Chapter 8: Public Health Policy (Stanhope)
Action taken to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school, is called what kind of power? a. Executive b. Legislative c. Judicial d. Police
ANS: D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.
The relationship between nursing practice, health policy, and politics can best be described as nursing: A. advocacy. B. policy process. C. process. D. profession.
ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.
One effect of the use of block grants was a: a. Reduction of federal expenditures b. Decreased ability of states to spend money on programming c. Guaranteed continuation of programs with demonstrated effectiveness d. Shift from hospital-based to community-based nursing care
ANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures.
The state orders a person newly diagnosed with tuberculosis to be quarantined. What type of law allows the state to do this? a. Constitutional b. Common c. Judicial d. State
ANS: A Constitutional law provides overall guidance for selected practice situations.
When a local health department provides a hypertension screening to all individuals, which general category of health care functions is being used? a. Direct services b. Financing c. Information d. Policy setting
ANS: A Direct services are actions that provide health care directly to individuals.
It is important that nurses are involved in health policy because: a. Government and policy have a large impact on nursing and health. b. Policy affects nursing values as set forth by Florence Nightingale. c. Political science is a course of study that parallels nursing. d. Nurses must interpret laws to fit their practice.
ANS: A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care.
An occupational health nurse maintains a log of injuries from contaminated sharps because of the: a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD)
ANS: A OSHA is part of the Department of Labor. The Bloodborne Pathogen Standard became effective in 2002.
A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. This demonstrates the nurses involvement in: a. Policy b. Politics c. Law d. Health policy
ANS: A Politics is the art of influencing others to accept a specific course of action. Therefore political activities are used to arrive at a course of action (the policy).
Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: A. Centers for Disease Control and Prevention. B. Centers for Medicaid and Medicare Services. C. Health Resources and Services Administration. D. National Institute of Nursing Research.
ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.
The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. Unites States Department of Health and Human Services (DHHS) b. Public Health Service c. Health Resources and Services Administration d. World Health Organization
ANS: A The DHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency.
A member of the military receives health care services through which department? a. Defense b. Labor c. Agriculture d. Justice
ANS: A The Department of Defense delivers health care to members of the military, including their dependents and survivors, and to retired members and their families.
When a school nurse reports suspected child abuse, there is a breach of confidentiality. This breach is allowed because of: a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior
ANS: A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position.
Nurses are available to provide health services for women and children due to the provisions of the: a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) program
ANS: A This act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs.
Congress's legal base for actions in health care include (select all that apply): a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending power
ANS: A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military.
State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) A. Documentation of client status and progress B. Documentation of services C. Living wills and advance directives D. Resident's rights in long-term care facilities E. Right to death with dignity
ANS: A, B, C, D, E State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.
The Centers for Disease Control and Prevention accomplishes its mission by (select all that apply): a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environments
ANS: A, B, D The Centers for Disease Control and Prevention implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments.
A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? A. Executive branch of government B. Legislative branch of government C. Local representative D. Senate hearings
ANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.
The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: A. federal and state. B. federal, state, and local. C. all, but primarily state and local. D. all, but primarily federal and state.
ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.
Needle stick legislation clarified the role of employers to: a. Use Universal Precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste including needles.
ANS: B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices.
Health policy can best be defined as a set course of action to: A. administer public health care programs at the federal level for disaster preparedness, response, and recovery. B. obtain a desired health outcome for an individual, family, group, community, or society. C. support publicly funded health care programs at the local, state, and national levels. D. support health care development and research to improve the health status of citizens.
ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.
The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: A. apply only to underdeveloped countries. B. are guides for in-country initiatives and priorities. C. carry the weight of international law. D. provide mandates for in-country legislatures.
ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.
States have certain continuing education requirements for persons to renew a nursing license. This type of law is called: a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power
ANS: B Licensing is regulated by each states nurse practice act as a function of the board of nursing.
A doctoral prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which federal agency could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. Department of Health and Human Services (DHHS) d. World Health Organization (WHO)
ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care.
One of the main purposes of the Patient Protection and Affordable Care Act was to: a. Create a government-funded insurance program for all Americans. b. Make health insurance affordable for the middle class and small businesses. c. Decrease the rates of chronic disease in the United States. d. Increase the funding for public health agencies.
