offer insurance the high cost of care (can't afford it) personal preferences beliefs about western medicine (natural care)
Conduct medical research which allows Americans to live longer and healthier. This agency seeks to enhance health, lengthen life, and reduce illness and disability and is responsible for biomedical and public health research?
National Institute of Health
Who funds NIH?
Federal grants
The nations health protection agency, saves lives and protects people from health threats, and responds if they arise. It is the leading public health agency and is dedicated to saving lives and protecting the health of Americans, what is this agency (they develop methods to prevent and control disease?
CDC
What is the name of the agency ensures safe food and drugs; regulates the manufacturing, labeling, and packaging of foods, drugs, cosmetics, over the counter meds?
FDA
Which governmental agency regulates workplace safety?
Department of Labor
Provides funding for WIC, regulates the grading and inspection for food?
Department of Agriculture
Provides care for federal prisoners?
Department of Justice
Administers financial aid programs to the elderly, financially needy, and disabled people; it is the federal agency that is directly involved with the health and healthcare of U.S citizens and refugees/immigrants
Department of Health and Human Services
What public health entities are regulated by the U.S federal government (select all that apply)?
a. food
b. medication
c. school health
d. devices
e. environment
A, B, D, E
The department of health and human services has identified several areas for which health disparities exist among various demographic groups and need to be addressed (select all that apply) ?
a. infant mortality
b. cancer screening
c. cardiovascular disease
d. diabetes
e. end-stage renal disease
A, B, C, D
and also includes HIV/AIDS and immunizations
Direct care (intervention) is ?
Direct care intervention is performed with the patient (interaction with the patient)
Examples: patient teaching, emotional support, any type of physical care (cleaning an incision, administering an injection, ambulating with a patient)
Indirect care intervention is?
is performed away from the patient but on behalf of the patient or group of patients.
Example: advocacy, managing the environment, making referrals, collaborating with other members of the healthcare team, making a change of shift report, ensuring the availability of medically needed devices for the patient
All 3 levels of preventions (primary, secondary, tertiary) involve?
education, the nurse is always educating the patient
What are some essential Public health services?
- Monitor health and evaluate the services- look at costs, in regards to the individual, families in communities and monitor their health
- Diagnose and Investigate problems- communicable diseases, results of natural disasters
- Educate- any form to relay message regarding health to people
- Mobilize community- work with the community and get them involved, find out what they feel is important
- Develop policies- based on assessment and needs
- assurance of competent public health workforce
- research solutions to problems
What are some basic ways to give to people in public health nursing?
shelter
food
medical care
skill competencies in medical care workers
A nurse performs a variety of tasks as part of the nurse’s position at a hospital. Which task best exemplifies public health?
a. reading current nursing journals and interpreting the latest research into daily practice
b. instructing a client on how to best care for a suture site at home
c. participating in a video conference call with a client who lives in a remote area
d. facilitating a community-wide smoking cessation program one month out of the year
D
rationale: public health is what society does collectively to ensure the conditions exist in which people can be healthy
- a smoking cessation program is a public health intervention, in that it involves the collective effort of society to improve the health of its members
What are the core competencies (8 principles) in nursing (what a nurse needs to be good at)?
Assessment skills program planning and policy development communication skills cultural competency skills basic public health practices/skills financial planning management skills leadership skills
A nurse is coordinating a plan to bring vaccinations in a cost-effective way to a rural community that currently lacks access to them. This is an example of which public health intervention? A. surveillance b. outreach c. screening d. case management
D. case management
rationale: the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way
What is needed and is a personal responsibility for health in one’s own health through education and lifestyle changes (take charge of your life)?
active participation
Nursing is ?
- the protection, promotion, optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities, and populations
who sets the scope and standards for all professional nursing practice?
ANA
The Minnesota public health intervention wheel (conceptual framework)illustrates what?
it is a tool that illustrates what public health nurses do to improve health outcomes
- the wheel is a population-based practice model that encompasses 3 levels of practice ( community, system, and individual/family) and 17 public health interventions
- each intervention (out of the 17) and practice (out of the 3) improve the population health
- the wheel answers the question of what do public health nurses do and delineates public health nursing as a specialty practice of nursing
Minnesota public health wheel practices- systems-focused, community-focused, and individual/family-focused?
systems-focused- changes organizations, law, policies, and power structures, the focus is on the system that impacts health
community-focused- changes community norms, attitudes, awareness, practices, and behaviors. This practice level is directed at the entire populations within the communities and is measured in terms of what proportion of the population actually changes
Individual/family-focused- changes knowledge, attitudes, beliefs, practices, behaviors of individuals and families. This level is directed at individuals, alone or as part of a family, class, group
Red wedges: Surveillance, disease and health event investigation, outreach and screening
these are implemented in conjunction with one another. the screening follows either surveillance or disease and health event investigation and is often preceded by outreach activities in order to maximize the number of those at risk who actually get screened. Most often screening leads to case-finding, but this intervention could be carried out by itself
Green wedges in Minnsesota wheel of interventions: referral and follow up case management, and delegated functions
in practice are often implemented together
Blue wedges in the Minnesota intervention wheel: health-teaching, counseling, and consultation?
they are more similar than they are different and work well together
Orange wedges in Minnesota intervention wheel: collaboration, coalition building, and community organizing
they are all types of collective action and are most often carried out at systems or community levels of practice
Yellow wedges in Minnesota intervention wheel: advocacy, social marketing, and policy development & enforcement
advocacy is often viewed as a precursor to policy development; social marketing is seen by some as a method of carrying out advocacy
What level of prevention is TB testing for high-risk groups?
secondary
What level of prevention for the provision of shelters for victims of natural disasters?
Tertiary
What level of prevention for physical therapy, OT, speech therapy for a patient following a TBI?
Tertiary
What level of prevention for providing first aid to a kid that fell off the monkey bars and needs first aid?
Secondary
If a secondary level of prevention (care) is not given properly what happens?
The person moves to tertiary prevention as the person needs rehab for the disability
What level of prevention is giving immunizations to locals in a community?
Primary
What level of prevention do screenings occur?
secondary
What level of prevention is the disorder/disease/problem absent?
Primary
What level of prevention are the disease/chronic illness present and rehab is needed to avoid exacerbation?
Tertiary
Primary Prevention consists of :
vaccines, immunizations, health promotion, prevention of pregnancy, education about safety belts, helmets, safe-sex anything to prevent illness or injury
Risk assessment
Prevention education (can be controversial)
“Safer” sexual & drug use practices
Be careful about labeling, value-laden terms
Vaccinations
Secondary prevention consists of:
early diagnosis and prompt interventions that limit disability - identifies risks or hazards and modifies, removes or treats them before a problem becomes more serious intervention fo 1st aid treatment, STD screening Testing for TB Looking for early ID of TB Testing & counseling for HIV Post-test counseling Partner notification/Contact tracing
Tertiary prevention consists of:
(population in which disease or injury has already occurred)
rehab (already has the illness, issue), it is the maintenance of issues or illness, shelter for people after natural disasters, spiritual support, palliative care, pain control
Directly observed therapy (DOT)
Non-compliance; have to go to health depart and nurse must observe taking medication - enforced through police law
Management of AIDS in the home
Identify resources
Support groups
Standard Precautions
Learning to live with disease/family living with someone who has the disease
What agency or agencies oversee the environment/community?
CDC and the department of health and human services
the study of how individuals, groups, organizations, and society allocate and utilize finances, personnel, time, and physical space as components of resources is what?
Economics
- economic tools and other quantitative financial measures are used as a method of evaluating the existing governmental, private programs or the public, and private policy alternatives
What is the primary goal of community health?
a. to support and supplement the efforts of the medical profession in the promotion of health and prevention
b. to enhance the capacity of individuals, families, and communities, to cope with their health needs
c. to increase the productivity of the people by providing them with the services that will increase their level of health
d. To contribute to national development through the promotion of family welfare, focusing particularly on mothers and children
b
population-focused nursing practice requires which of the following processes?
a. community organizing
b. nursing process
c. community diagnosis
d. epidemiologic process
c. community diagnosis
rationale: it means providing care based on the greater needs of the majority of the population. The greater need is identified through community diagnosis
What is the focus of public health nursing?
it focuses on preventative, not curative services
In which steps are plans formulated for solving community problems?
a. mobilization
b. community organization
c. community study
d. core group formation
b. community organization
rationale: community assembles together to tackle a health concern (community)
Isolation of a child with measles belongs to what level of prevention?
a. Primary
b. secondary
c. tertiary
d. intermediate
A. primary
rationale: is a way to protect those that are not sick(specific disease prevention)
What type of family-nurse contact will provide you with the best opportunity to observe family dynamics?
a. clinic consultation
b. group conferences
c. Home visit
d. written communication
c. home visit
rationale: the dynamics are best observed in their natural setting
The nurse is locating populations in her region who are exposed to lead-based paint and providing them with information regarding the dangers of lead poisoning. This is an example of which public health interventions?
a. surveillance
b. outreach
c. screening
d. case management
b. outreach
Select the great public health achievement in the US in the 20th century?
a. elimination of common infectious diseases
b. recognition of tabacco as a health hazard
c. flouridation of drinking water
d. healthier mothers and babies
B,C,D
Personal Responsibility for health involves active participation in one’s own health through education. Which exemplify personal responsibility?
a. reviewing one’s own medical record
b. monitoring the positive and negative effects of prescription and over-the-counter medications
c. avoiding tobacco and recreational drug use
d. showing up for scheduled tests and procedures
e. eating the types of foods one most enjoys
A,B,C,D
Which of the following is the main factor that distinguishes public health nursing from other specialties?
a. focus in the competence in nursing practice
b. population- focused practice
c. educational preparation
d. long term care
b. population-focused practice
Culture can be defined as:
a. ethnocentric patterns of life
b. a set of values, beliefs, and assumptions about life
c. a changed belief system
d. specific behaviors
b.
