Chapter 12: Planning, Implementing, and Evaluating Community/Public Health Programs

When the community health nurse is examining barriers to successful behavioral change, the nurse identifies that there are no laws in the community that prohibit smoking in public areas, which leads to increased smoking and increased risks to health related to secondhand smoke. The nurse believes that a possible solution is to advocate for a citywide bans on smoking in public locations. Which type of factor is affecting the behavior in the community? A) Enabling factors B) Predisposing factors C) Reinforcing factors D) Unrelated factors

Ans: A Feedback:Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills. Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices. Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

A community health nurse is attempting to identify a target group for a program using geographic information system (GIS). Which type of information would the nurse be able to obtain? A) Family status B) Past interventions used C) Previous health problems D) Areas needing more study

Ans: A Feedback:GIS information includes information about race, age, and family status. Information about past interventions used or previous health problems can be obtained from talking with other nurses and health professionals. Areas needing more study can be obtained from the Guide to Community Preventive Services: Systematic Reviews and evidence-based recommendations, a federally sponsored initiative that provides recommendations about population-based interventions.

A community health nurse is engaged in the process aspect of quality management when the nurse does which of the following? A) Contribute to the revision of standards B) Ensure an adequate amount of resources C) Determine additional sources of funding D) Review services provided for client needs

Ans: A Feedback: As part of the process aspect of quality management, staff is encouraged to contribute to evaluation of the standards and revise them as needed. Adequate resources and funding are components of the structure aspect. Reviewing services provided is a component of the outcome aspect.

A community health nurse has just moved to your community. Which might be good ways for this community health nurse to identify group and community health problems? Select all that apply. A) Interview health professionals in the agency and other agencies to determine the needs B) Read about it in a national magazine C) Refer to the geographic information system (GIS) data for the community D) It is not necessary for the community health nurse to do so. It is best for the community health nurse to just pitch in and work to solve the problems of the community.

Ans: A, C Feedback: Interviewing health professionals in the area about the problems, what should be done, and what has been tried in the past and their input on why past interventions failed. Referring to the geographic information system (GIS) data for the community can look at groups of people by race, age, and family status. Reading about it in a national magazine is too broad of an approach as factors that affect the nation may or may not reflect what is happening in your community. It is critical for the community health nurse to identify group and community health problems in order to effectively influence the health of the community.

Several quality management models are helpful in measuring and improving the quality of care. They are designed differently but are developed to enhance care giving. Which of the following uniquely places the client within the model? A) Quality Health Outcomes model B) Donabedian model C) Omaha System model D) QSEN project

Ans: AFeedback:The Quality Health Outcomes model includes the client in the model and proposes a two-dimensional relationship among components. The Donabedian model consists of three components: environment structure, processes, and outcomes. The Omaha System model addresses process indicators, client outcome measures, and satisfaction with care. The QSEN project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics.

Which of the following interventions targeting health problems is most likely to be effective? A) Teaching about prenatal care to a group of men in a men's homeless shelter B) Teaching about prenatal care in a home for unwed mothers C) Teaching about prenatal care to a group of cub scouts D) Teaching about prenatal care to a group of senior citizens

Ans: B Feedback: It is crucial to analyze the extent to which individuals and families are affected by the problem. It would be a waste of resources to provide teaching about prenatal care to any of the listed groups except the home for unwed mothers.

A community health nurse is assisting with the evaluation of outcomes of a program. The client's response to care is being measured quantitatively. The nurse identifies this as which of the following? A) Benchmarking B) Quality indicators C) Process D) Structure

Ans: B Feedback: Quality indicators are quantitative measures of a client's response to care. Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. Process refers to activities and behaviors used to improve or maintain the client's status. Structure refers to the care environment, such as client mix, philosophy, facility, and staff.

Which of the following would be least appropriate source of information for the nurse to investigate when attempting to determine the importance of an issue for a community-based intervention? A) Special interest groups B) Client's concern C) State health department D) Local community priorities

Ans: B Feedback:A client's concern may be the initial spark that leads the nurse to identify a need, but this would be most restrictive source of information and thus would be limited in scope. Therefore, when determining the feasibility of a community-based intervention, several methods can be used to determine the importance of the issue including federal agencies, special interest groups, state health departments, and local community priorities. These sources would provide information about whether or not a problem has affected a sufficient percent of the population to warrant intervention.

After teaching a group of students about the various models used in program evaluation, the instructor determines that the students have understood the teaching when they state which of the following as the model most basic? A) Quality Health Outcomes model B) Donabedian model C) Quality and Safety Education for Nurses D) Omaha System model

Ans: B Feedback:The Donabedian model is recognized as a simplistic and basic method of measuring quality that has been used widely over the past 35 years. The Quality Health Outcomes model takes the Donabedian model a step further by including the client in the model. The QSEN project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. The Omaha System model focuses on process indicators, client outcome measures, and satisfaction with care.

