Exam 1 - Review Questions Flashcards
The population that best represents the differential vulnerability hypothesis is a group of:
Children with a family history of sickle cell disease and hypertension. Homeless pregnant teens in a substance abuse program. Native Americans at risk for diabetes. Overweight children.
Homeless pregnant teens in a substance abuse program. Correct
The differential vulnerability hypothesis states that vulnerable population groups are those that are not only particularly sensitive to risk factors but also have multiple cumulative risk factors. Being at risk for a certain health problem is necessary for the development of that problem, but it is not sufficient. The individual must also possess other characteristics that increase his or her vulnerability before the health problem actually develops. The combination of particular sensitivity to risks and the presence of cumulative causal factors may explain the increased vulnerability of certain populations.
In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to:
Assure access to health care for elderly Americans. Build hospitals to care for the medically indigent. Insure children without health insurance. Provide supplementary income for citizens with disabilities.
Insure children without health insurance. Correct
Title XXI of the Social Security Act, passed in 1998, established the State Children’s Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.
Vulnerability is multidimensional, and one of the primary contributors to vulnerability is:
Gender. Race and ethnicity. Resource limitations. Urban or rural residency.
Resource limitations. Correct
Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual’s ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.
A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely:
Educate about self-care and the women's rights as employees. Establish a partnership with a community to initiate a community health center. Help identify new cases and ensure that clients receive proper treatment. Teach how to lobby state legislators.
Educate about self-care and the women’s rights as employees. Correct
Helping clients understand their rights to protection from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.
After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family’s children may qualify for enrollment in the state children’s health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations?
Carrying out primary prevention. Setting family-centered, culturally sensitive goals. Trying to minimize the "hassle factor." Using the MAP-IT approach.
Trying to minimize the “hassle factor.” Correct
Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with non-restrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the “hassle factor.”
A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as:
Advocacy. Empowerment. Partnership. Social justice.
Advocacy. Correct
The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients’ preferences are accommodated.
Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual’s or group’s:
Cycle of dependency. Health literacy. Level of income. Race and ethnicity.
Health literacy. Correct
A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client’s ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.
Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as:
Frail older adults. Low-income families with newborns. Poor clients discharged from acute care. Clients requiring intravenous antibiotics.
Frail older adults. Correct
One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act’s more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.
An unemployed individual with AIDS develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to:
Barriers to access. Cascade effects. Cumulative risk. Socially based inequity.
Cascade effects. Correct
Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contribute to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.
ulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics (select all that apply)?
Better access to health care services but poor health outcomes. Greater likelihood of exposure to risk factors. Multiple risk factors but equal health outcomes. Worse health outcomes.
Greater likelihood of exposure to risk factors.Correct
Worse health outcomes.Correct
Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, <i>risk</i> is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.
One challenge in working with families for healthy outcomes when a following capacity-building practice model occurs when the nurse steps aside in:
Defining the problem. Designing family interventions. Evaluating the plan. Pre-encountering data collection.
Designing family interventions. Correct
In a capacity-building model of practice, nurses assume the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates actions for and with the family. When designing family interventions, nurses will be challenged to help families identify the primary problem confronting them (prioritizing) and stepping aside; accepting the family’s priorities as they work in partnership with the family to keep their interventions simple, specific, timely, and realistic.
When the community health nurse displays pertinent family information in a family tree format, the family can see the family structure, its members and their relationships over at least three generations and provides a visual source for planning family interventions. This approach also assists the nurse in making clinical judgments relevant to family structure and history. This type of family assessment instrument is referred to as:
Ecomap. Genogram. Family developmental task. Family diagnosis.
Genogram. Correct
The last step of Outcome-Present State-Testing is reflection. Reflection involves an examination of the current case and its clusters of evidence, keystone issues, outcomes, and interventions. This allows the nurse to store the details of this case in the nurse’s mental file and engage in self-judgment. By viewing the “whole picture” from outside the action, the nurse can identify increased options for future interventions. This purposeful and deliberate reflection fosters learning and is the critical thinking aspect that paves the way for the nurse to move from novice to expert practitioner.
