Community Quiz/Exam #1

b.) False A major limitation of the Health Belief Model is that the burden of responsibility for health behaviors is on the individual client.

A major limitation of the Health Belief Model is that the burden of action related to health behaviors is exclusively on the aggregate. a.) True b.) False

a.) morbidity. b.) mortality. d.) life expectancy. e.) cancer incidence rates. Some of the more commonly reported health indicators used by health providers, policy makers, and community health nurses to measure the health of the community are life expectancy, infant mortality, age-adjusted death rates, and cancer incidence rates. Birth rates do not provide relative data to measure the health of a community.

A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include (Select all that apply.) a.) morbidity. b.) mortality. c.) birth rates. d.) life expectancy. e.) cancer incidence rates.

b.) perceived barrier. Perceived barriers to action are one's beliefs regarding the tangible and psychological costs of an advised action. Perceived susceptibility is one's belief regarding the chance of getting a given condition. Perceived benefit is one's belief in the ability of an advised action to reduce the health risk or seriousness of a given condition. Cues to action are strategies or conditions in one's environment that activate readiness to take action.

According to the Health Belief Model, the inconvenience of driving to a gym to exercise is an example of a: a.) perceived susceptibility. b.) perceived barrier. c.) perceived benefit. d.) cue to action.

Hill burton act: only focused in construction of hospitals did not focus on helping health care Affordable care act: Provides healthcare but caused an increase premiums and now mandated to pay premiums

Analyze factors that have contributed to the failure of health planning legislation to control health care costs?

a.) community as client. It is essential that community health nurses understand and are comfortable with the concept "community as client" before participating in health care planning. When focusing on the individual or family, nurses must remember that these clients are members of a larger population group or community, and environmental factors influence them.

Before participating in health care planning, a community health nurse must understand the concept of: a.) community as client. b.) individual as client. c.) family as client. d.) environment as client.

Rates: count of event relative to the size of the population at risk -Population proportions or fractions -Numerator is part of denominator -Allows for meaningful comparison- other communities or trends over time

Calculate epidemiological rates in order to characterize population health: Rates?

-Promote healthy lifestyles -Preventing disease and injury -Protecting the health of communities

Define and discuss the purposes of public health: Why do we have it?

Functions: -Assessment: regular collection, analysis, and information sharing about health conditions, risks, and resources in a community (windshield survey questions) -Policy Development: local, state compliance, direct resources (ex: using money for covid) -Use of information gathered during assessment to develop local and state health policies and to direct resources towards those policies -Assurance: Necessary health services available in communities (ex: restaurant inspections; sewer system when build house; immunization clinics available) -Focuses on the availability of necessary health services throughout the community. -It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations and the capacity to respond to critical situations and emergencies. Key principles: -Emphasize primary prevention: Be healthy -Work to achieve the greatest good for the largest number of individuals. (Social justice) -Recognize that the client is a partner in health. (homeless clinic) -Use resources wisely to promote the best outcomes.

Define and discuss the three functions of public health: What do they do?

Pollution, repetitive motions in jobs, sweatshops, started moving to the cities (sanitation issues (systems, food safety, isolation and quarantine, diseases)

Discuss public health initiatives to combat the impact of industrialization on public health?

-List actual or potential problems -Develop diagnostic statement- identify health problem/risk, the affected aggregate or community, the etiological or causal statement, and the evidence or support for the diagnosis -Disability, Disease: What the issue is -Community or Population: Geopolitical/population/teen moms/People with addiction issues -Etiological Statement: Causal statement -Health Indicators: Supporting data/evidence/larger population

Formulate community and aggregate diagnoses?

B.) Toxins C.) Bacteria A.) Host D.) Environmental E.) Host

Kahoot Question #10: Select all that apply

A.) Home health nurse performing wound care for a client who is immobile C.) School nurse teaching a student who has. asthma about medications

Kahoot Question #1: Select all that apply

-Lack of physical activity contributes to obesity -Environment affects physical activity; can be a social event -Physical activity decreases after age 24 -Activity decreases with income -Any activity is good activity -CDC -Walk Score- rankings of walkability for cities

Physical Activity and Health?

