Community Health Test 1 - Ch 1, 2, 3, 5, 9, 11, 12, 24

The International Council of Nurses is a federation of more than how many national nurses associations? A. 100 B. 110 C. 120 D. 130

D - 130

True or false? The United States has found the most efficient and effective ways to care for all by decreasing health disparities and giving access to care equally.

False

True or false? The purpose of using levers of change is to decrease driving forces and/or to increase restraining forces

False - increase driving and decrease restraining

True or false? The U.S. healthcare system is a unique system of both independent power and action by the federal government.

False, it is a unique system of independent and collaborative powers of both federal and state governments

The nurse is working through an ethical dilemma using a decision-making process developed by the Ohio Nurses Association. After identifying the existence of the ethical dilemma, the next step in this process is to:

Gather and analyze relevant information (The Ohio Nurses Association (2006) developed a process to guide nurses in working through ethical dilemmas. This process includes the following steps, in order: 1) Identifying the existence of the ethical dilemma (conflict in values); 2) gathering and analyzing relevant information—including identification of stakeholders, interdisciplinary team members, and other sources of relevant information; 3) clarifying personal values and moral position, including the moral perspectives of other "players" in the scenario; 4) determining options on the basis of careful consideration of alternatives' benefits and risks; 5) making responsible decisions about actions or recommendations, in collaboration with other interested parties; and 6) evaluating the impact of the action and outcomes.)

True or false? Nongovernmental organizations use endowed funds or private fund-raising to address the needs of individuals, families, and populations.

True

Which country spends the most on healthcare?

United States

A client visits the office of an independent nurse practitioner to have routine blood work done. The client returns 1 week later for a follow-up visit to discuss the results and formulate a new treatment plan. On the basis of the client's insurance plan, the client is only obligated to pay $15 copay for this service. The total payment that the client's insurance company provides the practitioner is $180, which covers the $80 fee for a 15-minute visit and the $100 cost of laboratory services. On the basis of the nurse's current client load, $40 of the $80 fee for the visit covers overhead and the remaining $40 is profit. In terms of cost-benefit analysis, which is the actual financial cost to the nurse for providing this service?

$140 (Using cost-benefit analysis, the cost to the provider is the actual and direct cost of providing a service, which in this case would be $100 for the laboratory services plus $40 for office overhead, which equals $140. Clients are interested in their own out-of-pocket payment, which in this case would be $15. The actual total payment for the service is usually what matters to the payer or insurance company, which in this case is $180.)

Key Components to Advancing Public Health Systems

(1) identifying indicators of health, (2) being committed to providing healthcare professionals and the public with a system that works, and (3) generating policy that allows for the production of positive outcomes

*Chapter 3*

*Chapter 3*

*Chapter 9*

*Chapter 9*

*Chapter 2*

*chapter 2*

The nurse is interested in taking on a role in the state's political decision-making process. Which political skills will the nurse need to be effective in this role? (Select all that apply.)

- Ability to understand others' behaviors - Social skills - Ability to network (Healthcare professionals have political skills and active roles in healthcare leadership. These skills include the following: social skills and the ability to understand, interpret, and represent one's own and others' behaviors; the ability, qualifications, and power to influence others and make changes; the ability to develop, connect, and use different social networks; and having a high level of integrity, sincerity, and genuineness.)

Overall Goals of Healthy People 2020

- Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. - Achieve health equity, eliminate health disparities, and improve health of all groups. - Create social and physical environments that promote good health for all. - Promote quality of life, healthy development, and healthy behaviors across all life stages

Nurses are effective and influential shapers of healthcare policy because of their expertise in: (Select all that apply.)

- Clinical practice - Administration - Education - Research

Select the nursing ethical principles established by the American Nurses Association's (ANA) Code of Ethics for Nurses? (Select all that apply.)

