Exam 2

Case Management is one of the tools of Program Management. What are it's two domains?

1) Focuses on individual client 2) Collaborate, Advocate, and Coordinate

When evaluating evidence, how is the "grade" assigned and what is it based on?

•Quality of the evidence •Number of well-designed studies •Presence of similar findings in all of the studies

Program Management is the "hand" that controls what three things?

1) Multiple Providers 2) Reduces Overuse 3) Budgets how goals can be met with available $$$

Quality Assurance (QA) vs. Quality Improvement (QI)

-Quality assurance (QA) measures compliance against certain necessary standards, typically focusing on individuals -Quality improvement (QI) is a continuous improvement process focused on processes and systems

Evidenced Based Public Health

A public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods

Evidenced Based Nursing

An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.

A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: host and agent. host, agent, and environment. risk and causality. morbidity and disease.

B. host, agent, and environment. Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk for disease. The associations between risk and causality, morbidity and disease do not demonstrate the relationship to the development of flu.

Accredidation and Certification basics

CQI and Quality Assurance are part of the accreditation process. They are designed in addition to laws such as the National Health Quality Improvement Act to address the rising number of malpractice claims & to improve patient outcomes.

Put Licensing, Certification, and Accreditation in order from Good, Better, Best.

Licensing- GOOD Accreditation- BETTER Certification- BEST

What does POEM stand for and what questions do we want answered?

What are the results? (Are they important?) Are the results valid? How can the results be applied to client care?

What is Continuous Quality Improvement?

philosophy that encourages all members of a team to constantly ask what can be done better? • Focuses on systems issues

What are the Three domains for evaluation systems?

1.Quality 2.Quantity 3.Consistency

What are some reasons that Case Management is only implemented sometimes with individual patients?

1) Healthcare financing provides incentives to value outcomes over volume of care provided 2) Healthcare is delivered through a network of many providers 4) Very time consuming 4) Restricted to complex cases

What are the questions to ask about program planning to determine its success?

1) Is the program needed or wanted? 2) Is the program meeting its objectives? 3) Does the program address the needs? 4) Is the program making longterm changes? 5) Are activities being tracked? 6) Are there enough resources to maintain the program?

3 Factors from Healthy People 2020 Objectives

1) Offer a systematic approach to health improvement 2) Provide general direction and focus for measuring progress of improving health status within a specific amount of time 3) Objectives for improving clients' understanding for EBP

Types of evidence: A hierarchy of evidence, ranked in order of decreasing importance and use has been accepted by many health professionals.

1. Randomized controlled trials 2. Nonrandomized clinical trials 3. Quasi-experimental studies 4. Prospective cohort studies 5. Case-control reports 6. Qualitative studies 7. Expert opinion

A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: community forums. focus groups. key informants. surveys.

A. community forums. Community forums have the advantage of being low in cost and capturing the perspectives of a large number of persons. Focus groups and key informant methods limit the number of persons expressing their perspectives. Surveys are expensive and technically demanding.

The major sources of information for program evaluation are: Select all that apply. community indexes. media reports. program clients. program providers. program records.

A. community indexes. C. program clients. E. program records. Major sources of information for program evaluation are program clients, program records, and community indexes. The program participants, or clients of the service, have a unique and valuable role in program evaluation. Whether the clients, for whom the program was designed, accept the services will determine to a large extent whether the program achieves its goal. Thus their reactions, feelings, and judgments about the program are important to the evaluation.

The public health nurse is most likely to use what types of surveillance systems? Select all that apply. Active Passive Sentinel Syndronic

A. Active B. Passive Although all of the systems are important, the public health nurse is most likely to use the active or passive systems. A passive system may use the state reportable disease system to complete a community assessment or MAPPS. The active system is used when several schoolchildren become ill after eating lunch in the school cafeteria or at the local hot dog stand, to investigate the possibility of food poisoning, or to follow up the contacts of a newly diagnosed client with tuberculosis or a sexually transmitted infection (STI) at the local homeless shelter.

Which of the following is a unique characteristic of the role of the occupational health nurse? Adapts to the needs of the agency and specific groups of workers. Works as a solo clinician and/or independent contractor. Is interdisciplinary in nature. Specializes in health promotion and education.

A. Adapts to the needs of the agency and specific groups of workers. The customary role of the occupational health nurse has extended beyond emergency treatment and prevention of illness and injury. The interdisciplinary nature of occupational health nursing has become more critical as occupational health and safety problems require more complex solutions. The occupational health nurse frequently collaborates closely with multiple disciplines, industry management, and representatives of labor. Their role is unique in that the nurse adapts to an agency's needs as well as to the needs of specific groups of workers.

