Module 4 quiz evolve questions: Community
When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. What action would be the nurse's initial and most critical step for funding purposes? a. Identifying the target population's health problems and needs b. Prioritizing the community's problems c. Finding the lay leaders in the community d. Outlining the major causes of mortality in the community
A rationale: Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.
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? a. passive b. special c. active d. sentinel
A rationale: 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.
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: a. outcome b. process c. action d. structure
A rationale: 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 nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: a. promoter b. mediator c. intercessor d. obstructer
A rationale: The nurse advocate makes the client's rights the priority. The goal of promoter for the client's autonomy and self-determination may result in a high degree of client independence in decision making. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The nurse advocate does not exhibit roles of intercessor or obstructer in this situation.
Which of the following public health surveillance methods can also be used to examine specific disease and the impact on the health and economics of a population, such as COVID-19? a. sentinel method b. bioterrorism surveillance c. passive surveillance d. contact tracing
A rationale: The sentinel method of quality evaluation is based on epidemiological principles. This method is an outcome measure for examining specific diseases and the impact on the health and economics of a population, such as COVID-19. Changes in the sentinel indicate potential problems for others. For example, increases in encephalitis in certain communities may result from increases in mosquito populations. Data may be collected at the health department through a state or local required disease reporting system. The health department would be notified, and an immediate mosquito control strategy would be put into place.
A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: a. beneficence b. justice c. deontology d. veracity
A rationale: Beneficence can be impaired when excessive attention to cost supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Justice, as an ethical principle for case managers, considers equal distribution of health care with reasonable quality. Veracity, or truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship with a client. Deontology is not an ethical principle that applies to this situation.
During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. What are the case manager's most logical next steps? (Select all that apply.) a. Research the client's health care coverage and its provisions. b. Reassess the client at discharge to ensure needed care is not overlooked. c. Identify and arrange for the resources to provide needed services. d. Gather information on local support groups. e. Discuss with the family their ability to provide daily visits to the client.
A, C, D rationale: Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care the client needs to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers. If necessary services or equipment is not covered by insurance, the nurse may act as an advocate and connect the client with other resources in the community if available. The nurse will want to reassess the client, but that is not part of the next steps.
A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: (Select all that apply.) a. community weaknesses in quality of services. b. community satisfaction. c. community conflict-resolution skills. d. community cost concerns. e. community weaknesses in quantity of services.
A, E rationale: Case management activities with individual clients and families will reveal the larger picture of health services and health status of a community. Through a nurse's case management activities, general community weaknesses in quality and quantity of services often are discovered.
The public health nurse is most likely to use what types of surveillance systems? (Select all that apply.) a. passive b. active c. sentinel d. syndronic
AB rationale: 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.
A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? (Select all that apply.) a. thumb sucking b. fantasies of denial c. bed-wetting episodes d. increased playfulness with peers e. desire to return to school
ABC rationale: The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.
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 goals of Quality Improvement include which of the following? (Select all that apply.) a. improve safety in care provided b. Improve the timeliness of programs c. Increase responsiveness of programs d. Increase effectiveness of programs e. Optimize internal resources
ABCDE rationale: The goals of 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, which in this case is the client. Quality improvement in public health can help teams use resources more effectively, and has been demonstrated to improve service delivery and customer service, and help meet national public health standards, such as those for voluntary public health department accreditation. Many agencies use concepts, such as client satisfaction questionnaires, or the plan, do, check, act approach to see if improvement has occurred in healthcare delivery.
What are the purposes of disease surveillance in public health? (Select all that apply.) a. Reduces morbidity and mortality and improves health through disease trend monitoring. b. Generates knowledge about disease or outbreak patterns. c. Tries to identify terrorist attacks before they occur. d. Provides a means for nurses to monitor disease trends. e. Allows the nurse to advocate for policy changes.
ABD rationale: 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.
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: a. hyperendemic b. pandemic c. epidemic d. sporadic
B rationale: 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.
The nurse's knowledge and understanding of the disease surveillance systems is critical to perform which activity? a. Facilitating planning and policy changes b. Improving the quality and usefulness of the data collected c. Detecting epidemics and pandemics d. Understanding the relationship between epidemiologic principles
B rationale: Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming.
A nurse is among the first responders to a disaster. What action by the nurse takes priority? a. Arranging for shelter for disaster providers b. Immediately developing plans for effective triage and client management. c. Beginning disease surveillance and planning health education d. Beginning community assessment as soon as possible
B rationale: The first priority when responding to a disaster is to immediately plan for, coordinate, and carry out effective triage. Disaster response includes community assessment, surveillance, health education, and coordination of shelter arrangements. However, the first task is to provide care for life-threatening injuries and conditions.
