ch 17

A community/public health nurse wanted to use normative-referenced evaluation to determine the effectiveness of an environmental pollution program in the community. After examining the number of asthma-related admissions at the local children's hospital, which of the following actions should the nurse take? a. Compare the admission levels attributable to asthma before and after the implementation. b. Compare the admission levels attributable to asthma with the admission levels attributable to accidents. c. Determine whether the admissions were attributable to asthma or other respiratory problems. d. Determine whether there were zero admissions because of the decreased incidence of asthma after the intervention.

A A zero rate is unrealistic because asthma may have multiple causes; removing one cause might decrease the incidence, but not to zero. In normative-referenced evaluation, measuring goal achievement may involve comparing the population in question with another population. An appropriate approach then would be comparing the population with itself before and after implementation

What is the purpose of outcome attainment? a. Answering the question "Were goals achieved?" b. Clarifying whether agency funds were appropriately expended c. Determining quantity of care given d. Measurement of community living outcomes

A Asking whether goals were achieved is identical with determining outcomes. Outcome attainment concerns measuring whether planned goals were achieved. Synonyms for this activity are performance evaluation, results of effort, and evaluation of effectiveness.

A nurse in a particular community decided that the priority was to decrease the number of teenagers who smoke. Which of the following should the nurse measure first? a. Percentage who currently smoke b. Attitudes toward smoking c. Prior experience with smoking cessation d. Knowledge about the dangers of smoking

A Before the nurse finalizes plans, baseline data on the behavior that is the target of change need to be collected. Although it would be useful to know all of the data mentioned, it is most helpful to know the proportion of teenagers who currently smoke, in order to determine any change. The proportion of the population that engages in smoking can then be compared with the proportion that engages after the intervention.

Stakeholders are defined as persons who a. Have expectations about care to be delivered. b. Have loaned money to the agency. c. Helped write the legislation for health care agency funding. d. Own stock in the agency.

A By definition, stakeholders are interested persons who have expectations about the care but are not directly involved.

Which of the following questions is answered by completing a cost-benefit analysis? a. Can similar outcomes be achieved with less cost? b. Can unlicensed assistive personnel give care equally rapidly? c. Was the care appropriate and given correctly? d. Was the nurse as efficient and as skilled as possible?

A Cost-effective measures determine the cost per unit of outcome, which helps establish conclusions as to whether similar outcomes can be achieved with less cost. Therefore, the question that is being asked is "Can similar outcomes be achieved with less cost?"

A community/public health nurse is planning the evaluation of a community education program about smoking cessation. Why is it important to complete this evaluation? a. It facilitates additional decision making. b. It clarifies the actual care involved in the service. c. It is required by accrediting agencies. d. It demonstrates that outcomes of the program were met.

A Evaluation yields data, which allow better comprehension and therefore better decisions. The purpose of evaluation is to facilitate additional decision making. The evaluation will help show whether the outcomes of the program have or have not met the goals.

What needs to be done when evaluation data are analyzed? a. Interpreting and judging the data before making any recommendations b. Examining data through the approach that has commonly been used by the agency c. Reviewing the literature and comparing it with current findings d. Using the Omaha System as the guiding framework

A Facts do not speak for themselves but must always be interpreted in context for meaning. Therefore, data used for evaluation must also be interpreted for meaning, and the desirability of the outcomes must be judged. The other responses are not appropriate for use in evaluating data.

To validate change in a population, which of the following should a nurse determine? a. Whether a high proportion of a random sample report change in their health behaviors b. Whether a majority of the population confirm changes in their health behaviors c. Whether each person the nurse individually taught reports a change in health behaviors d. Whether each staff nurse reports that their assigned families demonstrated a change in health behaviors

A Goals are written in terms of percentage of population, not an individual or a family. To study the population, a random sample of 10% to 20% is useful. It is not possible to obtain information from all community members

Which of the following is useful to review in determining whether the goals of the community/public health nurse are appropriate? a. The assessment of community members' health needs b. The focus areas for the nation in Healthy People 2020 c. Goals established by other, similar community/public health agencies d. Goals suggested by the public health research literature

A Healthy People 2020 is a guide to health care planning at the federal level, as well as for states and local communities. When the assessment and planning have been performed in partnership with the community, the health care is more likely to be appropriate. Goals are most appropriate when the nurse has assessed health needs of the aggregate, their readiness to change, and the resources available.