The Clean Air Act of 1970 was amended in 1990 to meet unaddressed or insufficiently addressed problems that included which of the following? Select all that apply. Addressing acid rain Addressing excessive noise and heat or cold extremes Addressing ground-level ozone Addressing stratospheric ozone depletion Tracking 75,000 industrial chemicals

A. Addressing acid rain C. Addressing ground-level ozone D. Addressing stratospheric ozone depletion The Clean Air Act of 1970 regulates air emissions from area, stationary, and mobile sources and authorized the EPA to establish National Ambient Air Quality Standards (NAAQS) to protect public health and the environment. The 1990 amendments to the Clean Air Act intended to meet unaddressed or insufficiently addressed problems, such as acid rain, ground-level ozone, stratospheric ozone depletion, and air toxins. The Occupational Safety and Health Act (OSHA) establishes guidelines for addressing excessive noise, heat, or cold extremes and industrial chemical use in the workplace.

Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP? Adopting quality indicators for evaluating websites claiming to contain EBP Avoiding the issue of community politics Creating the role of a knowledge manager Making decisions on behalf of the community

A. Adopting quality indicators for evaluating websites claiming to contain EBP Although the Internet is one source of evidence data, there may be a lack of quality indicators to evaluate the myriad of websites claiming to contain evidence-based information. It is essential to evaluate the quality of the information on the website, whether it comes from a reputable agency or scholar, and whether the source of the website has a financial interest in the acceptance of the evidence presented.

A recent news article reported the death of a 60-year-old road construction worker on a day with a posted heat advisory. An occupational health nurse would recognize the additional host factors that contributed to this fatality as which of the following? Age and work practices Gender and lifestyle Health status and age Work practices and health status

A. Age and work practices Each worker represents a host within the worker population group. Certain host factors are associated with increased risk for adverse responses to hazards of the workplace. These include age, gender, health status, work practices, ethnicity, and lifestyle factors. In this example, the factors noted would be the age of the worker and the fact that construction workers work outside with exposure to the elements for long periods.

Which of the following tools are used in analytic epidemiology? Select all that apply. Cohort study Case-control study Cross-sectional study Clinical trials Community trials

A. Cohort study B. Case-control study C. Cross-sectional study Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies. In experimental or intervention studies, the investigator initiates a treatment or intervention to influence the risk or course of disease. These studies test whether interventions can prevent disease or improve health. Clinical trials and community trials are examples of experimental studies.

There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. Which statements reflect the most significant concerns of nurses in the community-focused setting? Select all that apply. EBP requires compliance by the client. EBP requires little support. EBP demands change. EBP questions long-standing nursing practice. Lack of resources

A. EBP requires compliance by the client. D. EBP questions long-standing nursing practice. E. Lack of resources Although a community agency may subscribe in theory to the use of EBP, actual implementation may be affected by the realities of the practice setting. Community-focused nursing agencies may lack the resources needed for its implementation in the clinical setting, such as time, funding, computer resources, and knowledge. Nurses may be reluctant to accept findings and feel threatened when long-established practices are questioned. Cost can also be a barrier if the clinical decision or change will require more funds than the agency has available. Compliance can be a barrier if the client will not follow the recommended intervention.

Which of the following statements best explains the need for geologists, meteorologists, and chemists on the multidisciplinary team in environmental health? Earth sciences explain how pollutants travel in air, water, and soil. Earth sciences help us understand the strength of the association between exposures and health effects in human populations. Earth scientists study the negative effects of chemical exposure. Earth scientists work with the community to coordinate services to meet the community's needs.

A. Earth sciences explain how pollutants travel in air, water, and soil. Toxicology is the basic science that studies the health effects associated with chemical exposure. Epidemiology, an applied use in environmental health, helps us understand the strength of association between exposures and health effects in human populations. Environmental epidemiology is the study of the effect on human health of physical, chemical, and biological factors in the external environment. To understand how and when humans may be exposed to hazardous chemicals, radiation, and biochemical contaminants, earth sciences are used to help explain how pollutants travel in air, water, and soil. Therefore environmental health requires a multidisciplinary approach to assess and decrease environmental health risks. This may involve geologists, meteorologists, chemists, food safety specialists, sanitarians, radiation specialists, industrial hygienists, housing inspectors, clinical specialists, laboratory workers, and/or remediation specialists. This may also involve interagency cooperation (i.e., health department, department of environmental protection, housing department, public/private laboratories, tertiary care facilities, department of agriculture, transportation department).

Which of the following barriers are specific to the educator? Select all that apply. Fear of public speaking Low literacy Limited experience with the topic Lack of motivation Lack of experience with gaining participation

A. Fear of public speaking C. Limited experience with the topic E. Lack of experience with gaining participation Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes.

Which of the following factors has influenced the implementation of evidence-based practice in health care? Select all that apply. Increased expectations of consumers Advances in technology Nursing shortages Increases in lawsuits Implementation of electronic health records

A. Increased expectations of consumers B. Advances in technology D. Increases in lawsuits Evidence-based practice is important for all professionals who work in social and health care environments, regardless of the client or the setting with which professionals are dealing, including public health nurses who work with populations. Emphasis on EBP has resulted from increased expectations of consumers, changes in health care economics, increased expectations of accountability, advancements in technology, the knowledge explosion fueled by the Internet, and the growing number of lawsuits occurring when there is injury or harm as a result of practice decisions that are not based on the best available evidence.

