Ch. 16: Program Management

1. Which of the following best describes the steps in program management? A. Assess, plan, implement, evaluate B. Identify, initiate, implement C. Organize, operationalize, mobilize, subsidize D. Substantiate, negotiate, evaluate

ANS: A Assess, plan, implement, evaluate The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 276-277

18. A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? A. Choose the type of evaluation to be done B. Determine who will be involved in the evaluation C. Identify the goal and objectives for the evaluation D. Obtain answers to specific questions related to the program being evaluated

ANS: A Choose the type of evaluation to be done To do a program evaluation, first choose the type of evaluation you wish to do. Second, identify the goal and objectives for evaluation. Third, decide who will be involved in the evaluation. Fourth, answer the questions related to the type of evaluation. DIF: Cognitive Level: Apply (Application) REF: p. 285

9. A nurse is planning a program to teach cardiac health at the senior citizens center. Which of the following is an effectively written objective for the program? A. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. B. By the end of the program each participant will voice a commitment to walk at least 30 minutes a day. C. By the end of the program each participant will understand the need for physical exercise. D. Each participant will voice a commitment to engage in physical exercise each day.

ANS: A By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured. Only "will report walking 30 minutes a day at least 5 days each week" has a specific outcome action that can be seen and measured. DIF: Cognitive Level: Apply (Application) REF: p. 283

20. Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning Model? (Select all that apply.) A. Generate shared visions and common values B. Assess priorities in health problems C. Develop a framework for long-range planning D. Choose health priorities

ANS: A, C A. Generate shared visions and common values C. Develop a framework for long-range planning The elements of MAPP include: mobilizing community members and organizations, generating shared visions and common values, developing a framework for long-range planning, conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change, and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models. DIF: Cognitive Level: Remember (Knowledge) REF: p. 281

7. A community is examining which programs are needed within the community, the populations they will target, and how they will be funded. Which of the following would be the least risky decision for the community to make? A. Choose whichever option is the least expensive of agency resources B. Choose to do nothing C. Choose whatever the agency administration prefers D. Choose whatever the majority of clients prefer

ANS: B Choose to do nothing The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences. A "do nothing" decision is always the decision with the least risk to the provider. DIF: Cognitive Level: Apply (Application) REF: p. 279

16. A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which of the following persons would be most helpful as a key informant? A. Hospital administrator B. Hispanic community leader C. National expert on cultural competency D. Politician or county official

ANS: B Hispanic community leader Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. DIF: Cognitive Level: Apply (Application) REF: p. 280

12. Evaluation is underway for a statewide program to decrease teen injury and death associated with teens who drive while under the influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? A. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? B. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? C. How does the amount of alcohol intake by teens compare before and after participants enter into the program? D. What problems are identified as the program is implemented?

ANS: B How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? Summative evaluation is evaluation to assess program outcomes or as a follow-up of the results of the program activities. Two of the options are examples of questions used for formative evaluation. The goal is addressed in the question about statistics; however, the goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol. DIF: Cognitive Level: Analyze (Analysis) REF: p. 277

4. Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? A. All women ages 40 to 50 who have not had a menstrual period for 3 consecutive months B. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency C. Pregnant women who have received nutritional counseling but whose nutritional status did not improve D. Children ages 18 months to 5 years old who have been treated for nutritional deficiencies at the Central County Clinic

ANS: B Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency The client should be defined by biological and psychosocial characteristics, by geographical location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 277-278

19. Which of the following programs demonstrates the use of tertiary prevention? A. Developing an in-school clinic that provides birth control counseling and contraception B. Providing a diabetes management program for persons with diabetes mellitus C. Providing cardiovascular fitness evaluations at annual health fairs D. Setting up free blood pressure screenings at popular department stores and supermarkets

ANS: B Providing a diabetes management program for persons with diabetes mellitus The aim of tertiary prevention programs is to reduce complications from disease. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence). DIF: Cognitive Level: Analyze (Analysis) REF: p. 284

3. Which of the following best describes the purpose of strategic planning? A. To anticipate client needs now and in the future B. To match client needs, provider strengths, and agency resources C. To maximize effective use of agency resources D. To utilize provider strengths and competencies

ANS: B To match client needs, provider strengths, and agency resources Strategic planning involves matching client needs, provider strengths and competencies, and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