Essential to health promotion and disease prevention Sleep requirements: -Newborns (1-2 mo): 10.5-18 hrs -Infants (3-11 mo): 9-12 hrs during the night and 30-min to 2-hr naps, 1-4 hr a day -Toddlers (1-3 yrs): 12-14 hrs -Preschoolers (3-5 yrs): 11-13 hrs -School-aged children (5-12 yrs): 10-11 hrs -Teens (11-17 yrs): 8.5-9.25 hrs -Adults: 7-9 hrs -Older Adults: 7-9 hrs -Poor sleep increases chance of injury; awake 18+ hours similar to be intoxicated Audience- Nurses, shift workers, adolescents, parents/guardians -Promote good sleep hygiene, sleep assessments -National Sleep Foundation

Sleep and Health?

b.) secondary prevention. Secondary prevention includes early diagnosis and treatment to reduce the duration and severity of disease or dysfunction. Tertiary prevention applies to irreversible disability or damage and aims to rehabilitate and restore an optimal level of functioning. Option D is not a type of prevention.

Systems theory provides a framework that includes interventions that are possible at the three levels of prevention. The level of prevention that includes early diagnosis is: a.) primary prevention. b.) secondary prevention. c.) tertiary prevention. d.) supralevel prevention.

c.) Milio's framework Milio's theory demonstrates upstream conceptualization of understanding the community's health needs and resources; this theory complements the Health Belief Model (HBM). The HBM offers indicators of the perceived seriousness, perceived susceptibility, and cues to action related to specific health behaviors. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. Critical social theory exposes people to inequities to help them reach their full potential.

The belief that health deficits result from an imbalance between the population's health needs and its health-sustaining resources is the premise of which theory? a.) Orem's self-care deficit theory b.) The Health Belief Model c.) Milio's framework d.) Critical social theory

-Securing funding getting objectives that we need to work on to help guide us; Way for us all to provide same information regardless of what type of health environment they work; keep us on track to improve health of the entire nation as a whole

Discuss the purpose of Healthy People 2030?

Community-oriented: -BIGGER PICTURE; MORE THAN NURSING PROCESS -Promoting health of populations and aggregates -Uses knowledge of nursing, social, and public health sciences -Community health and public health nursing are often used interchangeably -Focus on disease prevention and health promotion Community-based: -Providing individual client care in the community setting (Hospice, home health nurse setting) -Application of the nursing process is setting specific -Emphasis on acute and/or chronic care

Explain the difference in community-based versus community-oriented nursing?

Natural history of disease- stage of disease progression Primary prevention- interventions prior to disease development -Identify protective factors and factors associated with increase risk -Health promotion and specific protection Secondary prevention- occurs after disease is present -Early detection of disease -Early treatment and cure interventions Tertiary prevention -Limit disability and rehab for irreversible diseases

Understand the use of epidemiological methods in primary, secondary, and tertiary prevention?

GOAL; WHAT PUSHED THEM INTO THE RIVER -Examines interfamily and intercommunity themes in health and illness. Delineates factors in the population that perpetuate the development of illness or foster the development of health -Emphasizes social, economic, and environmental precursors of illness (What causes it?) -Nursing interventions may include modifying social or environmental variables (i.e., working to remove care barriers and improving sanitation or living conditions) -May involve social or political action (Writing letters to local officials, attending board meetings, etc.)

What is the Macroscopic Approach?

FISHING THEM OUT OF THE RIVER -Examines individual, and sometimes family, responses to health and illness -Often emphasizes behavioral responses to an individual's illness or lifestyle patterns -Nursing interventions are often aimed at modifying an individual's behavior by changing his or her perceptions or belief system

What is the Microscopic Approach?

c.) binge drinking. Binge drinking is defined as drinking five or more drinks on a single occasion for men and four or more for women. Excessive drinking is drinking more than two drinks per day on average for men or more than one drink per day for women. Binge drinking is the most common form of excess alcohol use in America. Most people who binge drink are not alcohol dependent. Binge drinking is not age- and circumstance-appropriate behavior. Binge drinking is not the same as alcoholism or excessive drinking.