Which educational method has been shown to be most effective in fostering treatment adherence? Internet-based education In-person counseling Telephone counseling Self-directed learning

A. Internet-based education Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information.

The greatest risk for experiencing work-related accidents with subsequent injuries is to which of the following? New workers with less than 1 year of experience on the current job Older workers with 2 years of experience on the job Women over 50 years of age with 3 years of experience on the current job Workers with safe, low-level exposure on the job

A. New workers with less than 1 year of experience on the current job The population group at the greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job, because of characteristics such as risk taking, lack of knowledge, and lack of familiarity with the new job. Older workers may be at increased risk in the workplace because of diminished sensory abilities, the effects of chronic illnesses, and delayed reaction times. A third population group that may be very susceptible to workplace exposure is women in their child-bearing years.

The hospital infection control practitioner reports new cases of tuberculosis to the public health department. Of what type of surveillance system is this an example? Passive Active Sentinel Special

A. Passive Surveillance systems in use today are defined as passive, active, sentinel, and special. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems.

Which of the following domains are used in evaluating the strength of evidence? Select all that apply. Quality Quantity Cost effectiveness Consistency Usefulness

A. Quality B. Quantity D. Consistency Grading evidence has been debated so strongly that in 2002; the Agency for Healthcare Research and Quality (AHRQ) commissioned a study to describe existing systems used to evaluate the usefulness of studies and strength of evidence. The report reviewed 40 systems and identified three domains for evaluating systems for the grading of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs.

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? Repetition Integration Participation Sequencing

A. Repetition Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? Select all that apply. Use of films Small group interaction Use of games Session timing Session space

A. Use of films B. Small group interaction C. Use of games D. Session timing E. Session space Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is: acceptable to the community. contains cost and reduces legal liability. applied as a universal remedy. limited to research findings.

A. acceptable to the community. Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities.Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.

When a community health nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning land parcels for industrial use, the nurse is: advocating for ethical choices. communicating risk. controlling environmental damage. volunteering for service on state boards.

A. advocating for ethical choices. Understanding ethics is essential for nurses making their own choices, in describing issues and options within groups, and in advocating for ethical choices. Ethical issues likely to arise in environmental health decisions are the following: Who has access to information and when? How complete and accurate is the available information? Who is included in the decision making and when? What and whose values and priorities are given weight in decisions? How are short-term and long-term consequences considered?

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: an andragogical approach. a behavioral approach. an operational approach. a pedagogical approach.

A. an andragogical approach. Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: assess the literacy level of the group. see how many plan to attend. see whether the group is ready to learn. secure a good space for a group meeting.

A. assess the literacy level of the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.

A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: concurrent audit. outcome audit. retrospective audit. peer review.

A. concurrent audit. Staff/peer review processes are a specific approach to quality assurance that often use audit tools to determine quality of care. The concurrent audit is a process of audit that evaluates the quality of ongoing care by looking at the nursing process. A retrospective or outcome audit evaluates quality of care following the discharge of a client. Both audits are conducted in nursing peer review.

The nurse engaging in formative program evaluation would most likely: conduct medical record audits for quality assurance. make a home visit before a client is discharged from the program. participate in new client evaluation. write policy for risk management.

A. conduct medical record audits for quality assurance. Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. This type of evaluation is an example of formative evaluation of processes, which occurs on an ongoing basis while the program exists. Progress evaluation occurs primarily while implementing the program. The nurse who completes a daily or weekly log of clinical activities (e.g., number of clients seen in the clinic or visited at home, number of phone contacts, number of referrals made, number of community health-promotion activities) is contributing to progress evaluation of the nursing service.

A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect: current and past breast cancer events in this population of women. newly diagnosed cases of breast cancer in this population of women. past breast cancer events in this population of women. the population of women that had no evidence of breast cancer.

A. current and past breast cancer events in this population of women. The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population). A prevalence proportion is not an estimate of the risk of developing disease, because it is a function of both the rate at which new cases of the disease develop and how long those cases remain in the population. In this example, the prevalence of breast cancer in this population of women is a function of how many new cases develop and how long women live after the diagnosis of breast cancer.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: efficiency. progress. relevance. sustainability.

A. efficiency. A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. Sustainability is the continuation of a program when resources are adequate.

The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: improving the description of care. minimizing the assessment required. predicting the outcome. decreasing the communication needs.

A. improving the description of care. The Omaha System is a comprehensive method for evaluating client care. The components include a classification system for assessing and categorizing client problems, a database, a nursing problem list, and anticipated outcome criteria for the classified problems. It has the potential to improve the delivery of nursing care, documentation, and the descriptions of client care that will enhance nursing assessment, planning, implementation, and evaluation of client care and allow the collection of more pertinent client information (relevant, consistent, and measurable) for more effective and efficient nurse productivity and communication.

A traditional quality assurance program goal is to identify problems between the provider and client. Other goals of a traditional QA program are: Select all that apply. intervention in problem cases. peer review of all cases that are problematic. provide feedback regarding interactions between client and provider. provide documentation of interactions between client and provider.

