TEST II

Question 1

demographic characteristics, health, and disease status

Answer 1

Person factors of who

Question 2

geographical location, climate and environmental conditions and political and social environment

Answer 2

Place: “Where” factors,

Question 3

, time of day, week, month and secular trends over months and years

Answer 3

Time: “When” factors

Question 4

Epidemiological triangle

Answer 4

AGENT, HOST, and ENVIRONMENT.

Question 5

Model implies rate of disease will change when the balance among the three factors altered

Answer 5

Epidemiological triangle: AGENT, HOST, and ENVIRONMENT

Question 6

number of health events in specified period/population in same area in same specified period xk

Answer 6

rate

Question 7

Morbidity rates include which rates too

Answer 7

prevalence rates and incidence rates

Question 8

test’s ability to identify client with disease correctly.

Answer 8

Sensitivity

Question 9

the extent to which the test can correctly identify those who do not have the disease.

Answer 9

Specificity:

Question 10

The best screening test have what attributes

Answer 10

high sensitivity and high specificity

Question 11

A mechanism for the ongoing collection of community health information. Monitoring for changes in disease frequency is essential to effective and responsive public health programs.
· Allows nurse to evaluate the effectiveness of existing programs and implement interventions targeted to high-risk groups.

Answer 11

Disease Surveillance

Question 12

Uses of epidemiology in health services

Answer 12

Apply study results into prevention programs for communities and at-risk populations.
· Aim of health policy planning is to achieve positive health goals & outcomes for improved societal health.
· Community health nurses should exercise “societal responsibility” in applying epidemiological findings. Requires active involvement of citizen consumers.

Question 13

Focuses on the amount and distribution of health and health problems within a population.
· Purpose is to describe the characteristics of both people who are protected from disease and those who have a disease.
· Person, place, time factors

Answer 13

Descriptive Epidemiology

Question 14

Investigates the causes of disease by determining why a disease rate is lower in one population group than in another.
· This method tests hypotheses generated from descriptive data and either accepts or rejects them on the basis of analytic research.
· Epidemiologist seeks to establish cause-and-effect relationship between preexisting condition or even and the disease.

Answer 14

Analytic Epidemiology

Question 15

· Investigator can begin to understand the factors that contribute to disease by observing disease rates in groups of people differentiated by experience or exposure.
· Unlike experimental studies, this type of study does not allow the investigator to manipulate the specific exposure or experience that may influence disease development.

Answer 15

Observational studies

Question 16

What type of research are cross sectional studies, prospective studies, and retrospective studies?

Answer 16

They are types of observational researches

Question 17

-Examine relationships between potential causal factors and disease at a specific time.

Answer 17

Cross-sectional Studies: prevalence or correlational studies.

Question 18

a type of study that compare individuals with a particular condition or disease with those who do not have the disease.

• Investigators also select a control group from the general pop. A greater proportion of exposed cases than controls suggest a relationship between the disease and the risk factor.
• Data collection extends back in time to determine previous exposure or risk factors.

Answer 18

Retrospective Studies

Question 19

a study that monitors a group of disease-free individuals to determine if and when the disease occurs.

• Longitudinal/cohort/incidence studies
• Ex: birth cohort consists of all people born within a given time period. Study will assess the cohort with respect to an exposure factor associated with the disease. Looks for disease development. It summarizes data collected overtime by the incidence rates of new cases.

Answer 19

Prospective Studies

Question 20

-A study method to test treatment and prevention strategies. Randomly assign subjects at risk for a particular disease to an experimental or control group. Only experimental group receives intervention.

Answer 20

Experimental Studies(analytical epidemiology)

Question 21

a collective process which assesses, plans, implements, coordinates, monitors, and evaluate options and services to meet an individual’s health needs through community and available resources to promote quality cost-effective outcomes.

Answer 21

case management

Question 22

rapid changes in the healthcare environment and increased management care programs, also greater emphasis on health care cost occurred in what years

Answer 22

occurred during 1990-2005:

Question 23

may deny reimbursement to healthcare providers who exceeds the expected cost.

Answer 23

Managed Care Organizations (MCOs)

Question 24

Identify etiological factors of disease to encourage the most effective primary prevention activities and develop treatment modalities……who’s goal is this?