A 22-year-old college student explains to the nurse at the health clinic that she drinks four to five beers when she goes out with friends on Saturday nights. Otherwise, she rarely drinks during the week because of her classes, studying, and part-time job. This would be considered: a.) age- and circumstance-appropriate behavior. b.) alcoholism. c.) binge drinking. d.) excessive drinking.

Motor vehicle safety: -car seats, seat belts, road safety Vaccinations: -Mumps, Measles, Rubella, HPV, Hep A, COVID Safer workplaces: -OSHA Control of infectious diseases: -Hand hygiene; Mandatory reporting Decline in deaths related to coronary heart disease and stroke: -Awareness; Teaching prevention Safer and healthier foods: -Food Handling Family planning: -Contraception Fluoride in drinking water: -Decrease cavities and teeth decay; Improves oral health which helps improve overall health Tobacco control: -Age limit to decrease death/lung cancer

Identify 6 public health achievements over the past 100 years?

c.) Precontemplation In the precontemplation stage of change, the individual has no intention to take an action toward changing a behavior in the next 6 months. In the contemplation stage, the individual has some intention to take action toward behavior change in the next 6 months. In the maintenance stage, the individual has changed overt behavior for more than 6 months. In the preparation stage, the individual intends to take action within the next month and has taken steps toward behavior change.

A man has been smoking for 20 of his 40 years. He smokes a pack of cigarettes daily and states, "My dad smoked two packs a day and lived to be almost 90. Besides, I'm going to die from something anyway, so why quit"? He is in which "stage of change" in the transtheoretical model? a.) Contemplation b.) Maintenance c.) Precontemplation d.) Preparation

a.) asking an obese child and his or her parent(s) to complete a 24-hour food diary. A microscopic approach to the conceptualization of the problem of childhood obesity focuses on the individual child. A macroscopic approach focuses on the societal factors that influence health status. Analyzing aggregate BMIs, advocating a change in school lunches, and exploring societal and cultural values related to activity are examples of a macroscopic approach to the community health problem of childhood obesity.

A microscopic approach to the community health problem of childhood obesity would focus on: a.) asking an obese child and his or her parent(s) to complete a 24-hour food diary. b.) analyzing aggregate body mass indexes (BMIs) of school-age children in a school. c.) advocating for a change in health policy related to school lunches. d.) exploring changing cultural changes and societal values related to activity.

b.) educating about environmental health hazards. Educating the public about environmental health hazards is the first step in engaging the community problems of the environment. Environmental hazards are complex and interconnected; therefore, increasing the public's knowledge of the hazards leads not only to individual action but also public action. The other options are not the primary focus of the community health nurse.

A primary role of the community health nurse in facilitating community participation and partnership is: a.) solving environmental health problems. b.) educating about environmental health hazards. c.) altering individual behaviors. d.) implementing solutions to environmental racism.

b.) Decisional balance In the transtheoretical model, "decisional balance" describes weighing the benefits of a behavior change against the cost of behavior change. Perceived barriers to action are one's beliefs regarding the tangible and psychological costs of an advised action and include perceived unavailability, inconvenience, expense, difficulty, or time regarding health behaviors. In the precontemplation stage of change, the individual has no intention to take an action toward changing a behavior in the next 6 months. In the contemplation stage, the individual has some intention to take action toward behavior change in the next 6 months.

A smoking cessation class stresses increased lung function, money saved that is not spent on cigarettes, and smelling clean and fresh as benefits to quitting smoking. These support which concept? a.) Perceived barriers b.) Decisional balance c.) Precontemplation d.) Contemplation

c.) Healthy People 2020 An attempt to approach health at the aggregate level is the Healthy People 2020 initiative. It deals with issues ranging from decreasing ozone levels to decreasing Escherichia coli outbreaks. All of these issues deal with the broader environmental origins of disease, not just deleterious personal habits. OSHA, Clean Air for All, and the CDC have a more narrow focus.