A. intervention in problem cases. C. provide feedback regarding interactions between client and provider. Traditional QA programs can fit well with the CQI process. In most health care systems, the overall goal of specific QA approaches is to monitor the process and outcomes of client care. The goals of CQI are as follows: To identify problems between the provider and client through QA methods To intervene in problem cases To provide feedback regarding interactions between the client and provider To provide documentation of interactions between the client and provider Specific approaches are often implemented voluntarily by agencies and provider groups interested in the quality of interactions in their setting. Having peer review of all problematic cases is one step of the audit process for measuring quality. INCORRECT

Clinical medicine and epidemiology differ from each other in the major aspect of: practice focus. health monitoring. determinants of health and disease. evaluation of interventions.

A. practice focus. Epidemiology is the study of populations to monitor the health of the population, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals. Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health. Epidemiologic methods are used extensively to determine to what extent the goals of Healthy People 2020 (US Department of Health and Human Services, 2010) have been met and to monitor the progress of those objectives not fully met at present.

When applying the nursing process to environmental health, the community health nurse would examine criteria that include the immediate and long-term responses of the client to the planned interventions. Another important factor to consider in the evaluation process would be: recidivism of the problem for the client. consideration of community policy and laws. relationship between the disease and the environmental factors. coordination of actions to meet the client's needs.

A. recidivism of the problem for the client. If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. In the evaluation stage, the nurse should examine criteria that include the immediate and long-term responses of the client, as well as the recidivism of the problem for the client. Consideration of laws and policies in the community occurs in the planning phase. Examining the relationship between the disease and the environmental factors occurs in the diagnosis phase and coordinating actions to meet the needs of the client is a step in the intervention phase.

Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: total quality management (TQM) to achieve continuous quality improvement (CQI). quality assurance (QA) to achieve continuous quality improvement (CQI). risk management to achieve quality. continuous quality improvement (CQI) to achieve total quality management (TQM).

A. total quality management (TQM) to achieve continuous quality improvement (CQI). Total quality management provides direction for managing a system of care, whereas continuous quality improvement using quality assurance and quality improvement focuses on the care a client receives within the system. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes. CQI focuses on the sources of differences in the ongoing process of health care delivery and seeks to improve the process. Risk management focuses on reducing financial risk.

Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be: two new cases divided by 16 at risk. two new cases divided by 20. six cases divided by 20. four cases divided by 16.

A. two new cases divided by 16 at risk. An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time (Rothman, 2012). The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it. People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it.

Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends? A nurse in community health conducts an education class for clients newly diagnosed with diabetes. A nurse in community health investigates a breakout of whooping cough in a local middle school. A nurse in community health organizes a health fair at the community health center. A nurse in community health participates on a county school board that addresses student health issues.

B. A nurse in community health investigates a breakout of whooping cough in a local middle school. Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness. Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital. Community health nurses who conduct education classes, organize health fairs, and address student health issues are using prevention strategies.

Evidence-based public health utilizes which of the following guidelines? Select all that apply. Decision making for the community served Application of program planning frameworks Judicious use of the Internet for use of evidence Conducting evaluations Disseminating what has been learned

B. Application of program planning frameworks D. Conducting evaluations E. Disseminating what has been learned Evidence-based public health is defined as a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. An expanded definition of evidence-based public health includes making decisions on the basis of the best available evidence, using data and information systems, applying program planning frameworks, engaging the community in decision making, conducting evaluations, and disseminating what has been learned.

An effective industrial disaster plan is a written plan that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel (transportation, fire, EMS, and hospitals), and other key resources in the community. Another factor that influences the effectiveness of an industrial disaster plan is which of the following? Addressing activities for work areas that are at greater risk Conducting a response agency worksite walk-through Testing with a biannual drill Training specific employees for fire brigade procedures

B. Conducting a response agency worksite walk-through Effective disaster plans should: (1) be written and shared with all who will be involved, (2) train employees in first aid, CPR, and fire brigade procedures, (3) be clear, specific, and comprehensive across all shifts and all work areas, (4) be coordinated with agencies that will respond, (5) be tested at least annually, (6) be evaluated and changed as indicated, (7) include an up-to-date hazard inventory that includes clinical information on exposures and appropriate treatment, (8) provide updated information to the responder agencies as needed, and (9) conduct a response agency worksite walk-through. Representatives of these agencies should visit the worksite and accompany the nurse on a worksite walk-through so that they are familiar with the operations.

Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community? Point source report Consumer confidence report Material Safety Data Sheet Environmental standards report

B. Consumer confidence report When a community is provided drinking water by a water supplier (as opposed to individual wells), the water provider is responsible for testing the water according to EPA standards. The results of the testing must be reported to those who purchase the water, in the form of a consumer confidence report (CCR). Nurses should review consumer confidence reports, sometimes referred to as right-to-know reports, to learn what pollutants have been found in the drinking water. Pollution sources are characterized as point sources. A point source pollutant is released into the environment from a single site, such as a smoke stack, a hazardous waste site, or an effluent pipe into a waterway. Environmental standards are reviewed at the community level. Material Safety Data Sheets provide information about the chemical makeup, the health risks, and any special guidance on safe use and handling of chemicals in the workplace.