The philosophy of hospice care includes which of the following?
a. provide the client with all life-sustaining measures
b. provide care only for the client in a health care insitution
c. provide support for clients and families during the dying process
d. provide pain management only
c.
Which of the following clients are eligible tor receive home care services (select all that apply)?
a. homebound older adults
b. terminally ill children
c. an individual on a ventilator
d. a client discharged from a same-day surgery facility
a,b, c
The first visiting nurse services were established by?
a. local and state health departments
b. wealthy and upper-class women to meet the need of their communities
c. hopital administrators as a means to increase inpatient beds
d. nurses to assure a professional practice environment
d
The collection and analysis of standardized patient data allow the Centers for Medicare and Medicaid Services to :
a. penalize agencies with poor outcomes
b. provide financial rewards to agencies that achieve best patient outcomes
c. identify agencies with best practice (they take this and share it with people)
d. provide agencies poor performance from participating in the Medicare program
C. identify agencies with best practice
List at least three factors necessary to promote health?
rest
diet
exericse
What is the most important step in policy development?
a. convincing the political parties to support the poilcy
b. defining the issue and getting it on the agenda (1st step)
c. determining who has stakes in the policy
d. trying to convince the public to accept the policy
b
What must be created before establishing the evaluation plan to determine the success or lack of success of a public health program?
a. set or short and long-term goals
b. decisions on who will collect the data
c. observable and measurable outcomes
d. to insist that the patient have a hospital bed in the home
c. observable and measurable outcomes
What is the primary factor in how a hospice nurse makes decisions while giving care in the patient’s home with the caregiver present?
a. make sure the patient had a comfortable, pain-free death
b. to encourage the caregiver and family that they need to address the reality of the patient’s death
c. to prevent the decline of the caregiver’s health
d. to insist that the patient have a hospital bed in the home
c. to prevent the decline of the caregiver’s health
- the caregiver is very important in hospice care just as important as the patient
In addition to the factual data such as name, address, diagnosis, what information is of major importance when a new referral for home care is received?
a. the amount of reimbursement the agency will receive
b. the family’s reaction to the home visit
c. the purpose of the referral for the home visit
d. if the patient requires any additional home care services
c. the purpose of the referral for the home visit
A patient who is homeless has been admitted to the hospital with multiple health problems. The nursing case manager, physician, social worker, and dietician work together to care for the patient. This interprofessional interaction is referred to as:?
a. collaboration
b. consultation
c. continuity
d. coordination
a. collaboration
Ideally, nursing case management planning identifies goals that are:
realistic, measurable, and specific
Which represents the correct order of events in the policy-making process?
1) policy formulation
2) policy assessment
3) policy adoption
4) policy implementation
5) policy modification
6) setting an agenda
setting an agenda (example if a group of nurses meet to discuss the number of children that die in hot cars and how likely that they are to gain support from their state legislators policy formulation (after agenda is set, policy can be formulated)
policy adoption (board decides to allow use of cell phones only within certain waiting areas)
policy implementation
policy assessment (to see if the policy is producing favorable outcomes)
policy modification (changes may need to be made to a policy)
Factors that increase cost in healthcare economics?
lack of preventative care
- lifestyle and behaviors
- demographics
- medications
- technology
- shift for profit
- fraud- loss of money
What is the measurement of Health care economics?
Cost-benefit analysis
what is it? lists all costs and benefits that are expected with intervention during a specific time (if total benefits are greater than costs, the interventions have a net positive value)
The nurse applies cost-benefit analysis to the healthcare model. Which costs are the primary concerns of the client? (Select all that apply)
a. total payment for the service
b. out-of-pocket payment
c. suffering and pain
d. actual and direct cost of providing services
e. psychological costs
B. out of pocket payment
C. suffering and pain
E. Psychological costs
clients are interested in their own out-of-pocket payment, as well as the psychological costs, suffering, and pain, which are difficult to quantify yet have long-standing negative effects. The total payment for the service is usually what matters to the payer
What are some barriers to healthcare?
- Insurance- affects the distribution of health care services
- Poverty- people with income below the poverty level have higher mortality rates than middle-income people
- Access to care- the inability to afford supplemental insurance, high out of pocket expenses
- Rationing healthcare- reduces access to care- where care is not provided, public health needs to ensure that essential services are available (assurance)
Medicare is for:
People over 65 years old, permanently disabled or on hemodialysis
PartA- hospital care, home care, skilled nursing facility
Part b-
Medigap
Part D
Medicare Part B covers:
doctors office, diagnostic tests, PT, some equipment, some outpatient services, (must pay for part B)
Medicare Medigap covers:
self pay insurance to covers gap in medicare
Medicare Part D covers:
pays a portion of medication cost (prescription coverage)- a person pays for part D and pays a slight copay at doctor visits
Medicaid provides:
financial assistance to low-income people, blind and disabled families with dependant children
-financed by Federal and State government
Child health insurance program (CHIP)- state insurance for children whose family does not qualify for Medicaid
Problems with Medicaid if you hold Medicaid is:
Inability to find a provider who accepts Medicaid, which limits access to care
High out of pocket expenses
The nurse case manager, who refers a 67-year-old patient to a skilled nursing facility for rehabilitative care, knows that it will be billed under which component of medicare?
a. Medicare part A
b. Medicare part b
c. Medicare part D
d. Medigap
A. Medicare part A
To treat an infected foot, a patient with Medicare Part A has prescribed a 2-week course of IV antibiotics, wound care, and physical therapy for mobility training. The nursing case manager recommends discharge to:
a. a skilled nursing facility
b. an acute care hospital
c. an acute rehabilitation facility
d. home health services
a. a skilled nursing facility
When developing a program offering for patients who are newly diagnosed with diabetes, the nursing case manager demonstrates an understanding of learning styles by?
a. administering pre and post-test assessment
b. allowing attendees time to voice their opinions
c. providing a snack with a low glycemic index
d. utilizing a variety of educational material
d. utilizing a variety of educational materials
What are the steps in a risk assessment that identify risk and its effect?
- Hazard identification–> what is the hazard, or in the air and the hazard is identified as a factor
- Risk description–> what is the risk
- Exposure assessment–> how long were you exposed
- Risk estimation–> epidemiologists will determine the outcome
What are two types of risk factors?
Modifiable (can change)
Non-modifiable (can’t change)
What are examples of modifiable risk factors?
(behavioral risk factors that can be modified) physical inactivity obesity and being overweight high cholesterol smokers alcoholics high blood pressure diabetes type 2 unhealthy diets poor sleep quality metabolic syndrome stress
What are examples of non-modifiable risk factors?
gender
genetics- family history
age
ethnicity
Major causes of non-communicable diseases are?
use of Tabacco excessive use of alcohol poor diet lack of exercise middle or low income *these contribute to heart disease, COPD, diabetes, cancer
Risk factors that affect overall health?
- childhood and maternal undernutrition
- inactivity
- addictive substances
- sexual and reproductive health
- environmental risks–> air pollution
How can nurses play a role in risk factors?
by playing a role in health promotion and education (this will bring awareness) they will need to educate the families (individually or on a societal level)
Which are an example of determinants of health (select all that apply)?
a. living in a community with clean and fluorinated water
b. having a death rate of 500 per 100,00 population
c. living in a neighborhood with a high crime rate
d. smoking two packs of cigarettes day
e. having an infant mortality rate of 95 deaths per 1,000 live births
A, C, D
*determinants of health are factors that affect outcomes of health status, such as physical environment, social environment, health behaviors, and individual health, access to healthcare
Which risk factors are associated with overall health in a community?
a. allergy
b. traumatic injury
c. air pollution
d. down syndrome
c. air pollution
When caring for people from other countries a nurse must be?
be culturally sensitive/culturally relevant and gender-sensitive
How would you improve the attendance of underserved children in a neighborhood where they are not getting immunizations and have not been vaccinated per health guidelines, the clinic is poorly attended, Which would be the nurse’s best action to revise the program and improve attendance in the clinic?
Interview members of the neighborhood to determine why they do not use the clinic
Which model/theory is based on avoidance of disease?