When devising a social marketing strategy for a community health issue, which of the following concepts is being integrated when the selection of one option inherently requires giving up on another option? A) Self-interest B) Competition C) Consumer orientation D) Exchange

Ans: B Feedback:The concept of competition is being integrated by selecting one option that inherently involves the giving up of another option. Self-interest is demonstrated when people act in their own interests. Consumer orientation is reflected in the problem-solving process directed at the target. Exchange is demonstrated when an individual gives something to get something.

In order to evaluate a health program, which of the following should the community health nurse focus on when planning the program? A) Measurement of goal attainment B) Creation of objectives that are specific, measurable, attainable, relevant, and timely. C) Patient satisfaction D) Measurement of consistency with standards

Ans: B Feedback:When planning a health program, the community health nurse should focus on the creation of objectives that are specific, measurable, attainable, relevant, and timely (acronym SMART). The other options describe what must be measured in the evaluation of the health program.

In an effort to ensure success of a proposed community intervention program, the community health nurse would include which of the following? A) Formal leaders B) Advisory group C) Target population D) Local knowledge

Ans: B Feedback: A key factor for ensuring the success of any intervention is to appoint an advisory group that includes representatives from the target and service communities. Formal leaders are important in obtaining information about the possible target population. The target population is important in making sure that the planned intervention is appropriate. However, it does not ensure that the intervention will be successful. Local knowledge provides information about possible environmental and social factors influencing the problem. However, it also does not help to ensure the success of the planned intervention.

A community health nurse is seeking seed money to set up a health promotion program for pregnant adolescents. The nurse would seek which type of grant? A) Planning B) Start-up C) Management D) Facility

Ans: B Feedback: The type of grant would be a start-up grant, for example, seed money. Other types of grants include planning grants (i.e., initial project development), management or technical assistance grants (e.g., for fund raising or marketing), and facilities or equipment grants (e.g., money for a building, computer, or van).

Which of these behaviors is most likely changeable? A) Smoking cessation among a group of people who have smoked for 20 or more years B) Smoking cessation at a work place where smoking is common and deeply imbedded C) Smoking cessation in a school for students who have only recently started smoking D) Smoking cessation in a public environment where cigarettes are openly sold and persons are allowed to smoke

Ans: C Feedback: The behaviors that are easiest to change include those that are still in the developmental stage and have only recently been established (as would students who have only recently started smoking and not among a group of people who have each smoked for 20 or more years or at a work place where smoking is common); are not deeply imbedded in cultural patterns or lifestyle (not in a workplace where smoking is deeply imbedded nor in a public environment where cigarettes are openly sold and persons are allowed to smoke).

A review of factors influencing a population's behavior related to childhood obesity reveals several reinforcing factors. Which of the following would the community health nurse identify? A) Children's belief that they like to be similar to other children of the same age B) Children's view of themselves as becoming independent from adults C) Offering of incentives to students' modeling positive food choices D) Proposed monitoring of children's behavioral changes by the local PTA

Ans: C Feedback:Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. In this case, it would be the offering of incentives to student's modeling positive food choices. The children's belief in being similar to others and view as becoming independent are examples of predisposing factors. Proposed monitoring would be an example of enabling factors.

A group of students are reviewing material in preparation for test on program evaluation models. The students demonstrate understanding of the material when they identify which model as dynamic with interventions always acting through the system and client? A) Donabedian model B) QSEN project C) Quality Health Outcomes model D) Quality Practice Setting Attributes model

Ans: C Feedback:The Quality Health Outcomes model includes the client in the model and proposes a two-dimensional relationship among components. Interventions always act through the system and the client, creating a dynamic model. The Donabedian model is recognized as a simplistic and basic method of measuring quality. Structure, process, and outcome can be depicted in a box-shaped model. The QSEN (Quality and Safety Education in Nursing) project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. The Quality Practice Setting Attributes model is used as a tool to assist in ensuring the quality of nursing practice and the nursing profession by promoting continuing competence.