ANS: B One of the main purposes of this legislation was to make health insurance affordable for middle class families and small businesses with one of the largest tax cuts for health care in history: reducing premiums and out-of-pocket costs. This act does not create a government-funded insurance program nor does it increase funding for public health agencies.
If a nurse researcher wants to get information on the occurrence of an internationally important disease, where would be a good place to seek this information? a. The United Nations website b. The World Health Organization (WHO) website c. The World Bank website d. The World Health Assembly website
ANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death.
The United States Department of Health and Human Services (DHHS) is part of which branch of the government? a. Judicial b. Executive c. Legislative d. Health
ANS: B The executive branch includes regulatory departments, one of which is the United States DHHS.
When planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level, it is called: a. Evolution b. Devolution c. Block granting d. State administration
ANS: B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the states is called devolution. This was a major effort during the Reagan administration.
When writing to a legislator to advocate for funds to support advanced practice nursing education, a nurse should remember to (select all that apply): a. Limit the letter to one page in length. b. Identify oneself as a nurse. c. Provide only factual information. d. Share personal knowledge about the issue.
ANS: B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.
Nurses working in hospice and home care settings need to be knowledgeable of health policy to: a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.
ANS: C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services that are providing.
While researching various health care services that are provided in prisons, a nursing student learns that these services: a. Are funded by the Department of Defense b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illness
ANS: C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the Department of Justice. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.
A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? A. Citizen action committee B. Nursing diagnosis C. Nursing process D. Socratic method
ANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.
When a nurse is sued for malpractice and goes to court, which type of law is being used? a. Constitutional b. Common c. Judicial d. Institutional
ANS: C Judicial law is based on court or jury decisions.
The practices of physicians, nurses, and other health care providers are differentiated by the: a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. United States Department of Health and Human Services
ANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers.
Nursing practice is governed by: A. boards of nursing established by the U.S. Department of Health and Human Services. B. nurse practice acts promulgated by federal and state legislative boards. C. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. D. nurse practice acts promulgated by the states in conformity with broad federal guidelines.
ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.
A nurse is interested in census data. Which federal departments website would be a good place to start? a. Department of Labor b. United States Immunization Survey c. Commerce Department d. World Health Organization
ANS: C The Commerce Department handles the United States Census and population estimates and projections.
The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and provide: a. Vaccines for smallpox, anthrax, and plague b. Regulation of nuclear weapons c. Surveillance of bioterrorism threats d. Regulation of foreign nurses entering the United States
ANS: C The DHHS and the new federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States.
A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: A. American Public Health Association's guidelines. B. website of the Centers for Disease Control and Prevention. C. Healthy People initiatives. D. Pan American Health Organization's mission statement.
ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.
The first major federal government action relating to health was the: a. Passage of the Social Security Act b. Creation of the National Institutes of Health (NIH) c. Creation of the Public Health Service (PHS) d. Creation of Medicare and Medicaid
ANS: C The PHS was created in 1798.
A nurse is found to be negligent. Because of the doctrine of respondeat superior, the one responsible for that negligence is the: a. Administrator b. Nurses immediate supervisor c. Nurses employer d. Nurse
ANS: C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurses employer.
A nurse would like to propose legislation requiring all schools to employ a registered nurse. The first step taken in the legislative process would be: a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbying
ANS: C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.
Which branch of the government interprets the states rights to grant abortions? a. Executive branch b. Legislative branch c. Judicial branch d. Federal branch
ANS: C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states rights to define access to reproductive health services for citizens of the states.
A nurse believes additional funding is necessary to support a home-delivered meal program for the elderly. The best way to share these ideas with a legislator is to: a. Send an e-mail. b. Write a formal letter. c. Attend a town hall meeting. d. Schedule a face-to-face visit.
ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication.
A goal of the Division of Nursing is to: a. Enhance nursing competence in providing high-tech skills b. Apply disease prevention, environmental health, and health promotion concepts c. Provide scholarships for advanced nursing education d. Enhance racial and ethnic diversity in the nursing workforce
ANS: D One of the Division of Nursing goals is to enhance racial and ethnic diversity and cultural competency in the nursing workforce. The other statements apply to other agencies or are false.
The federal government provides for the protection of the publics health by: a. Interpreting decisions related to womens right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at the borders
ANS: D The United States Constitution gives the federal government the authority to provide for the protection of the publics health. By monitoring the influx of disease at the borders the publics health is being protected.