Approaching health at the aggregate level is the initiative of which agency or document? a.) Occupational Safety and Health Administration (OSHA) b.) Clean Air for All c.) Healthy People 2020 d.) Centers for Disease Control and Prevention (CDC)

B.) Partnering with a laboratory company to provide free HIV screenings for the public A: policy development C: Assessment D: Assessment

Kahoot Question #2

a.) aggregate of people. An aggregate is a community composed of people who share common characteristics. An aggregate of people describes the "who" of a community, including personal characteristics and risks. Location in space and time looks at the geographical location of a community. Social system is the relationships that community members form with each other. Census tracts facilitate the organization of resident information in specific community geographic locales.

One dimension of a community, which looks at personal characteristics and risks of a group, is called: a.) aggregate of people. b.) location in space and time. c.) social system. d.) census tract.

d.) critical theoretical perspective. Critical theoretical perspective exposes people to inequities to help them reach their full potential. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. The Health Belief Model (HBM) evolved from the premise that the world of the perceiver determines action. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level.

The community health nurse is teaching a prenatal class and includes the societal cost of fetal alcohol syndrome in one of the educational sessions. The nurse is demonstrating an understanding of: a.) Orem's self-care deficit theory. b.) the Health Belief Model. c.) Milio's framework. d.) critical theoretical perspective.

d.) Francis Root. Francis Root was an 1877 graduate nurse sent by the Women's Board of the New York City Mission to provide care to sick individuals in their homes. This was considered an innovation in nursing care in the United States and the precursor to modern visiting nurses' associations. Lillian Wald and Mary Brewster established a district nursing service in New York City in 1893. Florence Nightingale began her work in the mid-19th century and is credited with establishing "modern nursing."

The first visiting nurse in the United States was: a.) Lillian Wald. b.) Mary Brewster. c.) Florence Nightingale. d.) Francis Root.

c.) Risk The term risk refers to the probability of an adverse event. Prevalence is the number of all cases of a specific disease or condition in a population. Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted. Incidence describes the occurrence of new cases of a disease or condition in a community over a period of time.

The health literature accessed by the community health nurse often addresses the probability of an adverse event. What term refers to the likelihood that healthy people exposed to a specific factor will experience a specific health condition? a.) Prevalence b.) Rates c.) Risk d.) Incidence

c.) Public health system The Public health system strives to improve the health of entire populations by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities. Although MCOs and government financing entities (Medicare and Medicaid) focus on the health of their clients, they do not focus on the community and population in general. The focus of the Affordable Care Act was to mandate health insurance for individuals.

Which entity strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities? a.) Managed care organizations (MCOs) b.) Medicare c.) Public health system d.) Affordable Care Act

a.) Orem's self-care deficit theory Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. The Health Belief Model (HBM) evolved from the premise that the world of the perceiver determines action. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level. Critical social theory uses societal awareness to expose social inequalities that keep people from reaching their full potential.

Which theory is based on the assumption that individual needs and related activities are the focus of nursing care? a.) Orem's self-care deficit theory b.) The Health Belief Model c.) Milio's framework d.) Critical social theory

b.) The Health Belief Model The Health Belief Model (HBM) offers indicators of the perceived seriousness, perceived susceptibility, and cues to action related to specific health behaviors. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level. Critical social theory uses societal awareness to expose social inequalities that keep people from reaching their full potential.

A community health nurse explores a group of teenagers' beliefs about the seriousness of eating disorders and their related susceptibility. The nurse is applying principles from which theory? a.) Orem's self-care deficit theory b.) The Health Belief Model c.) Milio's framework d.) Critical social theory

a.) Work-related exposures b.) Atmospheric quality e.) Radiation risks Environmental health is a vast field of subcategories, including living patterns, work risks, atmospheric quality, water quality, housing, food quality, waste control, and radiation risks. Families and job availability are not environmentally related.