The Health Belief Model
- this is more for the individual than the community
Components of the model
a. what is the perceived susceptibility to a disease
b. what is the perceived seriousness of the disease
c. what are the modifying factors (how do you fit in the model)
d. cues to action
e. perceived benefits/barriers
f. self-efficacy (can I do this - looks at their ability to make a health-related change)
What is the goal of community health nursing?
to improve practice, keep people healthy, keep the cost down, try to keep expenses down
Who came up with the expanded health belief model?
Milio’s framework
- This is more for the public health/community health
- Economic, political, and environmental health determinants
- the range of choices is shaped by government and private policy
- to improve health status choices must be readily available and less costly than health-damaging options
- the range of health-promoting or health-damaging choices available is affected by personal resources
- health deficits result from an imbalance between a population health needs and its health resources
The belief that health deficits results from an imbalance between a population’s health needs and its health-sustaining resources is the premise of which theory?
a. Orem’s self-care deficit theory
b. health belief model
c. Milio’s framework
d. Critical Social theory
c. Milio’s framework
A public health nurse explores a group of teenagers’ beliefs about the seriousness of eating disorders. The nurse is using which theory?
a. Orem’s self-care deficit theory
b. The health belief model
c. Milios framework
d. Critical social theroy
b. the health belief model
examples are:
- people who believe they won’t get the flu don’t get the vaccine
- people who think they are unlikely to get skin cancer are less likely to wear sunscreen or limit sun exposure
- Perceived barriers are related to the social consequences, danger, discomfort, expense, inconvenience
What was the name of the model that promoted a healthy lifestyle?
Pender’s Health Promotion
Purpose–> to promote a healthy lifestyle
Concepts–>
- prior related behaviors
- personal factors
- perceived benefits
- perceived barriers
- perceived self-efficacy (Do they have the motivation)
- interpersonal influences
- commitment (are you committed to this change?)
Skinners learner model does what when a person makes progress?
there will be a reward (positive reinforcement) this will encourage the improvements based on a reward system
Which most accurately describes “rate”?
a. course of a disease
b. primary measurement used to describe either the occurrence or the existence of a specific state of health or illness
c. probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem
d. characteristic or event that has been shown to increase the probability that a specific disease or illness will develop
B. the primary measurement used to describe either the occurrence or the existence of a specific state of health or illness
US department of health and human services (umbrella) oversees?
CDC
FDA
Centers for Medicaid and medicare
agency for healthcare research and quality
NIH
health resources and service administration
What agency overlooks the Legislation and Regulation of Nurses :
Board of Nursing- defines the scope of practice
Grants a license to RN, LPN, and schools of Nursing
Sets educational standards and requirements for license
can deny, suspend or revoke a license
Steps in Public Policy formation?
- define an issue and get it on the agenda
- Ensure commitment of resources
- Establish a schedule for implementation
- Evaluate and analyze the policy
Measures of Morbidity and Mortality :
Rates - a measure of the frequency of a health event in a defined population during a specific time
Incidence - describes the occurrence of new cases of a disease or condition in a community over a period of time relative to the size of the population at risk for that disease or condition during that same period of time
Prevalence- all cases (new or in population) only was to come out of it is when you die, prevalence rates are higher with chronic diseases
ex; type of studies to determine prevalence is cross-sectional studies- they examine the relationships between potential causal factors and disease at a specific time and uses a cross-section of a population
mortality rate - a measure of death rates
Epidemiologic triad
classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment
Web of causation
epediomlogical model that strongly emphasizes the concept of multiple causations while de-emphasizing the role of agents in explaining illness
Which rate measures the number of people in a given population who have influenza at a given point in time?
a. adjusted
b. indidence
c. prevalence
d. specific
c. prevalence
Core Public Health Functions and EBP
- Assessment- involve the community members in identifying health problems and find new solutions to health problems
- Policy development- EBP used to develop policies that support community health efforts
- Assurance- used to monitor health status and to provide health care to high-risk groups in the community, Used to evaluate effectiveness, accessibility, and quality of personnel and services
Quality healthcare has what characteristics?
- Effective- services based on scientific knowledge
- Safe- avoid errors
- Timely- reduce harmful delays
- Client-centred- respond to the individual’s needs
- Equitable- provide quality care to everyone
- Efficient- avoid waste
Community assessment is a critical process for the future because it can:
a. identify the need for a community commission
b. i identify a method to improve the health of at-risk clients
c. provide a means of grant funding for clinics
d. provide a client base for at-risk neighborhoods
B. identify a method to improve the health of at-risk clients
groups, that share common characteristics/ risk-factors that may predispose them to a disease or groups and thier problems that may lead to health problems is called?
aggregates (are in the community)
ex: pregnant teens
HIV clients in a community
*aggregates get together and advocate as a group to help address a public health challenge
The community health nurse explores pedestrian access to all healthcare facilities in the community. Which tool would be most helpful in performing this task?
a. Geographical information systems
b. Functional health patterns
c. Epidemiologic model
d. Developmental model
a. geographical information system
Define what is in the community and what it consists of ?
- Community is a group of people that share at least one common characteristic in their lives who interact with each other and a common solution is to solve a common problem and they have a sense of member belonging
1. geographical community (don’t always interact)–> boundaries and physical location that may predispose population to health problems
2. Aggregates (may interact or not)- groups that share common characteristics/risk factors that may predispose them to a disease they form a group
3. population of the community–> may or may not interact
Physical Status of a community and its effects ?
Biological- vital statistics, incidence and prevalence of disease and death, life expectancy, and risk factors (drug users, smokers, occupational hazards)
Emotional–> consumer satisfaction, crime rates
Social–> communication between community members and community leaders, recreational activities, educational institutions (ex: town meetings, health department)
Community Structure –> what are the services and resources :
- Healthcare facilities in the community–> rehabs, hospitals, clinics (provide WIC, education, and check to see if your baby is getting the right nutrition, this is for low-income women, infants and children)
- Health department (coordinates a heart disease prevention program for the county in which you live, they routinely meet with citizens and have screenings for heart disease risk factors), voluntary agencies–> county or local (red cross, catholic charities, salvation army)
- Demographic –> who is your population and you want to gear your interventions to the right population
- Healthcare personnel–> Drs, nurses, pharmacy, PT, OT, eyes, ears, ENT
Process and Function in communities?
organizations–> formation of community partnerships with community groups, ability to collaborate
Effective communications–> ability to compromise with conflict
Groups–> ability to collaborate in the identification of problems
Participation of groups–> in implementing goals-encourages commitment for successful change
What do you want to see as health outcomes for a healthy community? A healthy community provides–>
- accessible and acceptable health services
- Education
- A safe and crime-free environment
* if a community does not have these that can make it an unhealthy community
- if there are no full size grocery stores then people wont have access to healthy food, if there is crime and assaults it is not safe, if there are no facilities to exercise, people will be unhealthy and if there is no healthcare facilities (the size of the facility matters as well) people wont have access to preventative issues and all have a negative outcome for these people living in the community
What are the types of community assessments?
- windshield assessment–> provides an overview for the community
- Comprehensive data collection
- Needs assessment–> consists of data collection, analysis of problems in the community, planning, implementation and evaluating
* community assessments identify a method to improve the health of at-risk clients
- they can initiate a neighborhood clinic at low or no cost to the community that is struggling to get their children vaccinated (this puts them at risk)
What are some nurse’s roles in community assessment?
a. Teacher–> always educating and teaching people
b. Facilitator–> make referrals to proper care needed for the best outcome
c. Advocate–> to get what you need to accomplish goals
d. Awareness of communities norms, values and beliefs- self-awareness and be culturally sensitive
e. Evaluate and communicate the change- this is what we did and this is why we are doing it
Lewin’s Model of Change
- unfreezing–> unfreeze the status-quo may occur gradually and rapidly (ex: changes in public health in response to COVID 19)
- Changing–> once the community is aware of need for change, change may begin (ex: if 90% of the community is aware, the next is change)
- Refreezing–> this is the stabilization, once the change has occurred, adapting to change
Community planning after the assessment are
- Assessment- should include a review of the literature to support the need for intervention
- PLANNING
plan for each identified problem
-prioritize the problems
-identify measurable goals and objectives (very important)
-determine intervention level
-validate intervention according to available resources - Intervention and Evaluation
-follow the initial plan
-prepare for barriers (unexpected problems) - Evaluation- this is important for obtaining additional funds for programs
-includes the cost-benefit analysis
-were outcomes achieved
-share analysis with participants
Hill burton act (regarding Federal Health Planning)
improved healthcare in rural areas and introduced systematic health care planning. Each state had an agency to plan for needed hospital analysis
what is the knowledge, values, practices, customs, and beliefs of a group and includes a unique meaning and information system, shared by a group?
culture
culture includes language, beliefs (is how they behave), religion, occupation, economics, art, politics, diet (patient says the food is blessed, indicates a cultural belief)
- culture is a learned behavior
- nurses need to be culturally competent
What does cultural competence in a nurse look like?