One major challenge in the development of social policies that affect families is related to:
Absence of any federal family policies. Indirect negative effects on families. Attempts at welfare reform. Ongoing debate as to what constitutes a family.
Ongoing debate as to what constitutes a family. Correct
The challenges of social policy for families are numerous. Given the ongoing debate as to what constitutes a family, social policy may specify a definition that is inconsistent with the family’s own definition, such as same-sex partnerships and/or marriage, legal definition of a parent, reproductive and fertility issue (surrogacy rights), care of older adults, health care proxy, teen request for confidential services.
A nurse is evaluating the outcome of a family with children’s action plan to address the incorporation of caregiving needs of the paternal grandfather. Although evaluation includes many tasks, the critical thinking process includes (select all that apply):
Conducting a summative evaluation meeting. Determining the timeliness of the plan outcome. Identifying changes in the family story. Identifying nurse-related barriers. Making the transition of nurse to family dependence.
Determining the timeliness of the plan outcome.Correct
Identifying changes in the family story.Correct
Identifying nurse-related barriers.Correct
Termination, transition, and summative evaluation are tasks of the evaluation process; however, the critical thinking process of evaluation must address whether the plan worked, was it timely, does it need to be revised, whether family barriers or nurse-related barriers existed that interfered with the plan, or figure out if the family story changed. Family barriers include family apathy and indecision. Nurse-related barriers include nurse imposed ideas; negative labeling; overlooking family strengths; and neglecting cultural or gender implications.
The nurse working with the family of a child recently diagnosed with juvenile diabetic asks the parents about any changes in their relationship since the child’s diagnosis. This family nursing approach can best be described as treating the family as a:
Client. Component of society. Context. System.
System. Correct
When the family is approached as a system, the focus is on the family unit and the family is viewed as an integrated system in which the whole is more than the sum of its parts. The interactions among family members become the target for nursing interventions. The systems approach always assumes that when something happens to one family member, the other members of the family system are affected, and vice versa. This includes interactions among parents and children as well as interactions between parents.
Two of the most significant barriers to practicing family nursing are the narrow definition of family used by health care professionals and social policy makers and:
Lack of consensus on what constitutes a healthy family. Medical and nursing diagnosis systems. Nursing's historical ties with the medical model. Lack of exposure of practicing nurses to family concepts.
Lack of consensus on what constitutes a healthy family. Correct
Family nursing is practiced in all settings. Family nursing consists of nurses and families working together to improve the success of the family and its members in adapting to normative and situational transitions and responding to health and illness. The diverse and changing definitions of “family” present a challenge to society’s notion of what constitutes healthy families. Healthy and vital families are essential to the world’s future, because families serve as the basic social unit of society.
When applying the bioecological systems theory to families, a major assumption of this model is
Families experience disequilibrium when they transition from one stage to another stage. Focusing on the interaction of the system with other systems rather than the individual. Maintaining stability through adaptation to internal and external stressors. What happens outside the family is as equally important as what happens inside the family.
What happens outside the family is as equally important as what happens inside the family. Correct
The bioecological systems theory of Bronfenbrenner (1972, 1979, 1997) is designed around the principles of nature and nurture and those principles can be applied to families. The family is at the center of the concentric circles representing microsystems, mesosystems, exosystems, macrosystems, and chronosystems. One assumption of this model is that what happens outside the family is equally as important as what happens inside the family, providing a more holistic view of interactions between family and society but not addressing how families cope or adapt to the interactions with these systems. The other statements apply to family development/lifecycle theory and family systems theory.
A community health nurse is working with a single parent with a special needs child and a child with asthma. The maternal grandmother lives with the family and was recently diagnosed with diabetes. The nurse understands the importance of including the grandmother in her assessment and interventions because families are:
Resistant to outside intervention or involvement. Involved in the health care of their members. Unable to manage the stress of complex health needs. Restricted in their ability to identify interventions.
Involved in the health care of their members. Correct
Health care decisions are made within the family, the basic social unit of society. Families are involved in the health care of their members and therefore are significant participants in the health care team, because they are an ever-present force over the lifetime of care.