What are the core competencies of the nurse participating in surveillance and investigation activities? Select all that apply. Basic patient assessment skills Effective communication skills Ability to collaborate with community partners Advanced-practice nurse with secondary science degree Leadership and systems thinking

B. Effective communication skills C. Effective communication skills E. Leadership and systems thinking The national core competencies for public health nurses were developed from the work of the Council on Linkages Between Academia and Public Health Practice (2010) and by the Quad Council of Public Health Nursing Organizations (2009). To be a participant in surveillance and investigation activities, the staff nurse must have the following: Analytic assessment skills Ability to provide effective oral and written reports Community dimensions of practice Basic public health science skills Leadership and systems thinking

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? Cultural sensitivity Efficiency in client service Learning of new skills Distraction-free surroundings

B. Efficiency in client service In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible.

During a recent heat advisory, baggage handlers at the local airport were placed on a 1-hour shift rotation. This work-health interaction demonstrates the theoretical application of which of the following? Aggregate populations Epidemiologic model Host risk factor Occupational exposure

B. Epidemiologic model The epidemiologic model can be used to understand the relationship between work and health. In this example, the environmental element, which includes all external conditions that influence the interaction of the host and agents, caused a shift in the work-health interaction that required a change in work practices to avoid heat stroke. INCORRECT

Changes in the workforce will pose new challenges to protecting worker health and safety. Which of the following trends will influence business strategies to increase health status, employment longevity, and satisfaction of workers? Select all that apply. Expanded younger workforce Female workforce increasing Increase in minority workers Job shifts to manufacturing More racially diverse workforce

B. Female workforce increasing C. Increase in minority workers E. More racially diverse workforce The US workplace and workforce are rapidly changing. Jobs in the economy continue to shift from manufacturing to service. Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. New chemicals, materials, processes, and equipment are developed and marketed at an increasing pace. The workforce will become older and more racially diverse. Minorities and women continue to represent more of the workforce, which raises issues for childcare and elder care. The demand for workers will outstrip the available supply. Therefore businesses must be concerned about strategies to increase health status, employment longevity, and satisfaction of workers.

A widely recognized chemical health hazard in health care environments is which of the following? Burn-out Latex allergy Radiation Viruses

B. Latex allergy In a health care environment, a worker with a latex allergy is at higher risk for and more vulnerable to an adverse reaction. The occupational health nurse should carefully screen workers for latex allergies and monitor these workers for optimal health protection. Latex allergies are widely recognized as a health hazard in these environments.

In health care facilities and clinical laboratories, the occupational health nurse needs to be aware of the worker groups that are at risk for exposure to biological agents. Besides the health care workers, worker groups at risk for exposure to biological infectious agents may include which of the following? Clerical staff Maintenance personnel Receptionists Chaplains

B. Maintenance personnel Many workers in health care settings or clinical laboratories are employed as maintenance workers, security guards, aides, or cleaning personnel, who tend not to be well protected from inadvertent exposures, which include contaminated linens in the laundry, soiled equipment, and trash containing contaminated dressings or specimens.

The community health nurse asks a client, "Have you ever been exposed to any radiation or chemical liquids, dust, mists, or fumes?" The nurse is conducting an: environmental advocacy activity. environmental compliance activity. environmental health assessment. environmental risk communication.

C. environmental health assessment. The key questions in an environmental health assessment should cover present and past conditions in work, home, and community environments. In an assessment of environmental exposures, the environment can be divided into functional locations such as home, school, workplace, and community. Nurses can act in the best interest of public health, and use their abilities as educators, advocates, and communicators to affect public policy, laws, and regulations that protect public health. Nurses can serve as a resource for state and federal legislators and their staff.

What are the purposes of disease surveillance in public health? Select all that apply. Tries to identify terrorist attacks before they occur. Provides a means for nurses to monitor disease trends. Generates knowledge about disease or outbreak patterns. Allows the nurse to advocate for policy changes. Reduces morbidity and mortality and improves health through disease trend monitoring.

B. Provides a means for nurses to monitor disease trends. C. Generates knowledge about disease or outbreak patterns. E. Reduces morbidity and mortality and improves health through disease trend monitoring. Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations). Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and to improve health. Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries as well as "environmental and occupational exposures" and personal health behaviors. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks.

What is the purpose of using an algorithm in the surveillance process? Tells the nurse who to call in the event of an outbreak. Provides the nurse with a step by step plan to identify events needing investigation. Provides the nurse with a system for telephone triage in an outbreak. It is a visual reminder of the epidemiologic triangle.

B. Provides the nurse with a step by step plan to identify events needing investigation. A quality surveillance system requires collaboration among a number of agencies and individuals: federal agencies, state and local public health agencies, hospitals, health care providers, medical examiners, veterinarians, agriculture, pharmaceutical agencies, emergency management, and law enforcement agencies, as well as 911 systems, ambulance services, urgent care and emergency departments, poison control centers, nurse hotlines, school, and industry. The type of information shared includes the use of an algorithm to identify which events should be investigated (i.e., using a precise step-by-step plan outlining a procedure that in a finite number of steps helps to identify the appropriate event).