- needs to value diversity
- acquires cultural knowledge
- adapts to diversity
- be open to the client’s ideas and ways of life
- exhibit respect and patience
- being aware of one’s own cultural heritage (self-awareness) –> this is very important
- utilizing an interpreter when one is needed to effectively communicate with the client
- understanding cultures and how they value personal space
- how are decisions made in their culture (as a family, individual)
- how does their culture value time (some are naturally late for appointments)
- nurses need to educate other staff which indicates cultural competence because they can facilitate social change
Behavior over time is also called a
functional health pattern
Case management goals are:
- ensure access to care
- coordinate services to care
- improve patient functional capacity
- provide alternatives to institutionalism
- provide cost-effective care- prevents duplication and overbilling
- identify high-risk groups that have the potential to improve health by coordinated care
case management serves as a means to achieve:
patient wellness and autonomy through advocacy, communication, educations, identification of service resources, and service facilitation
*achieves positive outcomes through patient education, information, ADVOCACY and EMPOWERMENT (it is motivational)
In client-focused case mangement is the patient the focus of care?
yes
client-focused case management is focused on the patient and family
system-focused case management?
the institution is the focus of allocation of resources and cost attainment
What factors played a part in the creation of home health care?
- development of health insurance
- rising costs in healthcare
- Increase in the medical and nursing specialization
Who primarily regulates the provisions of Medicaid and Medicare (select all that apply)
a. Insurane companies
b. local government
c. State governments
d. Local governments
c, d
Eligibility criteria for medicare for home health services are? (Select all that apply)
a. homebound
b. specific plan of care
c. skilled healthcare needs
d. intermittent care needs
e. continuous 24-hour necessity for care
a. homebound
b. specific plan of care
c. skilled healthcare needs
d. intermittent care refers to situations in which skilled care is needed for several hours during the day, several days during the week, for a specified time period
skilled care
involves the professional abilities of a registered nurse or his/her supervised designee (home health aide)
a necessity in-home health care means
that the service given by a home care agency is reasonable based on the status of the client
how long does Medicare pay for skilled needs for a client in home health care
60 days with appropriate renewals if skilled needs continue to exist
intermittent care
2 hours during the day, 3 days during the week, for 60 days
The standards of home health nursing practice are;
key elements of the nursing process:
1) assessment by collecting data about the home care client (the physical, environment and family)
2) diagnosis through the analysis of this data
3) outcome identification–> that helps the home care nurse identify nurse-sensitive measures
4) planning in the form of nurse-sensitive interventions directed at the identified outcomes (planning and outcomes need to be time-specific)–> usually 60 days
5) Implementation of nurse-(the direct and indirect care)centered actions in collaboration with clients and families, not with physicians
6) Evaluation–> goal is that the client and family have the information needed to become independent in care
From when a physician signs a referral for home health visit, within how many hours from receiving the referral should the nurse plan to make the initial visit to the client?
24 hours
What are the phases of a home health visit?
1) initiating the visit/preparation (pre-visit preparation–> purpose of the visit, referral for visit, contact the client before the visit)
2) Home visit/ the actual visit- assess main identifiers (name, address, DOB, mental health issues)assess the environment for safety and follow national safety goals –> medication safety, patient safety with oxygen, environment safety, educating the patient
3) Documentation–> each nursing note should include patient assessment, tasks performed and teaching accomplished, patients response to intervention, progress towards identified outcomes, and plans for the next visit
4) termination of the visit
5) post-visit planning
Roles of the case manager
Manager- monitors cost and resources and manages the cost of care
Clinician- develops and manages a plan of care for patients
Consultant- works with a multidisciplinary team
Educator- informs staff and patients of changes
Researcher- identifies quality outcomes and cost
Types of Home Health Agencies
Official –> federal, state, county, supported by taxes
Non-profit–> do not pay taxes, Independent home care agencies, hospital-based and voluntary based
Proprietary agencies–> for-profit and pay federal taxes, may be owned by an individual or corporation
Voluntary agencies–> cover gaps in service
OASIS (outcome and assessment information set)
Measures the outcomes of adult home care clients (medicare and Medicaid)
- used for quality improvement
- Used to assess (see below)
- the environment
- use of services
- functional status
- support systems
- sociodemographic information
- health status
What do nurses want to see as the main outcome for our patients after home health care?
that they can care for themself Independently
functional status is restored
they are self-sufficient with their care
Based on Oasis and documentation, what do Medicaid and Medicare use this data for?
determines which agencies are best practice and notices them
What is major in community assessment and planning?
collaboration with others
Goal of Hospice Nursing?
promote comfort
not cure disease
Hospice Nursing notes about it
a. program of care and support for people who have a terminal illness (have to meet criteria- 6 months to live)
b. the focus is on maintaining the quality of each day
c. the CAREGIVER is just as important as the patient
d. a team of professionals provides care for the whole person
e. care is available 24 hours a day
Hospice Benefits
Medicare Part A covers the patient if they are 65+ (age)
- Doctor must certify that an illness is terminal - 6 months or less to live
- Hospice services can be provided where ever a patient resides
- Approved hospice services are:
- MD and nursing services
- medical equipment and supplies
- home hospice aide
- dietary counseling (they will decline in eating over time)
- grief and loss counseling for family
- short-term inpatient care for symptom management
- medication for pain and other symptom control (palliative care)
Hospice team members
Patient and family are at the center of care
- physicians
- nurses and nurse practitioners
- counselors
- social workers
- physical and occupational therapy
- hospice aides
- volunteers
Hospice care includes services that are reasonable and necessary for the comfort and management of a terminal illness What services might be included (select all that apply)?
a. physician services
b. nursing care
c. Long-term in client pain control
d. Hospice aide service
e. Social worker services
a. physician services
b. nursing care
d. Hospice aide service - to help in home and assist caregiver
e. Social worker service
CMO
comfort measures only (example morphine for pain management )
A nurse provides palliative care to a client with end-stage renal disease and a chronic upper respiratory infection. Which interventions should be included in palliative care (select all that apply)?
a. providing the client with a foot massage
b. administering ordered analgesics
c. assisting with a kidney transplantation
d. clearing secretions from the clients airway for easier breathing
e. gently stretching the clients arms and legs to preserve the range of motion
A, B, D, E
palliative care is an interdisciplinary team-based care that is focused on the relief of suffering for clients with serious illness
- nursing interventions that help enhance the quality of clients lives, reduce pain and suffering and optimize functionality, and promote appropriate goal setting and decision making are integral to the excellent palliative care
A dying patient has constipation, what would the nursing intervention be?
Give the patient lactulose, prune juice, senna are preferable for dying clients
T or F
The client or unit of care is the population
T
T or F
The primary obligation in ethical principles in public health nursing is to achieve the greatest good for the greatest number of people or the population as a whole
T
T or F
The processes used by public health include working with the client as an equal partner
T
T or F
primary prevention is the priority in selecting appropriate activities
T
T or F
Public Health Nursing focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive
T
T or F
a public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service
T
T or F
Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of practice
T
T or F
Collaboration with a variety of other professions, populations, organizations, and other stakeholder groups is the most effective way to promote and protect the health of people
T
What are the goals of Health education
- attain optimal health
- prevent health problems
- identify and treat health problems early
- Minimize disability
- Outcome of health education-behavioral changes in the client
What are the 4 learning theories
Humanistic
Cognitive
Social learner theory
Developmental theory
Humanistic theory (group therapy, obesity program, members of a senior citizen program that want to develop health promotion)
good for adults
helps the group decide (work together)
-person needs to be aware of their values
-educator would help the learner develop the program
- helps an individual develop their potential in a self-directed and holistic manner
-Encourage their self-expression (let them speak)
-describe the influence that feelings, emotions, and personal relationships have on behavior
-Maslow’s hierarchy of needs
-nurse helps them facilitate the group discussion and guide the group as they develop their program
Cognitive Theory
- changing thoughts (depressed people-want to increase positive thoughts)
- belief is that by changing thought patterns (maladaptive)and providing information, the learner’s behavior will change
- increase in the person’s knowledge by increasing the person’s ability to think, learn and problem solve
Social learning theory (weight watchers-obesity, substance use disorders)
- good for all
- learning is enhanced through the concept of self-efficacy (can I do this), outcome identification, and incentives
- educator can use this theory to change behaviors by enabling a person to change either their expectations about a value or their ability to achieve the desired outcome
- instructs the group on selecting healthy food and exercise
Development theory (ex: teaching parents about toddler safety)
consider the developmental level of the learner
- learning occurs with the developmental stages from infancy to old age
- readiness to learn depends on each person’s developmental stage
- learning occurs differently in each developmental period
3 Domains of the learner
Cognitive, affective and psychomotor
Cognitive Domain (thinking, neuromuscular involvement, knowledge or mental skills)
- assess cognition first
- knowledge and their ability to recall information
- Comprehension–> can they understand information
- Application–> can they use the information that they learned
- Analysis–> breaks information into smaller parts
- synthesis->put parts back together to understand the total message
Affective Domain (person attitudes or emotions )
learning is focused on changing a person’s attitudes, beliefs, and values
-learner adapts behaviors of a new value system
-people need support to make changes and reinforce new behaviors
(individual support or support groups)
-active participation
-compliance and willingness to respond
The psychomotor domain (skills or physical skills)
this is doing (administering insulin)
- nurse needs to assess a clients intellectual and physical ability to perform a skill
- what is the patient’s ability to fill a syringe (return demonstration)
- need to allow time for the practice of the new skill
Concepts of community organization and education
Empowerment and problem-solving skills
- community competence/achieve goals through collaboration
- encourage active participation of a group
- elicit reasons from the community and have them define learning needs
Characteristics of an effective educator
- send a clear message
- don’t use medical jargon
- select the appropriate learner format
- create the best learning environment -present information from simple to complex
- inform the learner of the objectives
- stimulate recall of previous learning- connect to new knowledge
- elicit and assess performances (make sure they are getting it)
- assist in the transfer of knowledge (help a diabetic to order out food)
- keep in mind their level of cognition and developmental level
- assess their literacy level
Barriers to learning
- Lack of literacy
- assess patients age
- make sure they understand what they are being taught
- assess language get an interpreter if needed
- organize teaching into smaller units
- use visual aids as appropriate (iPad, computer, smartphone)
- assess hearing ability
- assess vision - Motivation- educators role
- educator must motivate and be positive
- praise
- build confidence in the learner
- explain how instructions relate to learners goal
- create positive expectations for success
In the 1900s what was the entity was responsible for covering public health nursing?