A community health nurse would include which in her assessment of environmental health? (Select all that apply.) a.) Work-related exposures b.) Atmospheric quality c.) Families d.) Job availability e.) Radiation risks

b.) In calculating a crude rate, the average population size may be used as denominator. Crude rates are calculated by using the number of events as the numerator. The denominator used may be the average population size or the population size at midyear and not the population at risk. Crude rates are subject to certain biases in interpretation.

A community nurse is reviewing health statistics to gain a better understanding of a population's health needs. Crude rates are available for several health occurrences. What statement accurately describes crude rates? a.) In calculating a crude rate, the numerator is the size of the population at risk. b.) In calculating a crude rate, the average population size may be used as denominator. c.) The denominator in a crude rate represents the population at risk for the event. d.) Crude rates are used frequently because they avoid bias in interpretation.

b.) "How close do you live to your workplace?" Environmental health effects can be immediate, long term, or intergenerational. Although often overlooked, a parent's occupation may put his or her children in danger. Living close to a coal mine could increase the children's risk for exposure to water or ground contamination from the mine, among other environmental hazards. The other options do not assess the proximity of the environmental hazard.

A public health nurse is surveying a population of coal miners. Which question would elicit information about related risk to a miner's children? a.) "Do you wear a respirator?" b.) "How close do you live to your workplace?" c.) "How many accidents has the mine had this year?" d.) "Do you have a good rapport with your boss?"

b.) exposure that is associated with a disease. A risk factor is an exposure that is associated with incidence of a disease. Risk is the probability that a specific event will occur in a given time frame. A risk assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures. A risk reduction is a proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health.

A risk factor refers to a(n): a.) probability that a specific event will occur in a given time frame. b.) exposure that is associated with a disease. c.) systematic way of distinguishing the risks posed by potentially harmful exposures. d.) proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health.

B.) 13

Kahoot Question #6:

c.) all resources available for use by the client, including health-related and non-health-related resources. The suprasystem includes a variety of organizations and community resources. Some are health related, such as the presence or absence of hospitals, clinics, primary care providers, or health centers. Support services such as Meals on Wheels, public transportation, and recreational facilities are also important. Governmental agencies used by the client are also assessed as part of the suprasystem.

The community health nurse understands that a client's health can be negatively or positively affected by his or her suprasystem. Which correctly describes a client's suprasystem? The suprasystem includes: a.) only health-related resources, such as primary care providers and insurance sources. b.) only non-health-related resources, such as use of public transportation. c.) all resources available for use by the client, including health-related and non-health-related resources. d.) all official (governmental) agencies used by the client or family, such as the health department or social services.

b.) Agent, host, and environment The epidemiological triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent. Environmental conditions at the time of exposure are also considered. Examination of these three elements allows assessment of the problem, determination of protective factors, and evaluation of the vulnerability of the host to disease. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. Answer options A and D do not represent an epidemiologic model.

The nurse working in the community is aware that there are different models for studying the epidemiology of a health condition in a population. One model of investigation of the interrelationships and characteristics of disease is the epidemiological triangle. This model analyzes what three elements? a.) Incidence, prevalence, and etiology b.) Agent, host, and environment c.) Person, place, and time d.) Virus, bacteria, and fungus

d.) epidemiology. Epidemiology involves the analysis of health data to discover the patterns of health and illness distribution in a population. It also involves conducting research to explain the nature of health problems and identify aggregates at increased risk. Statistical analysis is a general term for the analysis of data. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns. Census information is collected every 10 years by the U.S. Census Bureau to describe the population characteristics of the nation.

A community health nurse in the assessment phase of the nursing process conducted research to identify the distribution pattern of breast cancer within a population and the associated risk factors. This is called: a.) statistical analysis. b.) needs assessment. c.) census collection. d.) epidemiology.

c.) Intervention During the intervention step of the Health Planning Model, the nurse must prepare for unforeseen problems or complications and consider alternatives to meet the client's needs. The nurse gathers information about the needs of the community during the assessment step. During the planning step, the nurse determines which problems or needs require intervention and identifies the desired outcomes or ultimate goals of the interventions. Evaluation determines success or failure of the project.