When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: assessment. assurance. policy development. research.

B. assurance. When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of assurance. Assessment occurs when the nurse uses evidence-based practice for new insights and innovative solutions to health problems. When the nurse develops policies and plans using evidence-based practice that supports individual and community health efforts, the public health function of policy development is being addressed.

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: affective domain. cognitive domain. events of instruction. principles of effective education.

B. cognitive domain. The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles.

One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: create, publish, and distribute aims and purposes. create a strong customer-oriented philosophy that is process-driven. eliminate barriers to pride of work/performance. understand the purpose of inspection.

B. create a strong customer-oriented philosophy that is process-driven. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes (Oakland, 2014). Under TQM, quality is defined as customer satisfaction. Quality assurance/quality improvement (QA/QI) is the promise or guarantee that certain standards of excellence are being met in the delivery of care.

The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate: compliance and enforcement. environmental epidemiology. secondary prevention. toxicology.

B. environmental epidemiology. By examining specific populations or communities exposed to different ambient environments, environmental epidemiology seeks to clarify the relationship between physical, chemical, and biological factors and human health. Toxicology is the study of health effects associated with chemical exposures. Secondary prevention and compliance and enforcement are not associated with monitoring and public reporting.

A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: Centers for Disease Control and Prevention (CDC) reports. epidemiologic data. recent census data. voter registration records.

B. epidemiologic data. A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation. Incidence and prevalence are valuable indexes used to measure program effectiveness and impact, and these data are readily available on the Internet. Major sources of information for program evaluation are program clients, program records, and community indexes.

One of the basic concepts in epidemiology is the concept of risk. Risk refers to the: prevalence of an event occurring. probability that an event will occur within a specified time period. population most likely to develop a disease. rate of development of new cases.

B. probability that an event will occur within a specified time period. Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring. Incidence rates and proportions measure the rate of new case development in a population and provide an estimate of the risk of disease.

A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: continuous quality improvement (CQI). quality assurance (QA). risk management. total quality management (TQM).

B. quality assurance (QA). The goals of QA and QI are on a continuum of quality, and in public health they are: (1) to continuously improve the timeliness, effectiveness, safety, and responsiveness of programs, and (2) to optimize internal resources to improve the health of the community. Under a continuous quality improvement (CQI) philosophy, QA and QI are but two of the many approaches used to ensure that the health care agency fulfills what the client thinks are the requirements for the service. QA focuses on finding what providers have done wrong in the past (e.g., deviations from a standard of care found through a chart audit). CQI operates at a higher level on the quality continuum but requires the commitment of more organization resources to move in a positive direction. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes.

A nurse is concerned about the accuracy of the PPD test in identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of: reliability. sensitivity. specificity. variation.

B. sensitivity. Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Sensitivity represents the proportion of persons with the disease whom the test correctly identifies as positive (true positives). High sensitivity is needed when early treatment is important and when identification of every case is important. Reliability is the consistency of repeating a measure and is affected by variation in results. Specificity indicates how accurately the test identifies those without the condition or trait.

Analytic epidemiology differs from descriptive epidemiology because it searches for: "when" of disease patterns. "where" of disease patterns. "why" of disease patterns. "who" of disease patterns.

C. "why" of disease patterns. Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, on the other hand, searches for the determinants of the patterns observed—the how and why of disease patterns.

An elementary classroom of 28 students has had 13 children who have developed chicken pox over the last 3 weeks. What is the pattern of occurrence? Common source outbreak Point source outbreak Continuous source Mixed outbreak

C. Continuous source Patterns of occurrence can be identified when investigating a disease or event. These patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem. Intermittent or continuous source cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. In a point source outbreak all persons exposed become ill at the same time, during one incubation period. A mixed outbreak (which was described while investigating a foodborne gastroenteritis caused by a Shigella sonnei virus) is a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza.

A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? Assessment Protocol for Excellence in Public Health (APEXPH) Health Evaluation Data Information System (HEDIS) Mobilizing for Action Through Planning and Partnership (MAPP) Planning Approach to Community Health (PATCH)

C. Mobilizing for Action Through Planning and Partnership (MAPP) MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning.

The occupational health nurse is aware that several employees from the accounting/finance departments are complaining about exhaustion, anxiety, and heartburn and notes an increase in absenteeism for these departments. On further exploration, the nurse learns that a new chief financial officer (CFO) has been in place for 1 month. The new CFO is demanding higher productivity and turnaround with expectations of working overtime and weekends to "get the job done" ahead of deadlines. The occupational health nurse, using the epidemiologic model, recognizes this as a psychological agent that can best be described as which of the following? Employment conditions Nonfatal violence Organizational culture Shift work

C. Organizational culture Organizational culture refers to the norms and patterns of behavior that are sanctioned within a particular organization that set guidelines for the types of work behaviors that will enable employees to succeed within a particular organization or department. In this example, the new CFO has reset the expectations related to working overtime and weekends to beat deadlines. These factors and the employees' response to them must be assessed if strategies for influencing the health and safety of workers are to be effective.

Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases? Active Passive Sentinel Syndronic

C. Sentinel In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. INCORRECT

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: provide an online test module. ask whether there are any questions. ask for a return demonstration. give a short paper-and-pencil quiz.

C. ask for a return demonstration. Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.

The deliberate release of viruses, bacteria, or other germs with the intent of causing illness or death is: event outbreak. chemical terrorism. biological terrorism. surveillance.

C. biological terrorism. Biological terrorism is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations).

A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: accreditation. charter. credentialing. licensing.

C. credentialing. General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Credentialing is defined as the formal recognition by which individuals or institutions are designated by a qualified agent as having met minimum standards of performance. Licensure is typically viewed as recognition that a person has met a minimal set of standards to practice.

The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also: accessible and diverse. competent and compliant. culturally and financially appropriate. reasonable and deliverable in a timely fashion.

C. culturally and financially appropriate. Applied to nursing, evidence-based practice includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders. Culturally and financially appropriate best practices need to be identified when working with communities instead of individuals. The use of evidence to determine the appropriate use of interventions that are culturally sensitive and cost effective is a must.

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to: conduct a survey to determine how many children the fathers have. determine whether the fathers have benefited from this type of program before. meet with community members to form a planning body. provide the fathers with community resources.

C. meet with community members to form a planning body. The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur.

The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: consumers and the profession. legislature and the state board. profession and the state. public and the professional associations.

C. profession and the state. Individual licensure is a contract between the profession and the state whereby the profession (i.e., State Board of Nursing) is granted control over who can enter into and who exists in the profession. It requires written regulations to define the scope and limits of the profession's practice.

The Food Quality Protection Act of 1996 increased the protection of infants and children from pesticide exposure from multiple sources by establishing a new health-based standard of reasonable certainty of "no harm" that: considers the cumulative impacts of all pesticides that may share a common mechanism of action. establishes a 15-year renewal process for all pesticides. prohibits taking into account economic considerations when children are at risk. uses an additional tenfold margin of safety when there are adequate data indicating developmental risks.

C. prohibits taking into account economic considerations when children are at risk. The Food Quality Protection Act of 1996 added new provisions related to protection of infants and children from pesticide exposure from multiple sources. The law established a health-based standard of reasonable certainty of "no harm" that prohibits taking into account economic considerations when children are at risk. Other safeguards under the FQPA include the use of an additional tenfold margin of safety when there are adequate data to assess prenatal and postnatal developmental risks, a 15-year renewal process for all pesticides to ensure that they have up-to-date scientific evaluations over time, and a cumulative impact consideration.

The gold standard of evidence gathering in evidence-based practice is: clinical knowledge and judgment. expert opinions. randomized clinical trials. theories of practice.

C. randomized clinical trials. A hierarchy of evidence, ranked in order of decreasing importance and use, has been accepted by many health professionals. The double-blind randomized controlled trial (RCT) generally ranks as the highest level of evidence. Some nurses would argue that this hierarchy ignores evidence gained from clinical experience. However, the definition of evidence-based nursing presented above indicates that clinical expertise as evidence, when used with other types of evidence, is used to make clinical decisions.

A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of: assessment. primary prevention. secondary prevention. tertiary prevention.

C. secondary prevention. Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernable pathology (state of prepathogenesis). In this case, the client has already has asthma, so the nurse teaches the client to recognize and avoid exposure to asthma triggers. This is an example of secondary prevention. Health screenings are at the core of secondary prevention. Tertiary prevention includes interventions aimed at limiting disability and interventions that enhance rehabilitation from disease, injury, or disability. Assessment is a component of epidemiology.

According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse? Organize the data. Analyze the data. Interpret and disseminate the data. Determine if surveillance is appropriate.

D. Determine if surveillance is appropriate. The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice (Centers for Public Health Nursing 2001, pp. 15, 16) suggests that surveillance is one of the interventions related to nursing practice in public health. The model provides seven basic steps of surveillance for nurses to follow: Consider whether surveillance as an intervention is appropriate for the situation. Organize the knowledge of the problem, its natural course of history, and its aftermath. Establish clear criteria for what constitutes a case. Collect sufficient data from multiple valid sources. Analyze the data. Interpret and disseminate the data to decision makers. Evaluate the impact of the surveillance system.

The difference between the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) can best be described as which of the following? NIOSH enforces workplace safety, and OSHA educates about occupational injury and illness prevention. NIOSH monitors work-related injury/illness incidence, prevalence, and prevention, and OSHA governs financial compensation under workers' compensation. OSHA is part of the Department of Labor, and NIOSH is part of the National Institutes of Health. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices.

D. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices. OSHA is the federal agency within the US Department of Labor that develops and enforces workplace safety and health regulations. OSHA sets the standards, enforcing them at the federal, state, and local levels. NIOSH is the federal agency within the Centers for Disease Control and Prevention that identifies, monitors, and educates about the incidence, prevalence, and prevention of work-related illnesses and injuries and examines potential hazards of new work technologies and practices. Although NIOSH and OSHA were both created by the same act of Congress, they have discrete functions.