- Compassion and respect for the dignity, worth, and uniqueness of every individual - Promotion and advocacy to protect the client's health, safety, and rights - Participation in establishing, maintaining, and improving healthcare environments and conditions (Nursing ethical principles established by the ANA's Code of Ethics for Nurses include the following: 1) compassion and respect for the dignity, worth, and uniqueness of every individual; 2) primary commitment to the client (individual, family, group, or community), not to the physician; 3) promotion and advocacy to protect the client's health, safety, and rights; 4) responsibility and accountability for individual nursing practice by appropriate delegation of tasks to provide optimum care; 5) responsibility to preserve integrity and safety, maintain competence, and continue personal/professional growth; 6) participation in establishing, maintaining, and improving healthcare environments and conditions; 7) participation in the advancement of the profession through contributions to practice, education, administration, and research; 8) collaboration with other healthcare professionals and the public in promoting community, national, and international efforts to meet health needs; and 9) responsibility for articulating values, maintaining integrity, and shaping social policy.)

Evaluating Community Level Interventions

- Develop evaluation questions "focused on what happened, how well it happened, why it happened the way it did, and what the results were" - Determine indicators or measures you will use to answer your evaluation questions. - Identify where you will find the data you need to measure your indicators and answer your questions. - Decide what method you will use to collect data. - Specify the time frame for when you will collect data. - Plan how you will analyze your data based on the type of data you are using. - Decide how you will communicate your results

Which public health entities are often regulated by the U.S. federal government? (Select all that apply.)

- Food - Medications - Devices - Environment (The federal government plays an important role in the regulation of public health. Public health entities of regulation are often related to (1) food, (2) drugs, (3) devices, (4) occupation health, and (5) the environment through the Department of Health and Human Services. School health is typically regulated by state and local governments, not the federal government.)

Functions of Public Health in the U.S.

- Healthy People 2020: a national consensus plan identifying focal areas which need active and specific plans and implementations, based on levels of illness (morbidity) and death (mortality) that account for the physical, psychosocial, and financial suffering of citizens - Funding for the healthcare system in the United States comes primarily from privately-owned health insurance companies. Exceptions include programs that are publically funded, such as Medicare, Medicaid, TRICARE (civilian health benefits for military personnel, retirees, and dependents), Children's Health and Insurance Program (CHIP), and Veterans Health Administration

A client receives Medicare, has limited income, and lives in a large city. Which factors are likely to limit the client's ability to access healthcare? (Select all that apply.)

- Inability to afford supplemental insurance - High out-of-pocket expenses (The underinsured include older individuals who receive Medicare but cannot afford supplemental insurance or the out-of-pocket expenses associated with Medicare. Those living in a rural area, not an urban area, would be likely to have difficulty finding available healthcare providers. In-network providers would apply to private insurance, not to Medicare.)

The Department of Health and Human Services has identified several areas for which health disparities exist among various demographic groups and need to be addressed. Which are included among these areas? (Select all that apply.)

- Infant mortality - Cancer screening - Cardiovascular disease - Diabetes (The Department of Health and Human Services has identified six areas for which it has oversight and that require effort to reduce disparities. These areas are (1) infant mortality, (2) cancer screening, (3) cardiovascular disease, (4) diabetes, (5) HIV/AIDS, and (6) immunizations. End-stage renal disease is not an area of focus.)

Which steps must take place to improve the U.S. healthcare system, according to Porter? (Select all that apply.)

- Measurement and dissemination of health outcomes must be shared. - Clients' involvement in their health must improve and incentives for client involvement should be considered. (Porter lists the following steps that must take place to improve the U.S. healthcare system: 1) measurement and dissemination of health outcomes must be shared; 2) the delivery of prevention, wellness, screening, and routine health maintenance services must be fundamentally restructured (not preserved); 3) care delivery must be reorganized around medical conditions (not around the availability of physicians); 4) a reimbursement program for healthcare professionals as incentives to achieve better outcomes for clients must be established; 5) providers must compete for clients (not nurses) on the basis of the quality of the care provided; 6) all providers must establish electronic medical records; and 7) clients' involvement in their health must improve and incentives for client involvement should be considered.)

The client is a single mother of two who earns minimum wage at a part-time job and never graduated from high school. Which healthcare-related outcomes is the client at increased risk for, based on her circumstances? (Select all that apply.)