More than 50% of divorced people remarry, and for middle-aged families this results in more blended families This trend has increased challenges for these families in the area of:
Childcare. Family size. Family stability. Financial survival.
Childcare. Correct
Remarried middle-aged couples with families are often creating more complex blended families that create family challenges for childcare (custody arrangements, visitation rights). However on the positive side, remarriages contracted by adults older than 40 years of age may be more stable than first marriages. Nurses need to keep up to date on demographic trends pertaining to families in order to identify high-risk populations and plan for the implication of such trends on community service needs.
Family health can be defined as a dynamic relative state of well-being that involves the biological, psychological, sociological, cultural, and spiritual aspects of the family system. This approach to family health is consistent with which of the following principles (select all that apply)?
Assessment of the individual's health does not reveal the overall family system's health. Family functioning affects the health of individuals. Family system assessment specifically addresses the individual's health. The individual's health affects the family's functioning. Individual family members and the family system as a whole are assessed simultaneously.
amily functioning affects the health of individuals.Correct
he individual’s health affects the family’s functioning.Correct
Individual family members and the family system as a whole are assessed simultaneously.Correct
The biological/psychological/sociological/spiritual approach to family health considers individual members as well as the family unit as a whole. An individual’s health (along a wellness-illness continuum) affects the functioning of the entire family, and, in turn, the family’s functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.
In nursing centers, research questions emerge from the essential organizational practice of:
Academic affiliation. Creation of educational opportunities. Program evaluation. Strategic planning.
Program evaluation. Correct
Program evaluation, a systematic approach to improving and accounting for public health and primary care actions, is an essential organizational practice in nursing centers. Evaluation is thoroughly integrated into routine program operations; drives community-focused strategies; allows for process improvements; and identifies the need for additional services. Program evaluation separates what is working from what is not working and enables clinicians, faculty, and students to ask different questions and deal with pressing challenges. Therefore, research questions emerge from program evaluation.
When a business plan for a nursing center is being developed, the essential elements to include are a forecast for minimum startup funding, projected income for 1 to 3 years out, and:
Breakeven analysis. Community assessment. Feasibility study. Managed care contracts.
Breakeven analysis. Correct
The business plan provides information that forecasts the minimum funding necessary to create a nursing center and projects income 1 to 3 years from inception. A breakeven analysis is essential. The business plan must be modified in accordance with changing managed care reimbursement in a particular locale, as well as the state’s reimbursement parameters for nurse practitioners.
The health and wellness center is a type of nursing center that focuses on:
Health-promotion, disease-prevention, and disease-management programs. Programs affiliated with major for-profit health corporations. Programs for special populations and specific health conditions. Public health programs.
Health-promotion, disease-prevention, and disease-management programs. Correct
The health and wellness center is specific type of nursing center service model. The focus of the health and wellness center is health promotion, disease prevention, and disease management programs. The centers are generally supported by service contracts and public health departments, grants, fees for services, voluntary contributions, and shared resources from affiliated organizations. They may provide such services as outreach, public awareness programs, health education, immunizations, family assessment and screening, home visiting, social support, and enabling services. They complement existing primary care services.
Effective quality improvement programs for nursing centers should choose quality indicators that are priority indicators and measures for nursing centers and later add other measures after careful consideration. The best examples of priority indicators for nursing centers are:
Billing data, client account data, and provider productivity data. Epidemiologic data, billing data, and client satisfaction and utilization data. Demographic and disease-tracking data for the specific subpopulations being served. Data on prevention, utilization, client satisfaction, and functional status.