When composing a letter of inquiry, which of the following would a community health nurse include? A) Names and academic credentials of all the personnel who will be involved in implementing the program B) An extensive literature review of the evidence that supports the planned interventions C) Other funding sources for the project or program (prospective and committed) D) Lengthy description of the organization

Ans: C Feedback: The letter of inquiry is normally only two to three pages in length and includes a concise overview of the project. For example, it would likely include an overview of the organization and its purpose, the reason for the funding request, clearly stated need or problem to be addressed, overview of the proposed project or program, and other funding sources for your project or program (prospective and committed). The letter is brief, yet clearly lays out your plan. Names and academic credentials of all the personnel who will be involved in implementing the program, an extensive literature review of the evidence that supports the planned interventions, and a lengthy description of the organization would make the letter of inquiry unnecessarily long when it should be concise.

As the community health nurse engages in the process of seeking grant funding, the nurse ensures that the appropriate steps are followed. Place the following in their proper sequence.A) Contact funders B) Acquire proposal guidelinesC) Define the projectD) Identify the proper funding sourceE) Be aware of submission deadline

Ans: C, D, A, B, EFeedback:When seeking grant funding, define the project, identify the right funding sources, contact the funders (think of the funder as a resource), acquire proposal guidelines, and know the submission deadline.

The community health nurse is identifying factors that would influence behavior change. Which of the following would the nurse identify as enabling factors? A) Attitudes of the target population B) Knowledge of the family of the target population C) Availability of resources D) Values of the authority figures

Ans: CFeedback:Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills. Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices. Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

One community health agency has developed a clinical pathway that has proved useful with clients with heart failure. After review, another community health agency providing care to similar clients decides to implement that pathway. This reflects which of the following? A) Structure B) Process C) Outcomes D) Benchmarking

Ans: D Feedback: Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. The example reflects external benchmarking which occurs between similar agencies providing like services. Structure is reflected in the agency's organization, facility, personnel, and philosophy. Process reflects the standards, attitudes, and activities. Outcomes reflect the expected results, goals, efficiency, and satisfaction.

A community health nurse who is part of a committee that is deciding on which model to use for program evaluation reviews the Omaha System model. The nurse needs additional review of this model after identifying which of the following as an aspect for rating outcomes? A) Client knowledge B) Client behavior C) Client status D) Client ownership of problem

Ans: D Feedback: Ownership of the problem is component of the community, the group that shares a physical environment and ownership of a health-related problem. Knowledge, behavior, and status are how outcomes are rated in this model.

A community health nurse is participating in an agency program evaluation using the Quality Practice Settings Attributes model. The nurse is assisting with evaluation of the professional system. Which of the following would the nurse need to address? A) Communication with clients B) Staffing ratios C) Safety of practice D) Continuing education

Ans: D Feedback:Using the Quality Practice Settings Attributes model, evaluation of the professional system would address hiring, orientation, training, and continuing education. Communication with clients, families, and professionals are areas evaluated in the communication system. Staffing ratios are addressed in the care delivery process. Collaboration is addressed with the leadership element.

A community health nurse has identified the target population and is determining an appropriate intervention. Which of the following would be most important for the nurse to do next? A) Develop an intervention based on the nurse's previous experiences B) Review the literature for research on previously attempted interventions C) Access the National Center for Health Statistics Web site for data D) Learn about the target population's beliefs and ideas

Ans: DFeedback:Nurses may think that they know more about a topic, and therefore, their solutions are better than the target population's solutions. However, if nurses don't learn about the target population's beliefs and only consider their own, they will not be able to work out a solution with the target population that is acceptable and appropriate for them. Thus, the interventions will most likely be unsuccessful. Although reviewing the literature for research would be helpful on identifying possible strategies, the nurse needs input from the target population. Accessing the NCHS Web site would provide information about whether a problem has affected a sufficient percent of the population to warrant intervention. It would not be helpful in determining an appropriate intervention.

When participating in quality improvement activities, a community health nurse would be least likely to engage in which of the following? A) Daily prioritising of care needs for a caseload of clients B) Completing necessary documentation effiecntly C) Seeking supervision for a difficult client case D) Reviewing organizational personel

Ans:D Feedback:Nursing administration would be responsible for developing a formalized quality management program that would include a review organizational structure, personnel, and environment. Quality improvement activities for community health nurses include daily prioritizing of care needs for a caseload of clients, seeking supervision or skills development for a difficult case, and systematizing charting so that needed documentation is efficiently completed.

Which of the following change strategies would be most effective in maximizing the cooperation of the target population? Select all that apply. A) Use only one strategy that the nurse is most familiar with B) Knowing that as a nurse, the nurse knows more about the health topic than their audience C) Employ multiple strategies to promote health, prevent disease, and ensure a safe environment for populations D) Learning about the target population's beliefs regarding the health topic E) Focusing on health promotion and not disease prevention

C) Employ multiple strategies to promote health, prevent disease, and ensure a safe environment for populations D) Learning about the target population's beliefs regarding the health topic