- Morbidity - Mortality - Difficulty accessing care - Negative outcomes when receiving care (Marginalization often occurs in people who live below the poverty level in the United States, and these people frequently are poorly educated. In the chapters that follow, higher rates of morbidity, mortality, difficulty in accessing care, and negative outcomes when receiving care, will be seen as key issues in such populations. This client's circumstances would not increase her risk of experiencing a genetic disorder.)

The nurse applies a cost-benefit analysis to the healthcare model. Which costs are the primary concerns of the client? (Select all that apply.)

- Out of pocket payment - Suffering and pain - Psychological costs (Clients are interested in their own out-of-pocket payment, as well as the psychological costs, suffering, and pain, which are difficult to quantify yet have long-lasting negative effects. The total payment for the service is usually what matters to the payer. The providers are usually concerned with the actual and direct cost of providing a service.)

Which goals are part of the Patient Protection and Affordable Care Act (ACA), which was passed in 2010? (Select all that apply.)

- Reducing the costs and improving the efficiency of healthcare - Expanding health insurance coverage - Expanding healthcare access to children (Through the Patient Protection and Affordable Care Act (ACA), the Obama administration's goals in improving the overall healthcare system and the quality of care include but are not limited to the following: 1) expanding health insurance coverage, 2) shifting the focus of the healthcare delivery system from treatment to prevention (not from prevention to treatment), and 3) reducing the costs and improving the efficiency of healthcare. Additionally, the ACA expanded healthcare access to children. Through the ACA, youth are allowed to remain on their parents' healthcare plan to the age of 26, insurers are no longer allowed to exclude children from coverage because of preexisting conditions, and access has been expanded through state-based health insurance exchanges for uninsured families.)

A nurse has just finished providing teaching and care to a child with type 1 diabetes. On the basis of the five dimensions of healthcare identified by the Institute of Medicine, indicators of quality care include that the child: (Select all that apply.)

- Safely self-injected insulin in the office - Has maintained an appropriate blood glucose level consistently for 6 months - Received care that was identical to that provided to six other clients of various racial backgrounds - Received instructions directly from the nurse in the office, not via a parent (The Institute of Medicine lists the following dimensions of healthcare systems that should be considered when quality, cost, and access are examined: 1) safety: avoiding injury and harm from care that is meant to aid clients; 2) effectiveness: assuring that "evidence-based" care is actually delivered, by avoiding overuse of medically unproven care and underuse of medically sound care; 3) client-centeredness: involving clients thoroughly in the decision-making process about their care, thereby respecting their culture, social circumstances, and needs; 4) timeliness: avoiding unwanted delays in treatment; and 5) equality: closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes.)

Which represent ways nurses can actively engage in policy making? (Select all that apply.)

- Testify at congressional hearings - Disseminate information on health issues in the media - Serve as member son governing boards (In terms of policy making, nurses can 1) provide vital evidence that either supports or opposes a policy, 2) be members of an organization or a group that introduces a specific problem into the national agenda and identifies the goals and tools needed to implement it, and 3) advocate for and disseminate information on health issues through the media. Nurses may also advocate for their clients by testifying at congressional hearings, healthcare summits, and regional forums regarding the need to eliminate disparities in healthcare access among various client demographics. The American Nurses Association works with coalitions and advocates for nurses to serve as members of governing boards in each state, to advance the role and recognition of nurses, to prevent potential declines in quality, and to communicate with the Congress in the prevention of harmful changes in Medicare. Documenting client symptoms and reviewing articles in nursing journals are tasks commonly performed by nurses but are not directly related to policy making.)

Healthcare Workforce Diversity

- The United States has an increasing healthcare professional immigration from other countries. - There is an increasing need for a diverse workforce of healthcare providers who can provide culturally competent care for the accelerating minority population. - The less diverse the workforce, the less representative and influential will be the impact of the healthcare providers on healthcare policies.