the government
Which governmental agency had the goal of health for all by the year 2000 and has stated, “the development of society, rich or poor can be judged by the quality of its population’s health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantages as a result of ill-health”?
World Health Organization
A public health nurse is assessing the community for health needs, health risks, and environmental problems that may affect health. How can the nurse best obtain this data? (Select all that apply.)
a. Survey state and national policy makers
b. Interviews of people in the community
c. Reviewing records from local hospitals
d. Searching public records for health statistics related to the community
e. Conducting a windshield survey of the community environment
a,b,d,e,
Correct Response: Interviews of people in the community, Conducting a windshield survey of the community environment, Survey state and national policy makers, Searching public records for health statistics related to the community
Rationale: In the assessment function, the public health nurse can gather data by interviewing people in the community, conducting surveys, and searching public records for information.
The public health nurse is providing CPR training to day care workers at the local community recreation center. What essential service is the public health nurse providing?
a. Enforce laws and regulations to protect health and ensure safety.
b. Link people to needed health services and assure health care is provided.
c. Inform, educate, and empower people about health issues.
d. Ensure competent public and personal health care workforces.
c
Rationale: Ten essentials of public health include ensuring competent public and personal health care workforces. CPR is a requirement for day care workers who care for and monitor the health of children.
A tornado has destroyed an area of the local community and destroyed the local water plant. The public health nurses in that area mobilize and coordinate care with the hospital, emergency medical services, and the fire department. What core public health function does this action represent?
a. Assessment
b. Personal services
c. Assurance
d. Policy development
d.
Rationale: At the community level, health nurses collaborate with leaders in the preparation of an emergency preparedness plan under the core function of assurance.
A public health nurse is working in the local public health department performing kindergarten screenings and administering immunizations required for school admission. The mother of a client reports reservations about giving her child a vaccination. What is the nurse’s best action?
a. Describe the federal laws governing school children immunizations for school admittance.
b. Provide the mother with information to review on the proposed immunizations for the child.
c. Explain to the mother of the client that immunizations are required by local and state policies.
d. Continue screening of the child and report the refusal to the local school board.
b
Rationale: The state-level government health agencies are responsible for establishing state-wide health policies. The state defines immunization policies for all children entering the public school system. These laws are in place to prevent the spread of communicable diseases. Federal laws pass legislation on federal statutes such as Medicare, Medicaid, and Social Security. Local governments enforce ordinances such as building codes and nuisance ordinances.
The public health nurse has identified obesity as a health problem in the community. Which action taken by the nurse demonstrate the core policy development function of public health at the community level?
a. Attending a school board meeting to present current data
b. Tracking rates of obesity in each of the community schools
c. Formal interviews with the director of school nursing
d. Identifying financial resources for nutrition education programs
a.
Rationale: In the policy development function at the community level, the public health nurse recommends training and raises awareness of the issue by bringing information forward to key policy makers.
Which publicly funded health care program is aimed to assist families with children who are living in poverty?
a. TRICARE
b. Veteran’s Administration
c. Medicare
d. Medicaid
d
Which publicly funded health care program receives funding primarily through the state government?
a. Medicare
b. TRICARE
c. Medicaid
d. Veteran’s Administration
c
Rationale: Medicaid receives funding primarily through the state government. Medicare is federally funded, TRICARE is a program for active duty military and their families, and Veteran’s Administration is a program for veterans and both are federally.
State Children’s Health Insurance Plan (SCHIP) was put into place to provide coverage for children who were ineligible for Medicaid due to poverty requirements but unable to access health care with affordable private insurance.
FALSE
TRUE
true
A pregnant woman is in the public health clinic for her first prenatal visit. She is currently single, living alone in federal housing, unemployed, and does not have any type of health care coverage. What health care program will the nurse identify to the client to apply for health care coverage?
a. Medicare
b. Women, Infants and Children
c. The Children’s Health Insurance Program Medicare
d. Medicaid
d
Rationale: Medicaid is a part of the Social Security Act Amendments of 1965 that provides medical assistance for children, pregnant women or parents with dependent children, and senior and severely disabled persons. Women, Infants and Children is a supplemental nutrition program.
A senior client with Medicare for health care insurance is in the clinic for a checkup of a leg wound that does not seem to be getting better. The health care provider determines the client needs home health services for wound care. The client is concerned about the cost and asks what part of Medicare covers home health services. What would the nurse’s best response be?
a. “Part C”
b. “Part A”
c. “Part C”
d. “Part B”
b
Rationale: Medicare Part A covers in-patient hospitalization, some skilled nursing services, short-term home health, and hospice services to eligible clients. Part B is a supplemental and voluntary medical insurance program paid by the participants. Part C is part of the Medicare policy and allows private insurance companies to provide Medicare benefits. Part D is a prescription benefit plan.
How is Medicare funded by paid taxes?
a. From employee state withholdings
b. Via government subsidies of other programs
c. Through employers and employees equally
d. According to employer tax bracket
c
Rationale: Medicare is funded by payroll taxes employers and employees equally pay into the Social Security system along with the interest earned from trust fund investments.
The federally funded program Medicare provides free health care for what groups of individuals? (Select all that apply.)
a. Eligible seniors over the age of 65
b. Individuals with kidney failure
c. Families at 100% poverty
d. Children under the age of five
e. Legally disabled persons
a,b,e
Rationale: Mandatory federally health insurance program was established in 1965. It provides federally funded health insurance for persons 65 and older who paid into the Social Security system, certain disabled persons and those diagnosed with end-stage renal disease to receive quality health care that would otherwise be unavailable to them.
Which statement best describes policy?
a. Nurses are powerless to determine policies.
b. Policy comprises the actions that are taken to achieve a goal or objective.
c. It is a nurse’s responsibility to adhere to policies.
d. Nurses must support policies.
c
Rationale: Policy is defined as a plan of action or an agenda that outlines steps or actions to implement a stated goal or objective. Policy is also defined as principles that govern an action to achieve a given outcome.
Which of the following is the professional value that leads nurses to advocacy?
a. Self-interest
b. Treating all people exactly the same
c. Promoting needs of one while denying others
d. Social justice
d
Rationale: The guiding values of nursing include social justice and that “nurses should act to change those aspects of society that detract from health and well-being.” Nurses are required to hold the responsibility of upholding the values of their society.
Advocacy is a moral and professional responsibility and a fundamental role of nursing.
FALSE
TRUE
true
A home health nurse is visiting a new client with tuberculosis. The client has refused to take the required medication. What is the nurse’s next best action?
a. Contact the home health agency attorney to determine the specific regulations governing medication compliance in clients with tuberculosis.
b. Call the local police to assist in forcing the medication since it is required by the county and state health codes.
c. Document the medication regimen refusal in the client’s chart and let the client know you will be back to check again tomorrow.
d. Notify the health department director and the health department tuberculosis clinic supervisor the client has refused to take the medication.
a
Rationale: In clients who have active tuberculosis, community health nurse case management is indicated to ensure medication compliance and completion of treatment to prevent the further spread of infection. If a client refuses to comply and is at risk of spreading the infection, then the nurse will need to identify state and local health codes in order to proceed.