A community health nurse is using the Health Planning Model to improve a client's health. The nurse prepares for unexpected problems or complications in the client's care. This attention to unexpected problems takes place during which step? a.) Assessment b.) Planning c.) Intervention d.) Evaluation

I—Investigate potential exposures​ -Feel better on the weekends? Skin rash after herbicide use? P—Present work​ -Where? Face Masks while working? Longest job? R—Residence​ -Durable? Clean and stable? Lead present? Recently remodeled? Running water? Heat? (Coal? Gas? Wood burner?) E—Environmental concerns​ -Runoff? Safe? Lighting around? Sidewalks? Large farms nearby (corporation farms)? Waste dump nearby? P—Past work​ -Military? (Agent Orange) Worked on a farm? A—Activities​ -Hobbies? (Weld, Hunt, Fish, Sauter) Eat things from the river? R—Referrals and resources​ -Local health department nearby? OSHA? E—Educate -s/s of exposure?

Apply the basic concepts of IPREPARE to use for assessment of environmental exposures?

c.) Community as client Community health nurses focus care on health needs of aggregates; however, individual, families, and groups are important parts of aggregates. Appropriate nursing care and health promotion planned for aggregates affect individuals and vice versa. Use of the nursing process is one part of health planning for the community. Health planning is an essential component of community health nursing practice.

A community health nurse working as a school health nurse conducted a community assessment and determined that the focus of programs and health education for the academic year should address the problem of childhood obesity. In planning, it is important for the nurse to allow time for individual nursing assessment and education for children who are overweight or obese and to plan classroom education programs. The nurse is demonstrating an understanding of which important community health nursing concept? a.) Health planning b.) Aggregate health care c.) Community as client d.) Use of the nursing process

Binge drinking- 5+ drinks on single occasion for men, 4+ for women; most common form of excess alcohol use Excessive drinking- men- more than 2 per day; women- more than 1 per day -Non-Hispanic, caucasians highest drinking prevalence, non-Hispanic Caucasian men heaviest drinkers. Prevalence drops after age 44 -Causes liver problems and unintentional injuries -#1 used and abused drug by youth -National Drug and Alcohol Treatment Referral Routing Service- alcohol treatment -Legal drinking age, tax alcohol sales, decrease stores that sell it, hold retailers responsible for serving drunk or underage drinkers Who should avoid drinking: -Under 21 -Certain medications -Pregnant or trying to become pregnant -Recovering from alcoholism -Certain medical conditions -Driving or doing activities that require coordination or concentration

Alcohol Consumption and Health?

b.) Housing quality Older homes and buildings often have poor ventilation and harbor hazardous materials. The signs and symptoms this patient is experiencing may be a result of "sick building syndrome." Gastrointestinal symptoms might indicate an issue with food or water quality. Occupational risks do not take into consideration the environmental hazard related to housing.

An emergency department nurse assesses a 25-year-old patient with tachycardia, headache, and nausea. The patient denies drug use, heart problems, and smoking. She works from her house and states that everyone in her house has had the "flu" but that she is the only one who has not been feeling better. The nurse notices that the patient lives in the historic section of the town. What environmental hazard should the nurse be primarily concerned about? a.) Food quality b.) Housing quality c.) Water quality d.) Occupational risks

C: Providing influenza immunizations to employees at a local preschool A: Secondary B: Tertiary D: Secondary

Kahoot Question #3

a.) Proportionate mortality rate Proportionate mortality rate is calculated using the number of deaths resulting from a specific cause in a specific time period as the numerator and the total number of deaths in the same time period as the denominator. In crude death rates, the numerator is the number of deaths and the denominator is the average population size or the population size at midyear multiplied by a constant. Age adjustment or standardization reduces bias when there is a difference between the age distributions of two populations.

The percentage of deaths resulting from a specific cause provides the nurse with information about areas in which public health programs might make significant contributions in reducing deaths. Select the statistic often used for this purpose. a.) Proportionate mortality rate b.) Crude death rate c.) Age-adjusted death rate d.) Standardized mortality rate

b.) a proactive approach to care. c.) development of population-focused programs. Theory assists the community health nurse in applying upstream thinking, including a proactive approach to population-focused care. A reactive or individual approach prevents progress toward "big picture" initiatives and population-based programs.