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? Cognitive domain Events of instruction Principles of effective instruction Psychomotor domain

D. Psychomotor domain The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation.

The federal act that grants authority to the Environmental Protection Agency (EPA) which controls the generation, transportation, treatment, storage, and disposal of hazardous waste and ultimately called for the phaseout of land disposal of hazardous waste under a later amendment was the: Emergency Planning and Community Right-to-Know Act (EPCRA). National Environmental Policy Act (NEPA). Pollution Prevention Act (PPA). Resource Conservation and Recovery Act (RCRA).

D. Resource Conservation and Recovery Act (RCRA). The Resource Conservation and Recovery Act (RCRA) gave the EPA the authority to control the generation, transportation, treatment, storage, and disposal of hazardous waste. The 1984 federal Hazardous and Solid Waste Amendment to this act required phasing out land disposal of hazardous waste. The NEPA established the Environmental Protection Agency (EPA) and a national policy for the environment and provides for the establishment of a Council on Environmental Policy. The EPCRA was enacted to help local communities protect public health safety and the environment from chemical hazards. The PPA focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: a formative evaluation. an informal evaluation. an ongoing evaluation. a summative evaluation.

D. a summative evaluation. Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result. Formative evaluations are used to evaluate the progress of a program. An evaluation of program effectiveness may help the nurse evaluator determine both client and provider satisfaction with the program activities, as well as whether the program met its stated objectives.

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: assess the needs of potential outreach clients. recognize the special needs of vulnerable people in the area. identify how the problems of similar programs will not be repeated. identify the resources and activities that will help them meet their program objectives.

D. identify the resources and activities that will help them meet their program objectives. Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources.

When applying the nursing process to environmental health, the community health nurse would: conduct a focused assessment on the presenting problem. coordinate interventions with the physician only. examine criteria that include only the client's immediate response. include outcome measures that mitigate and eliminate the environmental factors.

D. include outcome measures that mitigate and eliminate the environmental factors. If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse would include outcome measures that mitigate and eliminate the environmental factors.

A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: action. process. structure. outcome.

D. outcome. The components of a quality assurance program are structure, process, outcome, evaluation, interpretation, and action. Outcome is the most important ingredient of a program because it is the key to evaluation of providers and agencies by external agents.

A disease outbreak of severe acute respiratory syndrome has occurred and has spread over several countries outside the United States. This level of occurrence is said to be: hyperendemic. sporadic. epidemic. pandemic.

D. pandemic. Pandemic refers to the epidemic spread of the problem over several countries or continents (such as severe acute respiratory syndrome [SARS] outbreak). If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. Sporadic problems are those with an irregular pattern with occasional cases found at irregular intervals. Epidemic means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and: evidence gathering. research design. research funding. research use.

D. research use. EBP represents a cultural change in practice. It provides an environment to improve both nursing practice and client outcomes. Several factors have been identified in the literature that support implementation of EBP or that will need to be overcome for nursing and other disciplines to successfully implement EBP. These factors include knowledge of research and current evidence and the ability to interpret evidence, among other factors. Gathering of evidence, research design, and funding are not associated with the slower development of EBP for nursing.

The purpose of recordkeeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: determine raises for personnel. explain cost overruns. foster independence in clinical practice. resolve legal issues in malpractice suits.

D. resolve legal issues in malpractice suits. Records are an important part of the communication structure of the health care organization. Accurate and complete records are required by law and must be kept by all agencies, both governmental and nongovernmental. In most states, the state departments of health stipulate the kinds of records to be kept and their content requirements for community agencies. Records provide complete information about the client (whether a family, group, population, or community), indicate the extent and quality of the services being given, resolve legal issues in malpractice suits, and provide information for education and research.

A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: efficiency. impact. relevance. sustainability.

D. sustainability. A program can be continued if there are resources for it. Programs funded as a demonstration project or through outside sources require ongoing funding to survive after the initial funding or time frame for the demonstration project has ended. If the reason for the evaluation is to examine the efficiency of a program, it may occur on an ongoing basis as a formative evaluation. If the evaluation of impact is the goal, long-term effects such as changes in morbidity and mortality must be investigated. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed.

An alternative definition of program management

In other words, it is Rational decision-making system (APIE) designed to help nurses design nursing services based on the Nursing Process on the program level

Evidence Based Practice

Includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders.

•Hierarchy of evidence: What is the highest level of evidence?

Randomized controlled trials

Evidence Based Medicine

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients.

Definition of Program Management

an organized approach to meet the assessed needs of: •Individuals •Families •Groups •Or Communities by reducing or eliminating 1 or more health problems

What is the ultimate goal of Program Planning?

ensure that health care services are acceptable, equal, effective & efficient

What is Quality Assurance?

maintaining desired level of care, paying attention to all levels of service •Prevents mistakes •Avoids problems •Focuses on client care

Randomized controlled trials

•Some include ways to judge that incorporate clinical experience, that is, professional guidelines •A systematic review of problems allows nurses to understand problems to find solutions with EBP •Evaluation of best practices allows nurses to attain the best success when working with communities