A community health nurse is at the local recreation center attending a community meeting where members are expressing concern about an upcoming bill on allowing fracking in their community. The community has requested the nurse assist them in preventing the bill from passing. How can the nurse use advocacy to assist the community with this issue? (Select all that apply.)
a. Write local policy makers regarding the communities’ feelings about the issue.
b. Collaborate with community representatives to develop a form letter to contact policy makers.
c. Develop a policy restricting fracking in community.
d. Research problems associated with fracking in communities and provide examples.
e. Locate advocacy groups against fracking and connect the community members with the group.
a,b,d
Rationale: The community health nurse in the role as advocate performs actions on the behalf of the community they serve. Functions include guiding community members in identifying policy makers and influential people in the community, identifying ways to make healthier environments for communities through research, and collaborating with community members on community health issues
Residents in the community have voiced concerns regarding a local pond. The pond is stagnant and residents report a higher than normal number of mosquitoes in the neighborhood surrounding the pond. What is the best legal or legislative resource the nurse can access to reduce or eliminate this problem?
a. Contact the local health department legal advisor.
b. Email the state attorney for public health.
c. Search the Internet for information on county ordinances.
d. Call local policy makers.
a
Rationale: This issue is a local issue and the local health department would be the best resource to contact in deciding what actions can be taken to reduce or eliminate this potential health risk.
One of the main roles of the public health nurse is advocacy. What is included in the process of advocacy? (Select all that apply.)
a. Contacting payer sources
b. Collecting information
c. Developing action plans
d. Identifying stakeholders
e. taking action
a, c, e
Rationale: Advocacy is a process where the community health nurse is trying to influence outcomes or championing a cause. Advocacy includes identifying the issue, collecting information, identifying influential people, building support, and taking action.
When considering cultural influences, how would the nurse interpret a Chinese patient’s lack of eye contact during a discussion about a newly prescribed medication as a sign of what?
a. Depression
b. Misunderstanding
c. Respect
d. Disinterest
c
Rationale: In many cultures (e.g., Native American, Chinese, Haitian), a younger client meeting the gaze of a clinician is a sign of disrespect. However, in other cultures (e.g., white American or German), eye contact is a necessary sign of respect. A clinician from those cultures might misinterpret lack of eye contact as signifying limited understanding, inattention, depression, or noncompliance.
What is the initial nursing intervention when conducting a cultural assessment regarding the health beliefs and values of a member of a non-white American culture?
a. Gaining insight into the patient’s cultural world view
b. Establishing an accepting environment
c. Arriving at mutually agreed-upon definitions of health beliefs and values
d. Determining the presence of any existing language or communication barriers
b
Rationale: Whatever method is chosen, it is important to create an atmosphere that encourages the client to tell his or her own story, with all its cultural nuances. Although the remaining options are valuable, they are based on an accepting environment between the nurse and the patient.
When considering health views, which statement is the basis for discussions concerning the effect of culture?
a. Cultural world views are responsible for the different beliefs regarding the cause of illness.
b. Cultural world views are seldom concerned with health care issues.
c. The beliefs concerning the causes of illness are shared by most world cultures.
d. Cultures generally share a world view regarding how illness should be treated.
a
Rationale: Different cultural world views tend to reflect different ideas about what causes disease. Beliefs and values are fundamental and differ concerning the origin and treatment of illness as well as the perception of health and wellness.
Culture is defined as the behaviors and beliefs characteristic of particular. (Select all that apply)
a. age group
b. ethnic group (ethnicity)
c. nationality
d. social group
all are correct
*all of these shape the concept of culture
In preparing a health and wellness care plan for the local senior citizen center, the nurse ensures the consideration of the three universal needs. What are the three universal human needs of the community?
a. Safety and security
b. Satisfaction in life transitions
c. Sense of belonging
d. Social relationships
e. Support for decisions
a,c
Rationale: After basic physiological needs are met including air, food, and water, then people work toward safety and security and the need for a sense of belonging.
A community nurse who routinely works in the immunization clinic notes an influx of new patients from Russia. The nurse wants to improve the self-awareness of this new population. What steps can the nurse take to cultivate cultural sensitivity toward this new client population? (Select all that apply.)
a. Provide care to the new population-based on broad cultural values of health.
b. Demonstrate a genuine interest in the lives and culture of the new clients.
c. Interview some of the new members and inquire about cultural values.
d. Acknowledge that differences in culture occur even within a common culture.
e. Perform an Internet search to improve knowledge on the new client population.
b,c
Rationale: There are many ways to improve cultural sensitivity, including interviewing individuals about culture and beliefs, being interested and keeping an open mind, and participating in a cultural event in the community.
While providing in-home wound care, the nurse notes the client is frequently vocal and screams at relatives when in pain. In performing a cultural assessment, in what area would the nurse document the frequent outburst and vocalizations?
a. Cultural identification
b. Communication
c. Biological variations
d. Family dynamics
c
Rationale: Biological variations include physical and biological traits that are unique to culture of a population. This can also include how they perceive pain and express pain.
A new client is scheduled at the clinic. During the assessment, the nurse notes a circular, dark-pink indention on the client’s abdomen. The nurse is aware the client is not from the United States. What is the nurse’s next best action in assessing this client?
a. Apply pressure to the area to determine if it blanches, then proceed with the assessment.
b. Ask the client to describe usual health beliefs and practices when the client becomes sick.
c. Assess the indention and ask the client the origins of the circular mark on the abdomen.
d. Assume the client performs the cultural practice of cupping and ask when the client last did this.
b
Rationale: A person’s practices regarding health are influenced by beliefs about causes and effects of illness. In order to be effective in providing care for persons from different cultures, community nurses must be accepting of others’ cultural practices.
During an intake assessment at the local health department, the nurse asks a Hispanic client where in Mexico they were born. The client becomes angry and reports being were born in Colombia. What is the best action for the nurse to take?
a. Ask the client to provide education on the differences between Hispanics from Mexico versus Colombia.
b. Apologize for the cultural insensitivity and make a mental note to be more careful in the future.
c. Express regret for the assumption and seek a Hispanic nurse to complete the interview process.
d. Explain to the client most of the Hispanic individuals who come to the health department are from Mexico.
b
Rationale: If nurses make a cultural mistake, they should first apologize and admit a limited amount of knowledge, then express a willingness and openness to learn from the mistake.
What is the goal of a community health assessment (CHA)? (Select all that apply).
a. Effective assessment of existing community health problems
b. Associating health need with possible community resource
c. Financing the implementation of the community health interventions
d. Identification of community health resources
e. Prioritization of community-focused health interventions
a,b,d,e
Rationale: The goal of a CHA is to identify the community health problems that are the priorities for intervention as well as community resources available to address each health problem or need. Financing the interventions are not a CHA goal.
Which factor is considered when determining social determinants of health? (Select all that apply.)
a. Childhood experiences
b. Social policies
c. Place of birth
d. Age
e. Employment history
a,c,d,e
Rationale: The circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness are termed the social determinants of health. These circumstances are in turn shaped by the wider context, including economics, social policies, and politics.
What is the source for established national objectives and health outcomes that guide health promotion in the United States?
a. World Health Organization (WHO)
b. The Millennium Development Goals
c. National Prevention Counsel
d. Healthy People 2020
d
Rationale: Healthy People 2020 are national objectives for improved health outcomes that guide the health promotion and disease prevention efforts in the United States. None of the other options has that specific goal.
Which ethical principles affect decision-making? select all that apply
a. fairness
b. equality
c. social justice
d. human rights
all are correct and affect decision making
A community health nurse is working with the nearby American Indian reservation to develop a program to reduce health disparities. What is a known health disparity of the American Indian that the nurse will want to address?
a. Stroke
b. Heart disease
c. Hypertension
d. Diabetes
d
Rationale: American Indian adults have high rates of diabetes (2 times higher than whites), TB (5 times higher), alcoholism (5 times higher), and higher occurrences of other health problems including unintentional injuries, suicide, and homicide.
Which group is more susceptible to health disparities and discrimination in health care systems? (Select all that apply.)
a. Ethnic or racial minorities
b. Individuals in drug treatment programs
c. Unemployed persons
d. Runaway teenagers
e. People who did not finish high school
a, c, d
Rationale: Those at the most risk for health disparities and discrimination in the health care system include the homeless, those who use and abuse drug,s and those who are experiencing financial obstacles
A public health nurse is developing a program based on the goals of the government initiative Healthy People 2020. What is a health indicator the nurse may use as a part of the program? (Select all that apply.)
a. Substance abuse
b. Exercise frequency
c. Technology usage
d. Environmental quality
e. Tobacco usage
a,b,e
Rationale: Healthy People 2020 is an ambitious government health iniative with a specific agenda for improving the health of all Americans. According to its premise, the health of the individual is inseparable from the health of the larger community. The achievement of its goals is determined by measuring and comparing many health indicators, such as weight, activity level, lifestyle choices, and environmental and social factors.
A public health nurse is developing an educational brochure on diabetes for the community clinic. Which group has a higher propensity toward the health disparities of cancer and diabetes?
a. African American
b. Alaskan natives
c. Asian
d. Algerian
a
Rationale: African Americans have a higher mortality rate compared with the white population. Other health problems for blacks include cardiovascular disease, stroke, cancer, diabetes mellitus, and higher rates of infant mortality.