A voluntary 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: a. charter b. credentialing c. licensing d. accreditation
B rationale: The voluntary approach involves a large governing or official body's evaluation of a person's or an agency's ability to meet criteria or standards through processes like accreditation or certification. 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. Required approaches to QI are methods used to manage a specific health care delivery system in an attempt to deliver care with outcomes that are acceptable to the consumer such as state licensure of a health department , licensing of health care providers, like boards of nursing.
A community health nurse involved in care management would most likely: a. manage the staff at a free clinic. b. monitor the health status, resources, and outcomes for an aggregate. c. develop, conduct, and evaluate health teaching programs in primary care. d. provide immunizations to migrant workers.
B. monitor the health status, resources, and outcomes for an aggregate. rationale: Care management is an enduring process in which a care manager establishes systems and monitors the health status, resources, and outcomes for an aggregate or a targeted segment of the population or a group. Care management strategies include use management, critical paths, disease management, demand management, and case management.
What are the core competencies of the nurse participating in surveillance and investigation activities? (Select all that apply.) a. Advanced-practice nurse with secondary science degree b. effective communication skills c. leadership and systems thinking d. basic patient assessment skills e. ability to collaborate with community partners
BCE rationale: 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
The major sources of information for program evaluation are: (Select all that apply.) a. media reports b. program records c. program clients d. program providers e. community indexes
BCE rationale; 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 purpose of record keeping by a community health agency is to maintain complete information on clients served and the extent and quality of services provided to these clients. Other important uses of these records may include which of the following? (Select all that apply.) a. Foster independence in clinical practice. b. Provide information for education and research. c. Determine performance raises for staff. d. Resolve legal matters in malpractice suits. e. Explain cost overruns.
BD rationale: Records provide complete information about the client, indicate the extent and quality of services provided, resolve legal issues in malpractice suits, and provide information for education and research.
In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: a. cooperation b. communication c. collaboration d. negotiation
C rationale: Collaboration is achieved through a developmental process that occurs in a sequence, yet it is reciprocal between those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required in all aspects. It requires the synergy of all parties involved. The goal of communication in the collaborative development process is to promote respect for, understanding of, and the accuracy of all team members' points of view. Cooperation is the ability to understand and meet the needs of others. Negotiation generally occurs in a situation involving conflict.
A community health nurse practitioner has been assigned to revamp the agency's old quality assurance program into a continuous quality improvement (CQI) program. The new program will: a. focus on using external standards and expectations to determine quality measures. b. include all members of the organization in problem solving, with a focus on what went wrong and who was responsible for the problem in order to diagnose and fix the problem. c. focus on methods of analysis of the scientific process to look at the structure, process, and outcomes of an organization, with all members of the organization involved in improvement. d. primarily involve senior management in identifying process improvement opportunities to detect errors and deficiencies.
C rationale: Model quality assurance and quality improvement programs are comprehensive. To accomplish effective long-term quality improvement in an organization, the program needs to address the structure, process, and outcomes within an organization. The program must include all members of the organization affected by the program. The focus of the program is systems change, not assignment of blame.
In the event of a disaster, shelters are generally the responsibility of which of the following entities? a. public health service (PHS) b. CDC c. american red cross chapter d. federal emergency management agency (FEMA)
C rationale: Shelters are generally the responsibility of the local American Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.
A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: a. community preparedness b. personal preparedness c. professional preparedness d. American red cross disaster training
C rationale: The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.
Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? a. scapegoating and blaming b. sense of urgency c. effects of stress on individuals d. anxiety
C rationale: The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.
To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: a. active TB cases b. immunizations c. vulnerable populations d. WIC enrollees
C rationale: When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.
The major factor that has increased the danger of natural disasters is: a. trade winds b. geography c. urbanization d. el nino
C rationale: The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.
Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? (Select all that apply.) a. Disillusionment is the longest phase in the stress reaction process. b. Disillusionment and reconstruction is most associated with response efforts. c. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. d. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. e. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster.
C, D, E rationale: The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Survivors will gather to share experiences and stories. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The last phase, Reconstruction, is the longest. Homes, schools, churches, and other community elements need to be rebuilt and reestablished.
The deliberate release of viruses, bacteria, or other germs with the intent of causing illness or death is: a. surveillance b. chemical terrorism c. event outbreak d. bioterrorism
D rationale Bioterrorism is the intentional use of microorganisms or toxins derived from living organisms to cause death or disease in humans or the animals and plants on which we depend 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).
What is the purpose of using an algorithm in the surveillance process? a. Provides the nurse with a system for telephone triage in an outbreak. b. Tells the nurse who to call in the event of an outbreak. c. It is a visual reminder of the epidemiologic triangle. d. Provides the nurse with a step by step plan to identify events needing investigation.
D rationale: 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).