Which statements regarding the relationship between politics and healthcare are true? (Select all that apply

- The government should be interested in health matters when a problem affects a specific group or a whole population. - Political solutions can be achieved at both the federal and state levels. (Politics interferes with every aspect of healthcare in the United States. In reference to a political issue, the government should be interested in problems that affect a specific group or a whole population. There are many examples of the positive role that governments play through policies and legislations, including providing equal opportunity through universal provision of education, healthcare, and often housing and nutrition programs. There is little agreement between the two major U.S. political parties (Democrats and Republicans) when it comes to whom, how, what, and when healthcare should be provided and who should pay for it. Solutions can be achieved by working at either the federal or the state level.)

Which programs are funded by the Community Transformation Grant program? (Select all that apply.)

- Tobacco free living - Physical activity - Healthy eating (The Community Transformation Grant program funds programs that promote tobacco-free living, physical activity, healthy eating, services to prevent and control high blood pressure and high cholesterol, social and emotional wellness, and healthy and safe environments. It does not specifically provide funds for autism awareness or managing attention-deficit disorder.)

Health Planning at the National and State Level

- U.S. Department of Health & Human Services - CDC - State health departments

Government Agencies and Public Health

- U.S. Department of Health and Human Services - State and local health departments

Trends in Public Health in the U.S.

- U.S. makes a report every year of the trends in the following areas: (1) health status and what determines health (determinants), (2) how communities use healthcare services (health utilization) and healthcare resources to help communities stay healthy, (3) how much money is spent on healthcare (expenditures), and (4) which citizens are the most vulnerable

Multilevel Interventions

- Upstream: at the societal, environmental, or policy level - Mainstream: at the population or community level - Downstream: at the individual level Prevention of disease by intervening upstream at the social or environmental levels or mainstream at the community level amplifies the impact of such interventions on population health

Health Planning at the Global Level

- WHO (Commission on Social Determinants of Health (CSDH) issued their report Closing the Gap in a Generation - three overall recommendations of the CSDH are to (1) improve the conditions under which all people are born, grow, live, work, and age to minimum standards; (2) ensure more equitable distribution of power, money, and resources; and (3) expand knowledge of the social determinants of health and establish a system to measure and monitor health inequity) - UN

Health Impact Pyramid

- a framework that describes the public health impact of interventions at different levels in the social ecologic model - At the base of the pyramid are interventions to address socioeconomic conditions such as poverty, lack of education, and lack of access to clean water or sanitation - top of pyramid: Health education and counseling - may be helpful in individual and family interventions, but must be repeated with each new client and may have little effect at the population level

Quality of Care

- defined by the Institute of Medicine (2001) as the degree to which health services for individuals and populations increase the likelihood of desired outcomes, and are consistent with current knowledge - the following dimensions of healthcare systems that should be considered when quality, cost, and access are examined: -- Safety: avoiding injury and harm from care that is meant to aid patients -- Effectiveness: assuring that "evidence-based" care is actually delivered, by avoiding overuse of medically unproven care, and underuse of medically sound care -- Patient-centeredness: involving patients thoroughly in the decision-making process about their care, thereby respecting their culture, social circumstances, and needs -- Timeliness: avoiding unwanted delays in treatment -- Equality: closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes

Department of Health and Human Services

- federal agency that is directly involved with the health and healthcare of U.S. citizens or refugees/ - identified six areas for which it has oversight. These areas are (1) infant mortality, (2) cancer screening, (3) cardiovascular disease, (4) diabetes, (5) HIV/AIDS, and (6) immunizations - 11 agencies that provide (1) assessment information regarding the level of health or illness in the nation; (2) assurance that the infrastructure, including trained personnel, is available to all citizens and refugees/asylees; and (3) legislation and implementation of health policy

International Council of Nurses

- federation of more than 130 national nurses associations, representing more than 13 million nurses worldwide - works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing work force - particularly active in the following: -- International classification of nursing practice -- Advanced nursing practice -- Entrepreneurship -- HIV/AIDS, tuberculosis, and malaria -- Women's health -- Primary healthcare -- Family health -- Safe water

Forming a Coalition

- it is important to be clear about the nature and scope of responsibility of the group - coalitions bring together consumers, health professionals, policy-makers, and other constituencies to work together to improve community health status. The strategy of using coalitions to bring about change recognizes that (1) population health results from the interaction of social, cultural, economic, and political determinants in the overall community and (2) both the problems and the solutions are embedded in the community system