While working in the free clinic, the public health nurse is assessing a migrant farm worker who has an infection of the right hand. The nurse cleans the wound, applies antibiotic cream, and wraps the area to keep it clean. The nurse is conducting an assessment to determine if the client has any contributing factors related to health disparities. Which of these are contributing factors to health disparities? (Select all that apply.)
a. Educational obtainment
b. Part-time employment
c. No means of transportation
d. Language barriers
e. A diagnosis of schizophrenia
c,d,e
Rationale: Access to health care resources, language barriers, and mental health issues are all contributing factors that can directly relate to health disparities. Other factors that positively influence the state of health and being able to maintain health include safe housing, quality education, clean water, food and air, and social support, just to mention a few.
What is the primary goal of health promotion?
a. Developing positive health promotion strategies directed toward individuals and communities
b. Providing health care professionals an opportunity to positively affect human health and well-being
c. Implementing health promotion strategies at all three levels of disease prevention among all humans
d. Affecting positive change to the health and well-being of individuals and communities
d
Rationale: Health promotion’s goal is to change health and well-being. Health promotion implements strategies developed in partnership with health professionals, individuals, and communities that includes all three levels of disease prevention.
What is the data collected through public health surveillance by the U.S. Centers of Disease Control and Prevention (CDC) ultimately used for?
a. Reduction of morbidity and mortality among the population
b. The development of health-related databases
c. Identification of potential health issues presenting in communities
d. Distribution to state and local health agencies
a
Rationale: Data are systematically collected, analyzed, interpreted, and disseminated so that they can be used to develop activities and programs that will reduce morbidity and mortality and improve health. The remaining options are specific foci that bring about the achievement of the goal of improved health.
What is the purpose of an epidemiological predictions and probabilities in relationship to health promotion?
a. Epidemiology relies heavily on predictions and probabilities in its scientific approach to wellness.
b. They determine the focus of health promotion strategies.
c. The need for health promotion has created the need for such data.
d. Predictions and probabilities are used to evaluate the effectiveness of health promotion strategies
b
Rationale: Analysis of epidemiologic data allows for the development of predications based on the statistical conclusions (probabilities). These are the basis for determining the possibility of getting a disease or becoming physically or emotionally challenged. It is this possibility that directs health promotion strategy development. Health promotion did not create the need for these forms of information nor are they used to evaluate health promotion strategies.
Health promotion and disease prevention are both focused on which level of intervention?
a. Secondary
b. Multi-level
c. Tertiary
d. Primary
d
Rationale: Health promotion and disease prevention are both focused on primary intervention
What is the role of the community health nurse? (Select all that apply.)
a. Administration of medications
b. Sterile dressing changes
c. Community-based health education
d. Provision of direct client care
e. Providing health promotion interventions
c,e
Rationale: Community health nurses provide both health promotion interventions and community-based health education. Teaching has been a critical part of the community health nurse’s role since the origins of the profession, and it frequently is the primary role or function.
What areas is health promotion focused on? (Select all that apply.)
a. Developing nursing interventions directed towards people’s resources to maintain well-being
b. Maintaining or improving health of families and communities
c. Reducing risks to health and controlling major causes of disease
d. Studying the causes and effects of disease
e. Assisting with discharge from acute care settings
a,b
Rationale: Health promotion has two components: 1) maintaining or improving the health of families and communities, and 2) developing nursing interventions directed toward people’s resources to maintain and enhance their well-being.
The desired outcome of health education is that the learner:
a. suggests alternatives to the nurse’s health promotion strategy.
b. demonstrates permanent behavioral change.
c. recites the nurse’s words verbatim.
d. passes a written examination.
b
Rationale: The goal of health education is for the learner to assimilate new information that promotes a permanent change in behavior. The other options lack evidence of behavioral change as a result of health education.
Which statement is true about the community health nurse?
a. Serves as the health expert in the community.
b. Focuses solely on disease prevention in the community.
c. Delegates the task of health promotion to community leaders.
d. Facilitates members of the community to take control of their health.
d
Rationale: The community nurse is not the “expert” but a facilitator, helping community members take responsibility for their health. The nurse will focus on both health promotion and disease prevention and the primary level of prevention.
When considering health literacy associated with health risks, what is the public health nurse’s primary concern?
a. Whether the individual or the community needs additional motivation to implement the change
b. Whether the individual or the community choices to implement or ignore the need for change
c. How expensive the implementation of the needed behavioral change will be
d. How beneficial the individual or the community views the change
b
Rationale: Most importantly, nurses in public health practice can observe whether members choose to apply risk information to their lives or ignore it. The other options represent considerations that can affect the process of change.
Considering health literacy, what intervention will the nurse implement when providing a patient education on a newly prescribed medication?
a. Supplementing the discussion with written material that patient can keep
b. Providing information regarding the condition the medication is prescribed for
c. Arranging for the family to share in the educational discussion
d. Asking the patient to summarize the information that was provided
d
Rationale: Health literacy is dependent on the patient being able to understand the information provided. A summary by the patient is an excellent way of evaluating understanding. Although the other options support learning, they are not as directly focused on understanding.
Which intervention will provide the nurse with the best understanding of a family’s health risks?
a. Assessing how the family and its member go about coping with health risks
b. Asking individual family members to define “health risk” in their own words
c. Engaging the family members in a discussion about health risks
d. Conducting a family-focused health literacy assessment
d
Rationale: The health assessment will be the best means of identifying potential health issues
What is included in health literacy? (Select all that apply.)
a. Musical literacy
b. Reading skills
c. Cultural literacy
d. Layman’s literacy
e. Scientific literacy
b,c,e
Rationale: According to the Centers for Disease Control, health literacy is a person’s ability to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Reading skills, cultural literacy, and scientific literacy each contribute to health literacy.
What is true of clients with low health literacy?
a. They are less likely to use emergency department services.
b. They are more likely to be hospitalized.
c. They are more likely to participate in health screenings.
d. They are less likely to report being in poor health.
b
Rationale: When health literacy is low or limited, a client’s health status and health outcomes are negatively impacted. As a result, clients with low health literacy are more likely to be hospitalized.
When working with a patient who is attempting to change a health-related behavior, what will the nurse reinforce? (Select all that apply.)
a. The patient’s ability to make the change
b. The need for the actual change in behavior
c. The amount of time it will take to make the change in behavior
d. The health-related benefits of changing the behavior
e. Problem-solving techniques needed to achieve the change
a,b,d,e,
Rationale: The learning model is a behavior change model emphasizing reinforcement of social competence, problem-solving, autonomy, and sense of purpose. Setting a time table is not typically a focus
What is the role of the nurse when using the adult learning model to bring about a change in a patient’s health behaviors?
a. Assessment of the patient’s understanding of the importance of the goal
b. Reinforcement of the goal as the change is being made
c. Determine the patient’s readiness to make the change
d. Role modeling for the patient as the behavior is being changed
b
Rationale: When considering the adult learning model, a goal is established and reinforced by the nurse, with rewards given for partial accomplishment, if necessary. Although the other options may be considered nursing responsibilities, they are not associated with the adult learning model in the change of behaviors.
The nurse wants to conduct an assessment that will protect the anonymity of the participants. What is the best tool to use?
a. Survey
b. Task force
c. Interview
d. Open forum
a
Rationale: A survey is similar to an interview in that it asks questions. However, instead of being conducted verbally, it is filled out online or on paper. This can be an advantage as it allows respondents to remain anonymous.
The nurse is considering a client’s readiness to learn. Which are considered cognitive factors? (Select all that apply.)
a. Age
b. Occupation
c. Motivation
d. Gender
e. Reading ability
c,e
Rationale: Motivation and reading ability are cognitive factors. Age and gender are physiological factors, and occupation is a psychosocial factor.
The nurse is planning to conduct a needs assessment. What methods might the nurse employ to make an assessment? (Select all that apply.)
a. Holding a closed forum
b. Making observations
c. Organizing a task force
d. Conducting a survey
e. Reviewing published literature
c,d,e
Rationale: Conducting a survey, organizing a task force, and reviewing published literature are all reliable assessment methods. An open forum, rather than a closed forum, is another assessment tool that allows group members to hear each other’s concerns, as well as to voice their own concerns or answers.
The nurse is considering the qualities of effective adult learners. What qualities are most common among this group? (Select all that apply.)
a. Family-focused
b. Practical
c. Goal-oriented
d. Self-directed
e. Fiscally conscious
b,c,d
Rationale: Adult learners are generally self-directed, goal-oriented, and practical. They bring prior knowledge to the learning sessions, and want to understand how the new information is relevant to their situation or needs
The nurse is considering the psychosocial factors that could affect a client’s readiness to learn. Which factors fit this category? (Select all that apply).
a. Family
b. Support person
c. Home
d. Gender
e. Occupation
a,b,e
Rationale: The client’s family, occupation, and support persons are psychosocial factors that influence the client’s readiness to learn. The client’s home is an environmental factor, and the client’s gender is a physiological factor.