A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: a. cooperation b. negotiation c. aggressiveness d. assertiveness
D rationale: Assertiveness is the ability to present one's own needs and is a behavior often seen in conflict situations. Negotiating is a strategic process used to move conflicting parties toward an outcome. Cooperation is the ability to understand and meet the needs of others. Aggressiveness is a behavior which may be exhibited in a conflict situation.
A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: a. continuity of care b. care management c. disease management d. case management
D rationale: Case management is identified as one of the 17 interventions in the scope of practice in community health nursing. Case management is defined as the ability to optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Case management, in contrast to the definition of care management, refers to activities implemented with individual clients in a system. Care management includes the concept of disease management.
The Quad Council for Public Health Nursing and the Association of Community Health Nursing Educators (ACHNE) have worked to advance the community and public health through which means? a. Voluntary credentialing and mandatory licensing programs b. Mandatory accreditation and certification programs c. Practice guideline clearinghouse, and quality indices d. Scope/standards of practice and nursing education curriculum
D rationale: Efforts to strengthen nursing practice in the community have been carried out by several nursing organizations. These include the American Nurses Association, Public Health Nursing Section of the American Public Health Association, Association of State and Territorial Directors of Nursing, and ACHNE, collectively known as the Quad Council for Public Health Nursing. In 2007, the Quad Council reviewed the scope and standards of practice for population-focused (public health), community health, and community-based nursing practice and developed new standards to guide the profession. The major area of concern of ACHNE is the quality of nursing education in preparing nursing students for practice in the community. ACHNE has identified the curriculum content required for the preparation of community health nurses.
The required 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: a. consumer and the profession b. public and professional associations c. legislature and the state board d. profession and the state
D rationale: 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 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: a. foster independence in clinical practice. b. determine raises for personnel. c. explain cost overruns. d. resolve legal issues in malpractice suits.
D rationale: 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 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: a. ongoing evaluation b. informal evaluation c. formative evaluation d. summative evaluation
D rationale: 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: a. assess the needs of potential outreach clients. b. recognize the special needs of vulnerable people in the area. c. identify how the problems of similar programs will not be repeated. d. identify the resources and activities that will help them meet their program objectives.
D rationale: 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.
A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about childcare. The next step in the program management process would be to: a. determine whether the fathers have benefited from this type of program before. b. provide the fathers with community resources. c. conduct a survey to determine how many children the fathers have. d. meet with community members to form a planning body.
D rationale: 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.
Nurses often participate in field assessment teams during a disaster response. These assessments are crucial to best help: a. match available resources to the population's emergency needs. b. encourage good intentions of those giving aid. c. separate casualties and allocate treatment. d. provide compassion and dignity.
a rationale: Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.
According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse? a. Determine if surveillance is appropriate. b. organize the data c. analyze the data d. interpret and disseminate the data
a rationale: The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice 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.
A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: a. recent census data b. voter registration records c. epidemiologic data d. CDC reports
c rationale: 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.
Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: a. anger b. inability to concentrate c. delayed stress reaction d. insomnia
c rationale: Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and coworkers or if they have left the disaster site thinking that so much more could have been done.
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? a. Assessment Protocol for Excellence in Public Health (APEXPH) b. Health Evaluation Data Information System (HEDIS) c. Mobilizing for Action Through Planning and Partnership (MAPP) d. Planning Approach to Community Health (PATCH)
c rationale: 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.
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: a. progress b. relevance c. sustainability d. efficiency
d rationale: 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.
A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: a. care management and continuity of care. b. care management and case management. c. advocacy and continuity of care. d. advocacy and case management.
d rationale: Clients are a part of larger systems: the family, the work environment, and the community. Each system interacts with the client to shape available options through resources, needs, and desires. The practice of advocacy may entail the ability to focus attention on the magnitude of problems caused by diseases affecting a segment of the population. Advocacy often stimulates a community's self-determination to find innovative actions to correct gaps in service.
Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases? a. active b. syndronic c. passive d. sentinel
d rationale: 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.
When acting as a mediator, the nurse advocate would: a. choose a new health plan for a client with limited funds. b. set up a doctor's appointment for an illiterate adult. c. provide health education to teens who need knowledge about sexually transmitted diseases. d. assist new parents in communicating with their health plan regarding well-baby coverage.
d rationale: Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The goal of the nurse advocate as mediator is to help parties understand each other on many levels so that agreement on an action is possible.
The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: a. the government provides economic support. b. religious organizations must bear the burden of the community. c. environmental hazards are minimal. d. individuals must ultimately recover on their own.
d rationale: Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period, all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.
The nurse engaging in formative program evaluation would most likely: a. write policy for risk management. b. participate in new client evaluation. c. make a home visit before a client is discharged from the program. d. conduct medical record audits for quality assurance.
d. rationale: 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.