The use of theory in population-focused community health nursing encourages (Select all that apply.) a.) a reactive approach to care. b.) a proactive approach to care. c.) development of population-focused programs. d.) development of individual-focused health protocols for community use.

A.) Key informant interviews (Individual conversations) B.) No conversation C.) Group conversations D.) No conversation

Kahoot Question #8

A.) 9

Kahoot Question #9

b.) Home visits to ill mothers and children c.) School health services d.) Industrial health services to local workers e.) Support programs for immigrants The Henry Street Settlement was a model comprehensive health care center that provided many services, including home visits to mothers and children, support services for immigrants, the first school health and industrial health programs, and many other services. Emergency care and first aid were not provided services.

Lillian Wald and Mary Brewster's Henry Street Settlement was a model of modern health care. Which services were provided to people living in the Lower East Side of New York City by the Henry Street Settlement nurses? (Select all that apply.) a.) Emergency care and first aid b.) Home visits to ill mothers and children c.) School health services d.) Industrial health services to local workers e.) Support programs for immigrants

Goal- health promotion 1.) Primary- prevent disease from occurring, decrease number of new cases -Consists of two elements: General Health Promotion and Specific Promotion. --General Health Promotion: enhance resiliency and protective factors and target essentially well populations. ----Examples: Promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise. --Specific Protection: Reduce or eliminate risk factors and include measures such as immunization, seat belt use, and water purification. -"Before"; usually education (Like to not smoke) 2.) Secondary- early detection and treatment -"Catching it early"; screening and early intervention; after a problem has begun but before signs and symptoms appear, and targets those populations that have risk factors. Example: Mammography, blood pressure screening, scoliosis screening, and Papanicolaou tests 3.) Tertiary- Targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. -Aims are to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning. -"They have it"; (usually individuals with hyperlipidemia, metabolic syndrome, heart disease, etc.) Example: Teaching insulin administration in the home, referral of a patient with spinal cord injury for occupational and physical therapy, and leading a support group for grieving parents.

List the three levels of prevention. Give examples of each?

b.) food bank in a local church. Social health is a positive interaction among groups with an emphasis on health promotion and illness prevention. The correct choice is a food bank in a local church because a food program alleviates problems with hunger and nutrition that affect health. The other options do not relate to health

Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a: a.) neighborhood block party. b.) food bank in a local church. c.) community yard sale. d.) school fundraiser for the school band.

a.) practice from a population focus A population focus for nursing addresses the health of all in the population through the careful gathering of information and statistics. A population focus better enables community health nurses to contribute to the ethic of social justice by emphasizing society's responsibility for health (Beauchamp, 1986). Helping aggregates help themselves empowers people and create avenues for addressing their concerns.Adopting a medical model of care and returning to earlier models of prevention will not empower people to understand and address their health issues. Modern community health nurses focus on the population, not the individual and family.

Modern community health nursing requires the nurse to __________, which empowers people to understand and address their health issues and disease. a.) practice from a population focus b.) adopt a medical model of care c.) return to earlier models of prevention d.) focus on the individual and family

New cases of disease or condition over a given period of time -Compared to population at risk -Numerator is part of denominator -Sensitive indicator to health changes in a population Attack rate- those exposed to an infectious agent that actually develop the disease

Morbidity Rates: Incidence?

How much actual disease exists at a given point in time -Compared to entire population -Includes new and old cases -Numerator is part of denominator

Morbidity Rates: Prevalence?

total number of deaths

Mortality Rates: Crude Death Rates?

Live births/deaths less than 1 year of age; significant health disparity in our country- Black infant mortality is double white infant mortality in U.S.