Answer 24

Epidemiology

Question 25

activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals

Answer 25

Primary prevention

Question 26

Health promotion and specific protection are considered forms of what type of prevention

Answer 26

Primary prevention

Question 27

those actions that are general in nature and designed to foster healthful lifestyles and a safe environment: eg: promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise

Answer 27

Health promotion

Question 28

efforts reduce or eliminate risk factors and include such measures as immunization and water purification

Answer 28

Specific protection

Question 29

those measures designed to detect disease at its earliest stage, namely screening and physical exams that are aimed at early diagnosis
interventions that provide for early treatment and cure of disease
epi data and clinical trials determine effective tx are crucial in disease identification eg: mammograms, guaic stool tests, tx of infections and dental caries
note: occurs after pathogenesis

Answer 29

Secondary prevention

Question 30

includes the limitation of disability and rehab of those of irreversible disease such as diabetes and spinal cord injury
epi studies examine risk factors affecting function and suggest optimal strategies in the care of the pts with chronic advanced disease

Answer 30

Tertiary prevention

Question 31

What do the following establish?
Strength of association, dose response relationship, Temporally correct relationship, Biological plausibility, Consistency with other studies, Specificity

Answer 31

Causality

Question 32

goals are to decrease fragmentation, enhance the clients quality of life, contain costs.

Answer 32

goal of nursing case management

Question 33

Answers the question, “among people who are well, how often is the test right?”

Answer 33

Specificity

Question 34

Answers the question< “among people with disease, how often is the test right?

Answer 34

Sensitivity

Question 35

Types of screening programs

Answer 35

selective vs universal

Question 36

Relevant for high risk group, low risk to benefit ratio,

eg: alcohol misuse, chlamydia, dental disease, depression, hearing, HIV, osteoperosis, skin cancer

Answer 36

Selective screening

Question 37

Easy to administer to large numbers of people, accurate results, referrals are a must, low risk high benefit,

REcomended adult screenings: BMI, BP, cholesterol, occult blood, mammogram, PAP

Answer 37

Universal screening

Question 38

is a notion which supports taking protective action before there is complete scientific proof of a risk; that is, action should not be delayed simply because full scientific information is lacking. Originated from concern that the use and release of hazardous substances into the environment have had negative consequences and that the public must become involved in calling attention to these activities.

Answer 38

precautionary principle

Question 39

Who does this describe?
Tend not to leave their culture behind
Travel back to homeland frequently
Maintain stronger ties with family in native land due to technological advances in communication tools
Recent increase in Asian and African immigrants
More likely to have immigrated for political reasons

Answer 39

New wave of immigrants

Question 40

a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values and practices with the goal of using this knowledge to provide culture specific and culture universal nursing care to people

Answer 40

Leininger’s Transcultural nursing:

Question 41

What are these characteristics of?

learned from birth through the processes of language aquisition and socialization
shared by members of the same cultural group
adapted to specific conditions related to environmental and technical factors and to the availability of natural resources
it is dynamic
all pervasive and universal phenomenon

Answer 41

Culture

Question 42

person’s tendency to view his or her own way of life as the most desirable, acceptable, or best and tendency to act in a superior manner towards people of another culture

Answer 42

ethnocentrism:

Question 43

used for fairly large aggregates of people who share characteristics that are not common to all members of the culture and that enable them to be a distinguishable subgroup. ethnicity, religion, occupation, health related characteristics, age, sex and geo location frequently used to identify subcultures

Answer 43

subculture:

Question 44

refers to desireable or undesireable state of affairs

universal feature of all cultures altho types and expressions of values differ widely

Answer 44

value:

Question 45

rules by which human behavior is governed and result from the cultural values held by the group

Answer 45

norms:

Question 46

· Identify target population
· Determine screening and eligibility
· Arrange services, monitor and follow-up, assessing, reassessing, planning care
· Assist clients with complex health care system, and continuity of care.

Answer 46

Possible management functions

Question 47

method to monitor and control services

Answer 47

HMO- Health Maintenance Organization,

Question 48

Origins of case management

Answer 48

long history of mentally ill elderly patient and community setting
Public Health

Question 49

o Assists the client or patient through a complex, fragmented, and often confusing health care system to obtain appropriate care
· System-centered case management
o Recognize that health care resources are finite
o Medicare, MCOs, and insurance companies demand cost-effective health care
· For hospitalized patients
o Health care services coordination begin either upon the patent’s admission or shortly therefore after and continues following the patient’s discharge

Answer 49

Client-centered case management

Question 50

Trends that influences Case Management:

Answer 50

Prospective Payment system (PPS) in the acute care setting, health care provider receives a fixed amount money based on the relative costs of resource they use to treat medicare patients with in each diagnosis-related group.
Third party negotiates reimbursement
Trend: health costs continue to escalate, population’s age and elderly are increasing, suffering from chronic illnesses.