Data on prevention, utilization, client satisfaction, and functional status. Correct
Evidence-based practice is the clinical application of particular interventions and documentation of client and population outcome data. Mechanisms for collecting and analyzing the findings (evidence) and timelines for sharing the evidence in appropriate forums need to be in place. Quality indicators and related performance measures are priority indicators in any type of nursing center, because these data will be presented to the nursing center’s board, funders, and the community at large and document the center’s contributions to the health and welfare of the community. Center staff must carefully consider and determine what outcome measures and quality indicators are worthy and have meaning for the community and health care system. It is prudent to begin with particular indicators and measures and incrementally add more. The Quality Task Force of the National Nursing Centers Consortium has developed guidelines for quality management for nursing centers that include standards for community nursing centers. Use of these standards and selected indicators and associated processes will enable a nursing center to document evidence-based practice in contributing to the health and welfare of the community. Examples of quality indicators for nursing centers include measures of prevention, utilization, client satisfaction, and functional status.
To identify the strengths and limitations of an organization and the community, and their capacity to support the establishment of a nursing center and maintain its viability, which of the following should be completed?
Business plan Community assessment Feasibility study Strategic plan
Feasibility study Correct
A feasibility study reveals the strengths and limitations of a given organization and community, and examines their ability to support the establishment of a nursing center and maintain its viability. Performing a feasibility study requires interviewing key individuals, conducting surveys and other data collection, and organizing focus groups and community forums. Epidemiologic, environmental, and other community assessments and data from public health agencies should be considered. The study should also take into account legal and regulatory policies. The overall process supports the emergence of business plans, strategic plans, and timelines.
A comprehensive primary health care center housed on the campus of the local high school in a predominately urban African-American community provides 24-hour/5-day-a-week access to physical and behavioral health care services for community residents of all ages. The center is measuring outcomes related to the use of services; immunization rates; use of alcohol, tobacco, and other drugs; weight; functionality; and responsible sexual behavior. These indices best identify a systematic approach to:
Achieving Healthy People 2020 objectives. Addressing the World Health Organization (WHO) common nursing research agenda. Achieving designation as a federally qualified health center. Qualifying for insurance reimbursement as a safety net provider.
Achieving Healthy People 2020 objectives. Correct
The Healthy People initiative has framed the nation’s health promotion and disease prevention agenda since 1980. Healthy People 2020 goals are to increase quality and years of healthy life and to eliminate health disparities, and these goals take into consideration demographic changes in the nation, with its more racially and culturally diverse and older population; escalating global influences on personal and national health status; and anticipated changes in the health care system. Healthy People 2020 is a systematic approach to improving the health status of the nation. The health indices noted above are part of the leading health indicators that pertain to nursing centers.
A community-oriented nurse has noted that pediatric clients diagnosed with HIV/AIDS do not have ready access to services that focus on the specific needs of this population. The nurse begins working with community stakeholders to develop a nursing center. The most appropriate model to consider for this nursing center would be:
Comprehensive primary care center. Federally qualified health center. Health and wellness center. Special care center.
Special care center. Correct
Nursing centers that focus on a particular demographic group or those with special health needs are special care centers. Services are responsive to the characteristics and needs of a particular group and provide specialized health knowledge and skills to the population. These centers are adjuncts to comprehensive primary care centers and may focus on the needs of populations such as those with diabetes or HIV/AIDS, adolescent mothers, the frail elderly, or people with cancer.
The nursing center director, in collaboration with key stakeholders, is identifying a research agenda for the nursing center. The research agenda incorporates World Health Organization (WHO) priorities for a common nursing research agenda, so it will include, at a minimum, which of the following (select all that apply)?
Cost analysis and documentation of cost-effectiveness. Demonstration of effective interventions that produce appropriate outcomes. Description of nursing interventions and linkages with consumer needs and resources. Identification and clarification of client needs, particularly those not engaged. Welfare-to-work transitions that influence access and use patterns.
Cost analysis and documentation of cost-effectiveness.Correct
Demonstration of effective interventions that produce appropriate outcomes.Correct
Description of nursing interventions and linkages with consumer needs and resources.Correct
Identification and clarification of client needs, particularly those not engaged.Correct
A research agenda is needed by every nursing center. The WHO has set priorities for a common nursing research agenda that include identification and clarification of client needs, particularly those not engaged; description of nursing interventions and linkages with consumer needs and resources; demonstration of effective interventions that produce appropriate outcomes; and cost analysis and documentation of cost-effectiveness. However, more than descriptive studies are needed. For instance, the psychosocial aspects of nursing practice are important. These include nurses’ ability to listen to, support, and interpret information to clients; client perception of the perceived value of nursing center services; accessibility, acceptability, and affordability of services; and environmental conditions that influence health care access and use patterns, such as transportation, criminal activities, and welfare-to-work transitions.