Which factor contributes to the possibility of relapse back into a negative health behavior? (Select all that apply.)
a. Being in the early stages of change
b. Experiencing a poor support system
c. Being depressed
d. Lacking effective coping skills
e. Dealing with a high degree of personal stress
c,c,d,e
Rationale: Relapse often occurs because of (1) negative emotional states; (2) lack of, or limited, coping skills; (3) decreased motivation; (4) stress; and (5) high-risk experiences. Being in the early stages of change is not considered a relapse factor.
When considering social learning theory, what patient-focused issue is considered most important for a person considering a change in a health-related behavior?
a. How difficult it is to make the change
b. Ability to make the change
c. The impact the change will have on health
d. Support of family and friends
b
Rationale: Most importantly, a person must believe in his or her capability to perform the behavior (self-efficacy). Although the other options have impact of the change process, little is achievable is the patient lacks self-confidence.
The nurse wants to use the domains of effective teaching to help organize a teaching plan. What domains should the nurse consider? (Select all that apply.)
a. Cognitive
b. Psychomotor
c. Affective
d. Spatial
e. Physical
a,b,c
Rationale: Learning occurs in three areas or domains: cognitive, affective, and psychomotor. The cognitive domain deals with intellectual development, the affective domain deals with values, emotions and beliefs, and the psychomotor domain deals with the actual performance of a new skill.
What is the most important role of the community health nurse?
a. Surrogate
b. Advocate
c. Leader
d. Educator
d
Rationale: The most important role of the community/public health nurse is that of a health educator. The nurse engages and inspires learners to effect change in their lives and move toward better health.
How can the nurse create an environment that is conducive to learning? (Select all that apply.)
a. promotes free expression.
b. Assert authority and discipline.
c. Ensure that the environment is not too comfortable.
d. Create an atmosphere of helpfulness.
a, d
Rationale: The best way to create an environment that is conducive to learning is to make the environment physically comfortable, and instill an atmosphere of helpfulness, trust, and respect that promotes free expression.
What principles can the nurse apply to maximize the teaching-learning process? (Select all that apply.)
a. Limit the use of practical application.
b. Adapt teaching to the client readiness level.
c. Discourage interaction among learners
d. Determine client attitudes toward the subject matter.
e. Make subject matter relevant to the client’s interests.
b,d,e
Rationale: Determining the attitudes of clients to the subject matter, adapting teaching to the clients’ level of readiness, and making the subject matter relevant to the clients’ interests are helpful for the health teaching setting. Practical application should also be incorporated, and interaction among learners should be encouraged.
The nurse is asked why it is important to teach psychomotor skills. What statement is the best answer?
a. “Psychomotor skills take more time to teach and it is good use of class time.”
b. “Cognitive skills are reinforced with psychomotor skills.”
c. “It is easier to teach psychomotor skills versus cognitive skills.”
d. “Most health topics involve some sort of “self-care” that the learner will need to do be able to do following the class.”
d
Rationale: Teaching psychomotor skills will make the learner more successful after the class ends. Examples include changing diet and exercise, giving injections, and conducting self-exams.
The Learning Model is a behavior change model emphasizing reinforcement of social competence, problem solving, autonomy, and sense of purpose.
FALSE
TRUE
true
Rationale: The Learning Model is a behavior change model emphasizing reinforcement of social competence, problem solving, autonomy, and sense of purpose.
Secondary prevention is maximizing health and wellness through strategies that are set in place before illness or injury is present.
FALSE
TRUE
false
Rationale: Primary prevention is maximizing health and wellness through strategies that are set in place before illness or injury is present. Secondary prevention is maximizing health and wellness through strategies that are set in place at the early and active chronic stages of pathogenesis of illness and injury.
Social learning is a client-centered communication style for eliciting behavior change by helping clients and groups explore and resolve ambivalence.
FALSE
TRUE
false
Rationale: Motivational interviewing is a client-centered communication style for eliciting behavior change by helping clients and groups explore and resolve ambivalence. Social learning is a behavior change model that considers environmental influences, personal factors, and behavior as key components to change.
Which nursing model for behavioral change addresses pre-contemplation, contemplation, preparation, action, and maintenance?
a. Social cognitive
b. Transtheoretical
c. Revised health promotion
d. Health belief
b
Which benefits of making exercise a habit could be described as “health promotion”? (Select all that apply.)
a. Improves cognitive function
b. Improves strength and balance
c. Reduces the risk of lung cancer
d. Increases longevity
e. Reduces the risk of colon cancer
a,b,d
Rationale: All of these benefits could be described as “health promotion,” except for reduction of cancer. The benefit of reducing cancer is more aptly described as a form of “disease prevention.”
What type of disease is the most common, costly, and preventable?
a. Chronic
b. Sexually transmitted
c. Infectious
d. Acute
a
Rationale: Chronic conditions are the most common, costly, and preventable. Tobacco and alcohol use, insufficient exercise, and poor eating habits are responsible for much of the illness, disability, and premature death related to chronic disease.
What factors does the Health-Belief Model specify that health-related behavior depends on? (Select all that apply.)
a. Perceived seriousness of illness
b. Perceived susceptibility to illness
c. Interpersonal influences
d. Benefits of taking action.
e. Situational influences
a,b,d
Rationale: The Health-Belief Model is a behavior change model useful for individual, family, or community health-related behavior. Community health nurses use this model to assess individuals and communities regarding their “health beliefs” prior to planning interventions. Interpersonal and situational influences are aspects of the Pender Health-Promotion Model.
Which is a strategy the nurse can use for improving wellness in a community?
a. Enacting personal barriers
b. Encouraging dependency
c. Ensuring the status quo
d. Enhancing awareness
d
Rationale: The public health nurse provides awareness through outreach and education in the community. While it’s easy to wish people had healthy behaviors, they will not change if they lack awareness of such behaviors
1.assessment
systemic data collection about a population including monitoring the population’s health status and provide/disseminating info about the health of community
- policy development
create policies that support health of the population through leadership and research
- assurance
making sure that essential community-oriented health services are available
examples of population
- people in the same neighborhood
- people on a sports team
- nursing students
- sorority
what a population focus is in PH nursing?
diagnoses, interventions and treatments are carried out for population
what is the primary goal of a community assessment?
identify the health needs of a community
factors that influence health status across life cycle
determinants of health
what are the 3 components on the intervention wheel?
- population-based
- 3 practice levels
- 17 interventions
Which of the 17 interventions is often seen as a precursor to policy development? A. Advocacy B. Counseling C. Case finding D. Health teaching
A
measures the proportion of the population affected by a specific condition in a specific time period
prevalence
Example: all students with the flu during fall 2016
prevalence: measure of all individuals affected by the disease at a particular time
what are the steps in environmental assessment?
Use your observational skills (e.g., windshield surveys);
interview community members, your individual clients and the families of your clients.
Review Web-based data on existing exposures, such as air and water pollution monitoring data, drinking water testing, and contaminated soil.
what are the 3 domains of learning?
- cognitive - thinking
- affective - feeling
- psychomotor - acting
Public Health 3 components
assessment (needs)
assurance (resources)
policy (intervention)
population versus aggregate
Population- group of people with common personal or environmental characteristics
ALL elders in a community
Aggregate- subgroup of people within a population
PREGNANT teenagers within a school district
Determinants of health
biology behavior social environment physical environment (what is experienced by the senses) policies and interventions
Milio’s framework for prevention (1976) provides a complement to the HBM
and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level
5 A’s of Health Care Access
availability, accessibility, affordability, acceptability, and accommodation
PHN independent and responsible for actions - respects community and individual right to self-determination; maintain privacy, honesty, and fidelity
Autonomy
Health Promotion Model (Pender)
actions to improve health using the following drivers-individual characteristics and experiences, behaviors, behavioral outcomes, health promotion, activities involve removing internal and external barriers and promoting public policy to remove barriers
type of model
USDHHS
principle government agency that protects the health of our country; under its umbrella are: CMS, CDC, NIH, FDA, SAMHSA
THE MISSION OF PUBLIC HEALTH IS
SOCIAL JUSTICE
ENTITLES ALL PEOPLE TO BASIC NECESSITIES SUCH AS ADEQUATE INCOME AND HEALTH PROTECTION AND ACCEPTS COLLECTIVE BURDENS TO MAKE THIS POSSIBLE
CONFLICTS WITH MARKET JUSTICE: ENTITLES PEOPLE TO WHAT THEY HAVE GAINED THROUGH INDIVIDUAL EFFORTS
DEFINE HEALTH
A STATE OF COMPLETE WELL-BEING, PHYSICAL, SOCIAL, AND MENTAL, AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY (WHO, 1958)
TH EXTENT TO WHICH AN INDIVIDUAL OR GROUP IS ABLE, ON THE ONE HAND, TO REALIZE ASPIRATIONS AN SATISFY NEEDS; AND ON THE OTHER HAND, TO CHANGE OR COPE WITH THE ENVIRONMENT.
- A RESOURCE FOR EVERYDAY LIFE
- NOT AN OBJECTIVE OF LIVING