National Prevention Strategy

- overall goal is to increase the number of Americans who are healthy at every stage of life - has four strategic directions for national prevention efforts that form the foundation for the plan and its recommendations: (1) creating healthy and safe community environments, (2) integrating clinical and community preventive services, (3) empowering people in making healthy choices, and (4) eliminating health disparities - 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

Central Goal of Public Health

- reduction of disease through prevention and the improvement of health in the community - public health involves organized efforts to improve the health of communities rather than individuals

Policy Making Process

- setting an agenda - policy formulation - policy adoption - policy implementation - policy assessment - policy modification

State and Local Health Departments

- state departments are influenced by the federal government, and influence local health department and NGO's - local health departments (city or county) can be governed by state health departments, the local departments often create their own structure based on of the needs of the local community

Social Determinants of Health

- the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness - obesogenic environment: an environment promoting or contributing to obesity - salutogenic environment: only healthy food choices are available and physical activity is incorporated into school curricula

Lewin's Model of Change

- unfreezing: moves a community from the stage of denial or lack of awareness of the need to change a condition or to address an issue, to a stage of preplanning or preparation for change - changing: dynamic process that may be more successful when it is actively managed rather than allowed to happen haphazardly - refreezing: the process of stabilizing once a change has occurred with the goal of sustaining the change in the community's systems, policies, and customs

Which represents the correct order of events in the policy-making process?

1) Setting an agenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification (The correct order of events in the policy-making process is as follows: 1) setting an agenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification. An agenda must be set before a policy is formulated; this phase involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the problem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The final step is modifying the policy on the basis of the results of the assessment.)

UN MDGs

1. To eradicate extreme poverty and hunger 2. To achieve universal primary education 3. To promote gender equality and empowering women 4. To reduce child mortality rates 5. To improve maternal health 6. To combat HIV/AIDS, malaria, and other diseases 7. To ensure environmental sustainability 8. To develop a global partnership for development

National Health Expenditure Accounts are a measure of expenditures on healthcare goods and services in the United States. In the most recent set of estimates, expenditures totaled what percentage of U.S. health spending?

3 (Government public health activity constitutes an important service category. In the most recent set of estimates, expenditures totaled $56.1 billion in 2004, or 3% of total U.S. health spending)

Which best describes a nongovernmental organization?

Agency that acquires resources to help others from private rather than public sources. (A nongovernmental organization is an agency that acquires resources to help others from private rather than public sources. A bilateral agency is one that is based in only one country but provides services to many other countries. Organization for Economic Cooperation and Development is a group that collects data related to healthcare use across a variety of professional and service parameters. A philanthropic organization is one that uses endowed funds or private fundraising to address the needs of individuals, families, and populations.)

Which is characteristic of the German healthcare system?

An average hospital stay of 9 days (The average length of hospital stay in Germany has decreased in recent years from 14 to 9 days, still considerably longer than the 5- to 6-day average in the United States. Health insurance coverage is maintained by all citizens sharing in the effort to have an insurance pool, and payment is based on income, not risk. Currently, physicians in private practice provide ambulatory care, and centralized nonprofit hospitals offer the majority of inpatient care. Nurses in the German healthcare system, called sisters, are mostly diploma-educated individuals working with a physician.)

Which best describes a philanthropic organization?

An organization that uses endowed funds or private fundraising to address the needs of individuals, families, and populations

A nurse is interested in exploring initiatives related to health, poverty, and development in Africa. Which organization would most likely be involved in such an initiative?

Bill and Melinda Gates Foundation (Philanthropies are organizations that are similar to NGOs but they receive funding through personal endowments. For example, the Bill and Melinda Gates Foundation focuses on health, poverty, and development in Africa, South America, Asia, and Australia. The Living Proof Project supports vaccine and nutrition programs, as well as decreasing the incidence of diseases such as polio, HIV/AIDS, and tropical illnesses. Nongovernmental organizations are private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States. The International Committee of the Red Cross is known most for its role in disaster relief. Oxfam International focuses specifically on issues related to hunger and nutritional health.)