One of the most significant challenges and threats to the survival of nursing centers is:
Consumers' perception that nurses are less desirable health care providers. Decreased numbers of advanced practice nurses available to work in nursing centers. Increased numbers of uninsured and nurses' ineligibility for insurance reimbursement. Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events.
Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events. Correct
Threats to the survival of nursing centers include the economics of the marketplace, such as increased numbers of uninsured, decreased availability of funding, and declining nursing workforce. There are increasing numbers of trained advanced practice nurses every year. Evidence-based analysis has shown that consumer satisfaction with nursing centers is high and nursing centers improve health outcomes. Although nursing centers represent a distinctive and innovative approach to the delivery of health care services, there will be an ongoing need for nursing centers to address policy and political issues that influence this model of health care, such as any existing insurance or program participation barriers, the public’s increasing disenchantment with managed care, double-digit increases in the proportion of the gross national product spent on health care, fiscal sustainability, and the national emphasis on achieving Healthy People 2020 goals and objectives despite the absence of universal health insurance.
Stakeholders facilitate or undermine a community’s efforts to address critical needs, solve problems, and improve health. A major barrier to collaboration is:
Limited resources. Shared risks. Professional agendas. Time.
Professional agendas. Correct
The objectives of Healthy People 2020 will be achieved through community collaboration over time, because communities have the potential to change. Productive collaboration requires staff expertise and commitment to change communication patterns and professional agendas, and to develop a common voice to generate positive community transformation through changes in policy, legislation, and funding that improve the health status of many. Collaboration takes time, effort, and resources, and requires the nurturing and support of relationships that evolve into a collective willingness to work together toward a common purpose, with sharing of risks, responsibilities, resources, and rewards along the way. The collaborative process itself will address time requirements, limited resources, and inevitable risks. Without the development of a collective willingness and the placing aside of professional or other agendas, a common purpose cannot be achieved.
The Healthy Communities and Cities movement can best be described as which of the following?
Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community. Movement that began in the United States in 1986 that targets health promotion in community practice. Movement that focuses on the effective development and utilization of public policy as the primary means for improving health in communities worldwide. Program that uses the principles of primary, secondary, and tertiary prevention in communities throughout the world in an effort to mobilize citizens to improve the health of their communities.
Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community. Correct
The Healthy Cities movement began in Europe in 1986 and has since spread worldwide. The Healthy Communities and Cities movement incorporates principles and concepts that focus on mobilizing local political, professional, and community members to improve the health of the community. The principles of health promotion and primary health care prevention guide the movement. The model was adopted and modified in the United States in 1988 and has been applied to rural and metropolitan areas to engage local residents in action for health.
A nurse has decided to use a bottom-up approach of Healthy Communities and Cities (HCC) to meet Healthy People 2020 goals for the community setting. Which would be the most appropriate intervention?
Design and implement a health promotion activity that can be scheduled at a senior center. Organize a community meeting of local politicians, clinicians, and community members to prioritize needs and plan for the purchase of equipment needed to better treat elderly clients with diabetes. Recruit the mayor and city council to designate an annual Elder Health day. Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults.
Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults. Correct
Healthy People 2020 goals include establishment of educational and community-based programs that focus on disease prevention and health promotion. Goals for community settings and select populations include culturally appropriate community health promotion and disease prevention programs. Increasing the proportion of older adults participating in organized health promotion activities is also a goal. Following the implementation steps of the Community Health Improvement Model: Development of Community Structure for Health Promotion, the nurse working to achieve Healthy People 2020 goals should mobilize local political, health professional, and community members, including members of the target population, to prioritize, design, and implement culturally appropriate health promotion activities for seniors in the community.