The community/public health nurse was enthusiastic about giving care to the community's residents. Which of the following actions should the nurse take when asked to attend a city council meeting? a. Appreciating the opportunity to meet the policy makers in the community b. Clarifying which agenda item was relevant to the agency and its purpose c. Insisting on dedicating the nurse's time toward giving care, not observing politics d. Pointing out that the nurse's caseload was too heavy to waste time in such a way

A Policies are expressions of goals and rules within a community, an expression of values. Policies can mandate, allow, or initiate actions that affect a community's health. Consequently, it is very valuable to meet policy makers and inform them of perhaps unrecognized health needs in the community.

A nurse is determining the quality of care that is provided. Which of the following factors would the nurse examine? a. Adequacy and appropriateness b. Agency mission statements c. Cost-benefit ratios d. Personal feelings about the care

A Quality is measured in terms such as efficiency, appropriateness, and adequacy.

A community/public health nurse was not sure the agency was large enough to fulfill some of its goals. Which of the following should the nurse evaluate in order to reach an accurate conclusion? a. The adequacy of resources, evident in such measures as waiting lists for services b. The financial base of the agency, evident in the agency budget c. The number of cooperative physicians, evident in the agency telephone referral list d. The number of nursing staff, evident in the staffing assignments

A The adequacy of resources is a crucial variable; waiting lists are one appropriate measure of how much care is currently needed but not yet received.

A community/public health nurse plans a program to improve the community's ability to prevent accidents. Which of the following measurements would be the best way to evaluate the outcomes of the nurse's intervention? a. Number of accidents in the subsequent year in comparison with the previous year b. Number of people who attended the educational program c. Number of requests for information received after the program d. Satisfaction level of those who attended the program

A The best evaluation is based on outcomes related to the intervention's purpose—in this case, a decrease in accident rate.

A community/public health nurse tried to keep the community informed of the progress of the new health programs at all the meetings that the nurse attended. Which of the following would be the reason for the nurse's ongoing communication? a. To avoid community dissatisfaction when expectations are not met b. To be sure that no one blames the nurse when unexpected happenings occur c. To fulfill the responsibility of keeping the community informed d. To be politically and culturally sensitive to the needs of the community

A The more the community/public health nurse is aware of stakeholders' expectations, the fewer surprises there will be later. Dissatisfaction occurs most frequently when expectations are not met. Continued communication allows early identification of misunderstandings, negotiation, and revision of the program to balance the interests of most of the stakeholders. It is not possible to satisfy everyone.

Which of the following is a necessary assumption for evaluation to occur? a. Accrediting agencies focus on careful documentation. b. Actions have both intended and unintended results. c. Nursing care is dependent on the reimbursement available. d. People expect professionals to document their care.

B Assumptions are that nurses are accountable for their own action and that nursing actions have results, both intended and unintended.

Which of the following factors can consumers easily evaluate? a. Appropriateness of the selected intervention b. Interpersonal skill of caregivers c. Quality of the care provided d. Effectiveness of the program

B Consumers can judge such factors as accessibility, waiting time, and cost, although not the intricacies, of the health care given. However, the most crucial factor is the interpersonal relationships of the caregivers with the clients.

One of the responsibilities of the community/public health nurse was to teach parenting classes to teenage mothers at high risk for committing child abuse. Which of the following would be an effective approach to helping mothers deal with their infants' behavior without resorting to physical discipline? a. Asking the mothers to listen carefully to the nurse's suggestions b. Asking the mothers to develop a contract to use the techniques discussed c. Asking the mothers to come to a consensus about how to deal with specific problems d. Asking the mothers to self-report abuse of their infants

B Contracts often increase the likelihood that actions will be performed, whereas the other options all have flaws: People other than the nurse may have helpful advice, fear is not the best motivator, and people who are not knowledgeable may not have good ideas, even in a group. Contracts increase commitment to specific actions and therefore increase the likelihood that the appropriate actions will be performed.