Question 51

maximize the quality and cost efficiency of health care services. Through regular reviews and audits, they ensure that patients receive the care they need without burdening the health care system with unnecessary procedures, ineffective treatments or overlong hospital stays. Utilization review nurses also help insureds to make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage

Answer 51

Utilization review

Question 52

knowledgeable in business, clinical, and efficacy skills, influential in the community, have autonomy in collaboration, must be aware of new changes in health care environment, new regulations, and frequently emerging reimbursement schedules.

Answer 52

Examples of needed skills and knowledge of case managers

Question 53

Listen actively – respect others when they are talking.
Speak from your own experience instead of generalizing (“I” instead of “they,” “we,” and “you”).
Do not be afraid to respectfully challenge one another by asking questions, but refrain from personal attacks – focus on ideas.
Participate to the fullest of your ability – community growth depends on the inclusion of every individual voice.
Instead of invalidating somebody else’s story with your own spin on her or his experience, share your own story and experience.
The goal is not to agree – it is to gain a deeper understanding.
Be conscious of body language and nonverbal responses – they can be as disrespectful as words.

Answer 53

Strategies to better care for health of diverse populations

Question 54

1. Take a Stand: Advocating for Change
   a. Nurses must make individual & collective decisions about which interests they want to serve with their specialized knowledge and skills.
2. Asking Critical Questions
   a. Consider relationships between non-health and health policies. They should ask how policies concerning ecological preservation, energy, housing, immigration, civil rights, crime, nutrition, and minimum wage might affect the well-being of people.
3. Facilitating Community Involvement
   a. To work with the community, nurses need to create the context in which people can identify health-damaging problems in their environments. In order to participate in change, affected people need to be able to ID and work on solving environmental problems. Second role is to provide support, information, and expertise to groups to assist them in meeting the goals they set for environmental change.
4. Forming Coalitions
   a. Form coalitions between groups who have not previously socialized or acted together to produce social change. Initiate dialogue and build a strong base of collective support. Join with communities to eliminate hazards and improve public health.
5. Using Collective Strategies

Answer 54

Community Health Nursing practice

Question 55

Cultural Differences in Causation of Illness
(cause and effect, function, measurement)
1. All events in life have a cause and effect.

2. The human body functions more or less mechanically (i.e., the functioning of the human body is analogous to the functioning of an automobile).
3. All life can be reduced or divided into smaller parts (e.g., the human person can be reduced into body, mind, and spirit).
4. All of reality can be observed and measured (e.g., with intelligence tests and psychometric measures of behavior).

Answer 55

Biomedical

Question 56

Cultural Differences in Causation of Illness: (natural balance, harmony)
This viewpoint is found most frequently among Native Americans, Asians, and others who believe that human life is only one aspect of nature and a part of the general order of the cosmos. Individuals from these groups believe that the forces of nature must be kept in natural balance or harmony to maintain health and well-being.

Answer 56

Naturalistic

Question 57

Cultural Differences in Causation of Illness: (supernatural)
The basic premise of this explanatory model is that the world is seen as an arena in which supernatural forces dominate. The fate of the world and those in it depends on the action of supernatural forces for good or evil. Examples of magical causes of illness include the belief in voodoo or witchcraft among some blacks and others from circum-Caribbean countries. Faith healing is based on religious beliefs and is most prevalent among selected Christian religions, including Christian Scientists. Various healing rituals may be found in many religions, such as Roman Catholicism,

Answer 57

Magicoreligious

Question 58

Leading Causes of preventable deaths in US
Healthy People 2010: of the worldwide preventable diseases, 25% are caused by poor environmental quality.
The environment directly affects health status and plays a major role in quality of life, years of healthy life lived, and health disparities. Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular systems. Secondhand smoke containing toxic and cancer-causing chemicals contributes to heart disease and lung cancer in nonsmoking adults. Globally, nearly 25% of all deaths and the total disease burden can be attributed to environmental factors.1

Poor air quality contributes to cancers, cardiovascular disease, asthma, and other illnesses. Poor water quality can lead to gastrointestinal illness and a range of other conditions, including neurological problems and cancer

Answer 58

Leading cause of preventable deaths in US

Question 59

Represents the percentage of deaths resulting from a specific cause relative to deaths from all causes.
· Helpful in identifying areas in which public health programs might make significant contributions in reducing deaths.

Answer 59

Proportionate mortality ratio (PMR): also describes mortality.

Question 60

· High (PMR) Proportionate mortality ratio ratio indicates?

Answer 60

= low overall mortality.

Question 61

This model implies The development of disease is dependent on the extent of the host’s exposure to an agent, the strength of virulence of the agent, and the host’s genetic or immunological susceptibility. Disease is also dependent on the environmental conditions existing at the time of exposure which include the biological, social, political and physical environment.

Answer 61

Epidemiological triangle