Which most accurately defines quality of care?

Degree to which health services increase the likelihood of desired outcomes and are consistent with current knowledge (Quality of care is defined by the Institute of Medicine as the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current knowledge. Reform is the improvement of what is wrong or unsatisfactory. Cost-benefit is an economic approach or analysis tool used to evaluate the effectiveness of a treatment or intervention. Workforce diversity is the presence of a variety of ethnic, racial, and cultural backgrounds of the workers in a specific area such as the health sector.)

Which type of payment system does the Netherlands have?

Dual-level payment system (The Netherlands has a dual-level healthcare payment system. All primary and acute care is financed from private mandatory insurance. Long-term care for the elderly, the dying, long-term mentally ill, and so on, is covered by money acquired from taxation and is considered a "social insurance.")

A nurse in the Canadian healthcare system is concerned because a client has been denied a surgical procedure that the nurse believes is essential to the client's recovery. Who should the nurse expect will have the most power to reverse this decision?

Health administrator (The most powerful individuals in the Canadian healthcare system are not physicians but health administrators, who put an emphasis on cost efficiency and social responsibility. Private insurance exists to cover services not covered under Medicare, such as vision needs, dental services, and pharmaceuticals for nonelderly people. This type of private insurance is acquired through employment contributions and represents a small portion of total health expenditures (15%). Nurses and nurse practitioners are important to the care of individuals and communities but play a lesser role in the administration of public healthcare.)

A family member receives Medicaid. Which is most likely to limit access of this person to healthcare?

Inability to find a provider who accepts Medicaid (Those covered by Medicaid have insurance but may experience problems accessing primary care due to their inability to find a private physician who accepts Medicaid clients. Out-of-pocket expenses may also be a factor in inability to access care. Preexisting conditions limited access to private insurance before the passage of the Patient Protection and Affordable Care Act of 2010 but should not limit access to healthcare in a client covered by Medicaid. Large insurance premiums would not pertain to Medicaid.)

In the United States, the system of healthcare has historically given and continues to give stronger support to which types of care?

Individual care with a focus on cure

A hurricane recently struck a nurse's hometown, and the nurse on behalf of the hospital is coordinating local relief efforts with nongovernmental organizations (NGOs). Which organization should this nurse most expect to work with in this situation?

International Committee of the Red Cross

Which characterizes physicians in France?

Physicians see about 15 clients a day (Characteristics of physicians in France include that physicians are unevenly distributed between rural and urban areas; about 50% of physicians are women; physician visits can take 15 to 30 minutes; and physicians see about 10 clients per day.)

The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. At the current meeting, the board has decided to allow use of cell phones only within certain waiting areas within the hospital, and nowhere else. Which stage of policy-making does this action represent?

Policy adoption (Policy adoption is the process of selecting the policy that will be implemented. Policy formulation is the stage in which various policy options are identified and explored. Policy implementation is the stage in which the selected policy is carried out by using human and financial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness.)

The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. After 6 months of a policy being in place and weeks of ongoing evaluation of the policy by individual board members, the board decided to expand the areas where cell phone use is permitted to include all waiting rooms and some client rooms. Which stage of policy-making does this action represent?

Policy modification (Policy modification is the step in which a policy that has already been implemented is maintained, changed, or eliminated on the basis of results of policy assessment. Policy adoption is the process of selecting the policy that will be implemented. Policy implementation is the stage in which the selected policy is carried out by using human and financial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness.)

The nurse is passionate about research for a cure for pediatric leukemia and has written the state representatives in Congress to urge them to expand federal funding for this research. This behavior is an example of involvement in:

Politics (Politics is the process of influencing the allocation of scarce resources, including financial resources, human resources, and time. A policy is a guideline that directs individuals' behavior toward a specific goal or a deliberate course of action chosen by an individual or group to deal with a problem. Public health is what society does collectively to ensure that conditions exist in which people can be healthy. Equity in healthcare refers to care that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status.)