A community/public health nurse was told to focus on teenage smoking. Which of the following actions should be the priority of the nurse? a. Ensuring that smoking is not allowed on school property b. Establishing community-wide programs on the dangers of smoking c. Lobbying to pass laws against teenagers' purchase of cigarettes d. Establishing programs to help adults, especially parents, give up smoking

B In most states, it is already illegal for teenagers to purchase cigarettes, and most schools do not allow smoking on school property. Although focusing on parents would be helpful (because children often copy what their parents do), the most important step is to focus attention on the problem throughout the community. Community attitudes predispose the population to support or work against various policies, services, or behaviors.

Which of the following activities represents a challenge when a cost-benefit analysis is performed? a. Calculating all of the indirect, less visible costs b. Placing an appropriate dollar value on the benefits c. Using computer software to calculate the results d. Controlling the variables of cost and benefit

B It is difficult to quantify such qualitative items as benefit value of health care. Not all outcomes can be quantified in terms of dollars.

How does summative evaluation help the community/public health nurse? a. Analyzing the data and recognizing gaps b. Determining long-term effect on health c. Improving care as it is being delivered d. Enhancing future offerings of the program

B Summative evaluation takes place after the intervention is complete, even as long as months or years later, to determine whether a long-term effect was accomplished.

The community/public health nurse wanted to most effectively and efficiently determine the health and well-being of the community. Which of the following is the easiest way to determine a community's health? a. Ask the members of the media who report on the community b. Examine epidemiologic statistics of morbidity and mortality c. Review the discharge diagnoses of clients from the community hospital d. Visit the local grocery stores and exercise programs

B The fastest and easiest way to get an overall grasp of the community's health is to examine morbidity and mortality data.

A community/public health nurse was asked to document the conclusions of the agency's evaluation of its programs. Which of the following actions should the nurse take? (Select all that apply.) a. Include compliments to staff members about their involvement with the programs. b. Be sensitive to local ethnic and cultural groups when discussing behaviors. c. Assume that very powerful and influential persons will read the report. d. Include an executive report for people who will not read a long document. e. Use professional language and include statistical analysis of the findings. f. Word negative findings in a positive way for community residents.

B, C, D, F Evaluation reports need to be written for their audience, which may require more than one format. The nurse must be politically and culturally sensitive. Negative realities can be addressed with positive words. Remember that the most powerful and influential persons in the community may read the report. Consider the perspectives of the community members, and write in a way that does not reinforce cultural stereotypes or blame. Because the report may be long, writing an executive summary is helpful for people who do not have the time to read the whole report.

The nurse wanted to determine the community's level of self-esteem and well-being. Which of the following would be the most effective way to systematically and accurately determine the satisfaction level? a. Asking every community member, "What is your level of self-esteem?" b. Asking the employing agency's director, who lives in the community, about satisfaction level c. Distributing self-esteem scales to a random sample of community members d. Observing the clients currently using certain community-based services

C Emotional well-being in a population can be measured by the proportion of members who experience self-esteem and satisfaction with their lives. However, it is not realistic to ask this question of every member of the community. Thus, a random sample surveyed with a tool reliable and valid for an individual should yield an accurate portrayal of the proportion of members who experience positive self-esteem and satisfaction with their lives. This is the best way to get the best assessment of the entire community.

How does formative evaluation help the community/public health nurse? a. Analyzing the data and recognizing gaps b. Determining what to do differently next time c. Improving care as it is being delivered d. Enhancing future offerings of the program

C Formative evaluation occurs during delivery of care and allows the nurse to modify the care currently being given to improve the outcomes for clients.

Which of the following groups created the standards for evaluating effective nursing care with communities? a. The American Association of Colleges of Nursing b. The American Public Health Association c. The Quad Council of Public Health Nursing Organizations d. The National Council of State Boards of Nursing

C The Quad Council of Public Health Nursing Organizations wrote standards, which were most recently published by the American Nurses Association in 2007. An updated version will publish in early 2013.