The Healthy Communities and Cities model process relies on a problem-solving approach to achieve goals. The best example of this approach is:
Community activists lobbying their state legislature to mandate increased primary care access. Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change. Health care professionals working independently to determine priorities for their community and then educating their community about the health promotion needs they have prioritized. Teachers using health promotion curricula to reduce teenage smoking in their community.
Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change. Correct
The goal of the Community Health Improvement Model is to encourage community members to take responsibility for the changes they wish to see happen. The model focuses on community involvement in every step of the process. Health care providers can best act as facilitators, educators, and promoters of the model, not “experts” who dictate solutions to the community.
An example of tertiary prevention related to Healthy Communities and Cities is:
Assessing the need for programs to treat alcohol addiction. Assessing the strengths of local schools' adolescent pregnancy prevention programs. Initiating an evaluation of a program to address endemic hepatitis A in a community. Organizing a community forum to explore health promotion priorities.
Initiating an evaluation of a program to address endemic hepatitis A in a community. Correct
Tertiary prevention includes initiation of community action when problems have occurred, and evaluation of progress and effectiveness of programs and policies.
Nurses working with communities to implement the Community Health Promotion Model (CHPM) are most effective when they:
Begin where the community is and then work to facilitate implementation of all nine steps. Serve in the role of expert, spearheading the community's work. Teach basic community and public health concepts before beginning to explain and teach the Health Communities Model. Work with community leaders to begin with step one and progress through step nine of the model.
Begin where the community is and then work to facilitate implementation of all nine steps. Correct
Nurses should begin where the community is. Nurses help facilitate implementation of the model, coaching community leaders so they understand and implement all steps of the model. Nurses are most effective when they serve as facilitators and coaches-not seeking to be “bosses” but instead sharing leadership and enhancing the skill development of those involved by “being on tap, not on top.”
Instrumental in the development of Healthy Communities and Cities is the concept of primary health care, which refers to meeting the basic health needs of a community by providing readily accessible health services. Primary health care seeks to provide affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual’s health, needs, and concerns. This is the primary health care principle of:
Affordable technology. Community participation. Equity. Multisectoral participation.
Affordable technology. Correct
The principles of primary health care and the Ottawa Charter for Health Promotion were influential in the development of the Healthy Communities and Cities movement. The principles of primary health care include equity, health promotion, community participation, multisectoral cooperation, appropriate technology, and international cooperation. Appropriate technology refers to the provision of affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual’s health, needs, and concerns.
The Ottawa Charter adopted by the Healthy Communities and Cities movement defined health promotion as the process of enabling people to take control over and to improve their health by enabling community members to increase control over and assume more responsibility for health; mediating among public, private, voluntary, and community sectors; and advocating on behalf of people who are powerless to make the changes necessary to promote health. The charter identified the most effective health promotion action as:
Creating supportive environments. Developing health-promoting public policy. Reorienting health services. Strengthening community action.
Developing health-promoting public policy. Correct
The Ottawa Charter for Health Promotion (World Health Organization, 1986) lays the foundation for the Healthy Communities and Cities movement definition of health promotion. In order of priority, the Ottawa Charter identifies developing health-promoting public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services as the key strategic health promotion action for achieving health for all. Health-promoting public policy supports health in a broad ecological sense that includes environmental, physical, social, and mental well-being. Although efforts to change individual behavior are important, the contributions of policies that affect the broader environment are thought to be more effective in achieving social change. Good examples of such impacts are statewide seat belt laws, helmet laws, and local nonsmoking ordinances.
The Community Health Improvement Model: Step 3-Development of the Community Structure for Health Promotion supports the development of local collaborative partnerships to enhance the objectives of Healthy Communities and Cities. The collaborative partnership best practice of “identifying specific community and system changes to be sought to effect widespread behavior change and community health improvement” would best apply to which concept of the Ottawa Charter for Health Promotion strategic framework?