Which is the fastest growing healthcare expenditure in the United States?

Prescription medications (Although hospital care accounts for the largest share of healthcare spending, prescription drugs are the fastest growing healthcare expenditure)

Which best describes a multilateral agency?

Receives funding from both governmental and nongovernmental sources (A multilateral agency is one that receives funding from both governmental and nongovernmental sources. A bilateral agency is one that is based in only one country but provides services to many other countries. The Department of Health and Human Services is a U.S. agency responsible for the health and welfare of citizens nationally. A nongovernmental organization (NGO) is an agency that acquires resources to help others from private rather than public sources.)

Which is the primary way that U.S. federal government has encouraged improved information management in the healthcare system?

Reimbursement and bonuses for physicians and hospitals for adopting electronic health records (As established in the American Recovery and Reinvestment Act, physicians who adopt and use electronic health records (EHRs) meaningfully can be reimbursed for their services up to $44,000 over 5 years. Similarly, hospitals that effectively utilize EHRs earn an incentive of $2 million through a one-time bonus. The other answers are not true.)

True or false? Equality is healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status.

True

True or false? Health planning occurs on both an ongoing and an episodic basis.

True

True or false? Health policies impact on the health of an individual, a family, and a population or community.

True

The nurse meets with a group of fellow nurses. They discuss the number of children who have died in hot cars and how likely they are to gain support from their state legislators to address the problem. The nurses are currently in which step of the policy-making process?

Setting an agenda (Setting an agenda, the first step in the policy-making process, involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the problem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The final step is modifying the policy on the basis of the results of the assessment.)

Systems Theory

States that social systems engage in reciprocal exchange or flows of information, energy, resources, and goods or services. Systems within the community are interdependent and interconnected. Change in one system leads to reciprocal changes in interconnected systems

A nurse works predominantly with clients who are active military personnel. Which publically funded program provides health benefits to this population?

TRICARE (Funding for the healthcare system in the United States comes primarily from privately owned health insurance companies. Exceptions include programs that are publically funded, such as Medicare, Medicaid, TRICARE (civilian health benefits for military personnel, retirees, and dependents), Children's Health and Insurance Program (CHIP), and Veterans Health Administration.)

Which best exemplifies a bilateral agency?

The U.S. Agency for International Development (USAID). (Bilateral agencies and organizations conduct their services within one specific country. USAID is a good example in the United States. It is a committed initiative that works with developing countries to enhance systems to fortify the health and welfare of international populations. Multilateral agencies and organizations receive funding from both governmental and nongovernmental sources. Examples of multilateral agencies include the United Nations and the WHO. The World Bank is another multilateral organization. Its major goal is to lend money to countries in need of developing their infrastructure on a variety of fronts.)

Levers of Change

The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces—leverage points identified in the force field analysis - tools or techniques that achieve the largest changes with the least investment of resources

Defining the Population of Interest

To develop a plan for a community program or initiative, first identify the population of interest that will be affected by, benefit from, or participate in the planned change. The population of interest may be an entire nation, state, county, or city on the basis of geographical or political boundaries

Which best exemplifies a public health goal in the United States?

To establish a free exercise program at a community center to promote fitness in a low-income neighborhood with high obesity rates (It is important to review several key components of the function public health serves through key initiatives, including a national consensus on goals, provision of systems of health insurance based on risk, not necessarily health, and the role of nongovernmental disease prevention and health promotion. In the United States, public healthcare includes disease prevention and health promotion based on science and cultural relevance. It is not focused on the health of the individual person but of the larger population. The goal of public healthcare is to keep populations healthy through a larger "reach" than connection at the individual level.)

A nurse is coordinating an initiative in the community to make sure that the healthcare needs of local refugees and asylees are recognized and addressed. Which federal agency should this nurse contact, as it is directly involved with the health and healthcare of refugees and asylees in the United States?

United States Department of Health and Human Services (The United States Department of Health and Human Services is the federal agency that is directly involved with the health and healthcare of U.S. citizens or refugees/asylees. The National Institutes of Health, Agency for Healthcare Research and Quality, and Centers for Disease Control and Prevention are three important organizations in which research is undertaken and used effectively to address key healthcare concerns such as HIV screening and care, address adverse events in hospital settings, and promote measures to decrease the rates of emerging infectious diseases.)