Which of the following is the typical research design used for evaluation in a community/public health agency? a. Analysis of variance b. Multiple regression analysis c. Time series design or other quasi-experimental method d. True experiment with randomization and control

C Time series design is very useful because it allows pretest and posttest results to be compared in order to demonstrate that change did (or did not) occur. Later evaluations indicate whether the change was lasting. Because nurses cannot manipulate variables or use control groups, only quasi-experimental methods, not random clinical trials, can be used.

The community/public health nurse was excited about creating a program for prenatal education and care for single teenage mothers. Before writing an application for a grant to fund the program, what should the nurse determine? a. Agency's policies about writing grants for such a program b. Number of single teenage mothers in the local high schools c. Whether local teenagers are interested in receiving such a service d. Whether anyone else in the area is offering such a service

D Although community/public health nursing interventions may be directed toward establishing new services, the nurse must first be sure that a proposed service is not duplicating services already existing in the community.

Why is documentation of evaluation so crucial? a. It helps explain why nurses have limited time to provide direct client care. b. It helps keep administrators informed of what the staff is doing before staff evaluation time. c. It helps the nurse better understand the evaluation and the findings. d. It helps provide a baseline against which to study trends and make program decisions.

D Among other reasons, documentation is necessary to provide a baseline from which to detect changes in outcomes. Such documentation also provides a basis for deciding whether programs should be continued and how they might be modified.

Which of the following personal beliefs best demonstrates the meaning of self-efficacy? a. "You are capable of continued growth and development." b. "You are responsible for your own health and well-being." c. "You can improve your own health and well-being by using imagery." d. "You can influence your environment and circumstances."

D By definition, self-efficacy is the belief that a person can influence his or her environment and circumstances.

Which of the following descriptions characterizes a problem with the use of case descriptions as an evaluation method? a. They lack statistical documentation, despite telling about an interesting event. b. They have to be repeated in order to verify that no other factor could have changed the outcomes. c. They are not considered "good" research. d. They cannot prove that the nursing intervention led to the specific health outcomes.

D Case studies cannot prove that the nursing intervention led to the specific health outcomes. However, if the change occurred shortly after the implementation and there were no other community changes that might have contributed simultaneously to the change, it is justified to suggest the implementation had an effect on the change.

A nurse is planning to involve the community in the evaluation process. Why is this a critical part of evaluation? a. The nurse has completed her ethical, legal, and political responsibilities. b. The agency retains state approval and national accreditation. c. The community does not feel ignored by the agency. d. The interventions helped community members make appropriate lifestyle changes.

D Community involvement is crucial to ensure that the interventions were effective for people affected by them.

Which of the following is an example of a criterion-referenced evaluation? a. Comparing the population with regard to the factor of interest before and after the intervention b. Comparing the population with another population with regard to the factor of interest c. Determining whether the objective is appropriate for the program d. Determining whether the objective was reached at the desired level

D In criterion-referenced evaluation, an investigator measures the extent to which objectives are reached. Comparing the population with regard to various factors is an example of normative-referenced evaluation. Determining the appropriateness of the objective does not match the definition of criterion- or normative-referenced evaluation; rather, it addresses specific program evaluation.

A nurse is planning to examine program outcomes. Which of the following would be the most important question to ask? a. Was the agency adequately funded? b. What organizational process was used? c. What techniques were used? d. What were the end effects on clients?

D Outcomes focus on the end results of the care, such as "Did change occur?" or "What are actual effects on clients?"

Which of the following factors has a direct correlation with the health and well-being of the community? a. The number of hospitals and other health agencies in the community b. The number of physicians who practice in the community c. The government funding level of the community d. The poverty level of the community

D Standard of living (level of poverty) is associated with health status.

Why is the perspective of third-party payers and administrators an issue when cost-benefit analysis is performed? a. Administrators do not focus equally on costs and benefits. b. Administrators are not experts in cost-benefit analyses. c. Administrators lack understanding of health care benefits used in such analyses. d. Administrators ignore the client perspective of time, energy, and money.

D The perspective is that of the provider or the payer, not that of the client. Client time, energy, and money are typically not considered in the cost-benefit analysis. This oversight is an issue because what might be least expensive for an agency can be extremely expensive for a family.