Population Health Exam 3 - Population-Focused Health Guidelines

Overarching goals of Healthy People 2020

- Attain high-quality, longer lives free of preventable disease (prevention) - Achieve health equity and eliminate disparities (health equity) - Create social and physical environments that promote good health (environments conducive to health for all) - Promote quality of life, healthy development, healthy behaviors across life stages (healthy development across the lifespan)

Barriers to EBP

lack of resources (time, funding, computers, knowledge) reluctance to accept findings resistance to questioning of long-established practices client noncompliance with recommended interventions

MAP-IT

mobilize: mobilizing key individuals and organizations into a coalition and identify roles for partners and assign responsibilities assess: assess both needs and assets in your community, work together as a coalition to set priorities, start collecting state and local data to paint a realistic picture of community needs plan: a good plan includes clear objectives and concrete steps to achieve them, consider your intervention points, think about how you will measure your progress implement: create a detailed workplan that lays out concrete action steps, identifies who is responsible for completing them, and sets a timeline/deadlines; consider identifying a single point of contact to manage the process and ensure that things get done; get the word out: develop a communication plan track: plan regular evaluations to measure and track your progress over time

PICOT format

population of interest intervention/practice strategy in question comparison outcome desired time frame

Grading the strength of evidence, look for

quality quantity consistency

Types of evidence

randomized control trial (double blind is highest level of evidence) non randomized clinical trials quasi-experimental studies case-controlled reports qualitative studies expert opinion

What are some of the greatest challenges in assuring the success of the National Prevention Strategy (check all that apply):

- Funding cuts - Lack of collaboration across agencies - Assuring the appropriate collaboration to address the multiple determinants of health, particularly those determinants not traditionally considered part of healthcare.

Social-ecological model

- Health care and health-related behavior are a function of individual, interpersonal, organizational, community, and population factors - Aim interventions at multiple levels

Social cognitive theory

- Individuals learned from their own behaviors and from observation of the behaviors of others and the benefits of those behaviors; also includes self-efficacy - Change strategies: verbal persuasion, role modeling, positive affective response, and positive reinforcement of the behavior

Community-based participatory research

- allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process - community members engaged in assessing, planning, implementing, and evaluating change - aim: create partnerships to promote health - collaboration within community organizations and community members is emphasized

National Prevention Strategy Challenges

- must survive external challenges from political opponents, as well as those looking for cost savings - must sustain the commitment and participation of the relevant federal agencies - must move beyond a narrow definition of prevention to further expand attention to health within non-health agencies (was created through ACA)

Health-risk appraisal instruments, although useful, have which of the following disadvantages (select all that apply)?

-Lack of cultural sensitivity. -Variable validity and reliability, failure to address access to care and other environmental issues.

Evidence-based practice

-The best available evidence from a variety of sources including research studies, nursing experience and expertise, and community leaders -Underlying principle: high-quality care is based on evidence rather than on tradition or intuition -A process whereby evidence, nursing theory, and the nurse's clinical expertise are evaluated and used, in conjunction with the client's involvement, to make critical decisions about client care for the best possible outcomes

Steps of EBP process

0.cultivating a spirit of inquiry 1.asking clinical questions 2.searching for the best evidence 3.critically appraising the evidence 4.integrating the evidence with clinical expertise and client preferences and values 5.evaluating the outcomes of the practice decisions or changes based on evidence 6.disseminating EBP results

At the request of a local housing authority, a public health nurse conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The public health nurse, the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level?

Aggregate client system level.

Although the definitions of evidence-based practice (EBP) in the literature vary widely, their common thread across all health care disciplines is:

Application of the best available evidence to improve practice.

Today, an evidence-based nursing practice can best be defined as which of the following?

Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served.

When a public health nurse uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of:

Assurance

Key agencies responsible for setting national health promotion guidelines

Healthy People (Office of Disease Prevention and Health Promotion with DHHS) National Prevention Strategy (many federal agencies)

National Prevention Strategy 4 Strategic Directions

Healthy and Safe Environments Clinical and Community Preventative Services Empowered People Elimination of Health Disparities

Community-oriented nurses use evidence-based practice (EBP) most effectively when they:

Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice.