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations, representing more than 13 million nurses worldwide. In which area is the International Council of Nurses particularly active?

Women's health (ICN is particularly active in international classification of nursing practice; advanced (not basic) nursing practice; entrepreneurship; HIV/AIDS, tuberculosis, and malaria; women's health; primary (not secondary) healthcare; family health; and safe water (not safe immunization programs.))

Force Field Analysis

a change management technique developed by Lewin, involves identifying factors within a community or organization that are driving or reinforcing change in the desired direction, as well as those that are restraining or resisting change

Policies

a set of principles that govern an action to achieve a given outcome, or guidelines that direct individuals' behavior toward a specific goal

Community Assessment

a systematic process that may use several approaches, including key informant interviews, analysis of data on health status and health behavior indicators, observation, and community surveys. The goal of a CHA is to identify the community health problems that are the priorities for intervention, as well as community resources available to address each health problem or need

Nurse Managed Health Centers

a unique model of community health services led by advanced-practice nurses and providing a wide range of services and programs to vulnerable and underserved populations. The communities served by NMHCs are usually geographically defined and are most often vulnerable and underserved population aggregates such as the rural poor, migrant farm workers, low-income mothers and children, inner-city neighborhoods, and immigrant communities

Logic Model for a Community Health Program

a visual representation of the logic behind the operation of the program—who will receive services (target population), what will be done (activities), when it will happen (timeline), where, and why (program theory) - usually a process map or flow diagram

SMART

an acronym for program objectives that are specific, measurable, achievable, relevant, and time-bound.

Health Planning

an organized and systematic process in which problems are identified, priorities selected, and objectives set for the development of community health programs on the basis of the findings of CHAs and health surveillance data - occurs at the global, national, regional, state, county, and local levels

Bilateral Agencies

conduct their services within one specific country - Example: U.S. Agency for International Development (USAID) - a committed initiative which works with developing countries to enhance systems to fortify the health and welfare of international populations

Equity

defined by the Institute of Medicine (2001) as healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status - i.e. of inequity: Whites, Blacks, and Hispanics with cancer, who lived in high-poverty geographic areas, experienced a systematically lower 5-year survival rate

IHR

implemented by the World Health Organization, legal brief that addresses transnational control of infectious diseases, and which was developed as a response to the increase in international travel and trade

World Bank

international organization that uses funds from developed countries to help initiatives of developing countries

Health Impact Assessment (HIA)

part of social determinants of health; helps communities make informed choices about improving public health through community design. HIA is a process that helps evaluate the potential health effects of a plan, project, or policy before it is built or implemented

Health Policies

policies that have an impact on the health of an individual, a family, and a population or community and are created within the government, institution, or professional association

Nongovernmental Organizations (NGOs)

private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States - Example: International Committee of the Red Cross

Politics

process of influencing the allocation of resources needed to enable policy and involves the strategies needed to achieve the desired goals

Multilateral Agencies

receive funding from both governmental and nongovernmental sources - Examples: the United Nations, the WHO, World Bank

Community Health Improvement Planning Process

systematic process that involves all sectors of a community to conduct a comprehensive CHA, identify priorities for action, develop and implement a CHIP, and guide future community decisions and resource allocations

Information Management

the ARRA offers significant incentives through Medicare and Medicaid funding to physicians and hospitals if they adopt effective HIT and electronic health records (EHRs)

Working with the Community

the community health nurse seeks the participation of community members and institutions as partners in planning and implementing programs, or changing policies, to achieve desired health outcomes at the community level

Public Health Policy

the decisions made in regard to the health of individuals and the community

Gross Domestic Product (GDP)

the final and total output of goods and services produced by labor input within the United States in one year as determined by the Bureau of Economic Analysis; the main economic indicator used in the processes of evaluating policies in terms of their contribution to the economic growth

Economics

the study of how individuals, groups, organizations, and society allocate and utilize resources