Creating supportive environments. Establishing health-promoting public policy. Reorienting health services. Strengthening community action
Strengthening community action. Correct
The Ottawa Charter for Health Promotion identified the strengthening of community action as a priority health promotion action. The strengthening of community action refers to promoting the community’s capacity, ability, and opportunity to take appropriate action to protect and improve the health of the community.
A nurse expands a community exercise program to include a senior exercise program targeted at strength and balance training in response to the Healthy Communities and Cities initiative to address the needs of free-living elders in the local community. The nurse is most likely applying the Ottawa Charter for Health Promotion priority health promotion activity of:
Developing personal skills. Establishing health-promoting public policy. Reorienting health services. Strengthening community.
Reorienting health services. Correct
Nurses participating in a Community Health Promotion Model collaborative partnership can redirect community health services toward local priorities and plans based on the Healthy Communities and Cities committee’s desired actions for health. This redirecting of community health services is an example of “reorienting health services,” a priority health promotion action of the Ottawa Charter for Health Promotion.
The Healthy Communities and Cities (HCC) movement emphasizes a bottom-up approach to community practice. The Community Health Promotion Model is a bottom-up community practice model that includes multisectoral planning and action for health, which is consistent with a locality development model (bottom-up approach). The aspects of the locality development model that have been integrated can best be described as which of the following (select all that apply)?
Emphasizing consensus and cooperation. Building a sense of community. Using a rational-empirical approach. Producing fundamental social change. Rational-empirical problem solving by outside experts.
Emphasizing consensus and cooperation.Correct
Building a sense of community.Correct
Different models of community practice exist. The locality development model is a process-oriented model that emphasizes consensus, cooperation, and building of group identity and a sense of community. The social planning (top-down approach) model stresses rational-empirical problem solving, usually by outside professional experts. Social planning does not focus on building community capacity or fostering fundamental social change. The social action model concentrates on increasing the problem-solving ability of the community through concrete actions that attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. The Community Health Improvement Model aims at creating partnerships within the community and focuses on community leadership development for health while using a bottom-up approach like the locality development model. This multisectoral cooperation (primary health care principle) by all parties in a community, from local government officials to grassroots community members, creates a stronger foundation for health-promoting public policy development, the highest-priority health promotion action identified for producing sustainable community health change.
In 1988 the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as:
What public-private partnerships do to treat vulnerable populations. What the government does to ensure that vital programs are in place. What the U.S. Public Health Service does to prevent disease, promote health, and deliver services. What society does collectively to ensure the conditions in which people can be healthy.
What society does collectively to ensure the conditions in which people can be healthy. Correct
In 1988, the IOM’s report stated that public health is “what we, as a society, do collectively to assure the conditions in which people can be healthy.” Consequently, the mission of public health is “to generate organized community effort to address the public’s interest in health by applying scientific and technical knowledge to prevent disease and promote health.” This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.
A registered nurse is seeking a position as a public health nurse. In reviewing the job description the nurse would expect to find a description of a position that focused on functions such as:
Monitoring pregnant teenagers for symptoms of complications of pregnancy. Offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. Preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. Correct
The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.
A public health nurse leader is encountering barriers when trying to shift the public health agency’s efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to:
Agency colleagues' push for nurses to focus on population initiatives. Costs associated with staff training and revision of documents. Lack of support from the agency's funding sources. Opinions that nursing should focus on the provision of direct client care and services.
Opinions that nursing should focus on the provision of direct client care and services. Correct
Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology; biostatistics; community development; service administration; and policy formation.
The role and goals of the community health nursing practice can best be described as:
Community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. Education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies
Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Correct
Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community’s health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.
A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of:
Assessment. Assurance. Policy development. Research.
Assessment. Correct
Assessment is a core function of public health and refers systematically collecting data concerning the population, monitoring the population’s health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.
The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is:
Assurance. Policy development. Primary prevention. Public transportation.
Assurance. Correct
The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:
Community-oriented care. Community-based care. Secondary care. Tertiary care.
Community-oriented care. Correct
Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.
A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents’ knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of:
Clinical community health practice. Community-based practice. Population-focused practice. Public health nursing.
Clinical community health practice. Correct
Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.