2. Which of the following best describes the ultimate goal of program planning? A. Avoid unanticipated conflicts in the program development phase B. Provide adequate funding to meet the program's resource requirements C. Ensure that health care services are acceptable, equal, effective, and efficient D. Prevent unnecessary duplication of services

ANS: C Ensure that health care services are acceptable, equal, effective, and efficient Although the other options are aspects of program planning, they address only limited concerns. The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

8. A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? A. Engage stakeholders B. Justify conclusions C. Gather credible evidence D. Focus on the evaluation design

ANS: C Gather credible evidence When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. DIF: Cognitive Level: Apply (Application) REF: p. 283

11. A nurse is completing a summative evaluation of a program designed to decrease obesity in school-age children. Which of the following is the most important question for the nurse to ask? A. Are school-age children satisfied with the program? B. Can parents and guardians support the program requirements? C. Has obesity in school-age children decreased? D. What is the program cost compared with the program benefit?

ANS: C Has obesity in school-age children decreased? Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: Are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. DIF: Cognitive Level: Apply (Application) REF: p. 277

14. Based on projected increases in the number of older U.S. citizens, a planning committee wants to establish a day care program for the community's older adult population. During which stage is the need for this program being assessed? A. Inactive stage B. Interactive stage C. Preactive stage D. Reactive stage

ANS: C Preactive stage The preactive stage is one in which assessment is based on the projection of a future need. DIF: Cognitive Level: Apply (Application) REF: p. 278

10. The nurse contacts participants who completed an educational program on breast self-exams to see whether they have any questions and to determine whether they are doing breast self-exams. Which of the following types of evaluation is being implemented by the nurse? A. Final evaluation B. Formative evaluation C. Goal evaluation D. Summative evaluation

ANS: D Summative evaluation Formative evaluation occurs on an ongoing basis while the program exists. In comparison, summative evaluation assesses program outcomes after the program is completed. DIF: Cognitive Level: Apply (Application) REF: pp. 277, 284-285

17. A nurse is conducting a needs assessment but has a limited budget. Which of the following data sources would the nurse most likely eliminate? A. Community forums B. Examination of community indicators C. Focus groups D. Surveys

ANS: D Surveys Surveys tend to be expensive when compared with other methods; therefore the nurse would want to consider other options if on a limited budget. DIF: Cognitive Level: Apply (Application) REF: p. 280

13. A committee concludes that a program's objectives were met and that activities received positive ratings from the community; yet the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? A. Adequacy B. Effectiveness C. Impact D. Sustainability

ANS: D Sustainability The aspects of program evaluation include the following: evaluation of relevance—need for the program; adequacy—program addresses the extent of the need; progress—tracking of program activities to meet program objectives; efficiency—relationship between program outcomes and the resources spent; effectiveness—ability to meet program objectives and the results of program efforts; impact—long-term changes in the client population; and sustainability—enough resources (usually money) to continue the program. DIF: Cognitive Level: Apply (Application) REF: pp. 284-285

5. After completing a needs assessment, the nurse is confident that he has identified the highest priority health programming need within the community. He presents his ideas at a community interest meeting, and the attendees show essentially no interest in being involved. Knowing that the health problem must be addressed he proceeds with implementation as planned. Which of the following is the most likely outcome of the program? A. Community members will become increasingly positive about the new program. B. Others will recognize the importance of the program and become involved. C. The public health agency will both publicize and expand the program. D. The program will fail because of the community's lack of interest.

ANS: D The program will fail because of the community's lack of interest. The needs to be met for the client population must be identified by both the client and the health provider. If the client population does not recognize the need, the program will usually fail. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279

15. Which of the following methods would be the most interactive approach to assessing a community's need? A. Define needs based on the current health status of the community. B. Examine past needs as identified by the agency as well as the community. C. Project future needs based on current trends. D. Use past and current data to project future needs.

ANS: D Use past and current data to project future needs. Stages used in assessing client need include the following: preactive—projecting a future need; reactive—defining the problem based on past needs identified by the client or the agency; inactive—defining the problem based on the existing health status of the population to be served; and interactive—describing the problem using past and present data to project future population needs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 278

6. A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the community. Which of the following aspects should the nurse investigate to make this determination? A. Whether the community, especially agency clients, desire a program B. Whether local politicians support the agency's idea for a program C. Whether agency professionals think a program is needed D. Whether all involved support the need for such a program

ANS: D Whether all involved support the need for such a program What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279