The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies?

Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease.

Which model described the human-environment interaction?

Bronfenbrenner's ecosocial/social-ecological perspective

The use of volunteer community health advisors (CHAs) to promote health within the community is an effective community-level intervention because CHAs:

Build community capacity to address individual and community health needs.

Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of:

Case-control studies.

The local public health nurse participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be:

Coalition building.

Key agencies responsible for setting evidence-based screening guidelines

Community Preventive Services Task Force U.S. Preventive Services Task Force

Preventive Task Force at population/community level

Community Preventive Services Task Force Guidelines: The Guide to Community Preventive Services: The Community Guide

A community-oriented nurse seeks to implement evidence-based practice (EBP) in the community clinic's programs. The best model for the nurse to apply is:

Community development.

In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client:

Compliance with a prescribed regimen.

A public health nurse is working with the City Council and the County Board of Health to assure safe pedestrian and bike pathways for the downtown business district of Town Y. This nurse is addressing which of the Healthy People 2020 goals?

Create social and physical environments that promote good health for all.

When nurses work with communities, "best practices"-the application of the best available evidence to improve practice-must also be:

Culturally and financially appropriate.

A community health nurse is revising the agency's nursing protocols to incorporate current evidence-based practice (EBP) clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following (select all that apply)?

Disempowerment of nurses in their ability to make clinical decisions. Experienced nurses' challenging of the need to change long-accepted practices. Unwillingness of clients to accept changes in familiar agency programs. Urban agency setting with restricted computer resources.

Individual level health promotion models

Health belief model Transtheoretical/Stages of change model

Through an extensive database assessment of the county, the public health county nurse manager has identified that his county has higher rates of chlamydia (a common sexually transmitted disease (STD)) among 10-17 year olds than any neighboring county or the state. His next step to begin to address this issue should be to:

Mobilize key partners in the community who are important stakeholders in addressing STDs among children and adolescents.

A community-oriented nurse wants to design the most effective intervention to reduce coronary heart disease (CHD) morbidity and mortality in a rural area. The program approach should incorporate the strategies of:

Multilevel intervention with a focus on primary, secondary, and tertiary prevention.

Healthy People 2020 is managed by who?

ODPHP within DHHS created in 1979 released by 10 year goals

Health belief model

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy

A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of:

Primary prevention using evidence-based practice (EBP).

Which of the following community health improvement projects uses subjective health perspective?

Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program.

An effective community-oriented diabetes program should include:

Self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.

Examples of the application of evidence-based practice (EBP) to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with:

The Intervention Wheel.

A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices?

There is multilevel responsibility for health behaviors

National Prevention Strategy 7 Priorities

Tobacco Free living preventing drug abuse and excessive alcohol use healthy eating active living injury and violence free living reproductive and sexual health mental and emotional well-being

Preventive Task Force at individual level

U.S. Preventive Services Task Force Guidelines: Recommendations for Primary Care Practice Considered by many to be the GOLD STANDARD for clinical preventive services

HP 2020 EBP-related objectives

improving clients' understanding of EBP improving clients' understanding of how EBP contributes to health care decisions

Physical Activity Guidelines

first came out in 2008 recommended for ages 6 or older by 4 agencies: DHHS ODPHP, CDC, NIH, President's Council on Fitness, Sports & Nutrition

Dietary Guidelines

reviewed every 5 years by law by USDA Center for Nutrition Policy and Promotion (CNPP) and HHS guidelines are for those ages 2 or older basis for federal food, nutrition, health programs, and policies, school lunch programs, federal nutrition education CNPP projects: Dietary Guidelines for Americans, MyPlate Initiative, SuperTracker, Healthy Eating Index

Interpersonal level health promotion models

social cognitive theory

Community level health promotion models

social-ecological model

Approaches to finding evidence:

systematic review meta-analysis integrative review narrative review

National Prevention Strategy Goal

to increase the number of Americans who are healthy at every stage of life

Transtheoretical model/stages of change

• Precontemplation, contemplation, preparation, action, maintenance, termination