Mortality Rates: Infant mortality rate?

d.) windshield survey. Community health nurses often perform a windshield surveys by driving or walking through an area and making organized observations to help gain an understanding of the environmental layout, including geographic features and the location of agencies, services, businesses, and industries and to locate possible areas of environmental concern through sight, sense, and sound. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns. Census information is collected every 10 years by the U.S. Census Bureau to describe the population characteristics of the nation. To conduct an informant survey, the community health nurse may gather data by interviewing key informants in the community. Informants may be knowledgeable residents, elected officials, or health care providers.

One of the first steps in community assessment may involve the community health nurse driving or walking through an area and making observations about such things as environmental layout and location of agencies, hospitals, industries, and so forth. This is called a(n): a.) census survey. b.) needs survey. c.) informant survey. d.) windshield survey.

Experimental (randomized clinical trial) -Test treatments and prevention strategies -Experimental group receives the intervention -Control group receives nothing or a placebo -Change in category called crossover- clients allows have the option to opt out and this may influence results -Ethical considerations- avoid introducing harmful exposures to subjects

Evaluate epidemiological study designs for researching health problems: Experimental?

a.) New cases of a disease or condition in a community over a period of time are included in incidence rates. Incidence rates describe the occurrence of new cases of a disease or condition in a community during a period of time relative to the size of the population at risk for that disease or condition during that same time period. In calculating this rate, the numerator is the number of new cases during the specific period of time, and the denominator consists only of those who are at risk for developing the disease or condition during the specific period of time. A prevalence rate is the number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time. Attack rates document the number of new cases of a disease in those exposed to the disease. The percentage of deaths in a specific period of time from a specific cause refers to the mortality rate.

A community health nurse participating in planning programs for the coming year considers incidence rates to better understand the needs of the community. Which statement below is the most accurate explanation of incidence rates? a.) New cases of a disease or condition in a community over a period of time are included in incidence rates. b.) The number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time is included in incidence rates. c.) Incidence rate refers to the number of new cases of a disease in those exposed to the disease. d.) The term incidence rate refers to the percentage of deaths in a specific period of time from a specific cause.

d.) Analytic epidemiology Analytic epidemiology investigates the causes of disease by determining why a disease rate is lower in one population group than in another. This method tests hypotheses generated from descriptive data and either accepts or rejects them on the basis of analytic research. Cohort studies obtain information about the cause of disease by establishing a relationship between the presumed causal factors and the effect. The study of the amount and distribution of disease constitutes descriptive epidemiology. When prevalence rates describe the number of people with the disease at a specific point in time, they are sometimes called point prevalences.

An epidemic is occurring in a public health nurse's community, and the nurse is working with the epidemiologist and other health professionals seeking to identify the causative agent. What phrase best describes such efforts? a.) Cohort study b.) Descriptive epidemiology c.) Point prevalence study d.) Analytic epidemiology

Effect on Healthcare: -Increased incidence of chronic lung diseases such as asthma, COPD (especially in big cities) -Overburdening medical resources d/t exacerbation of chronic diseases -Research shows that a healthy environment can increase the quality of life and years lived How can nurses interfere? -Perform a risk assessment on a client's environment (Need a baseline!!!; Safe assessment that can show whether changes can lead to sickness) -Discuss ways to prevent development of disease or exacerbation -Intervene to make changes to an unhealthy environment --Is Air Quality bad? Don't go outside on bad days; try to do physical activity indoors Nursing Actions: -Risk assessments should be performed for adults & children -These assessments can improve diagnosis timelines & access to tx -Early diagnosis & tx can improve pt outcomes, decrease exacerbations -Nurses should be careful to listen to community members discuss their perception of problems rather than impose their personal views. Collaborating with the community to determine needs is the 1st step How can nurses institute local changes? -Organize letter writing campaigns -Arrange mass demonstrations: Need a group to make a change -Lobby for political changes -Assist with litigation

Briefly explain some example laws and regulations relevant to environmental health and how government agencies use them to address environmental issues as well as how nurses can intervene to bring about change?

Observational- observing disease rates in groups of people, look at different factors that influence disease Cross-sectional (prevalence or correlational studies) -Examine relationships between potential causal factors and disease at a specific time -Can help generate hypothesis Retrospective -Examine individuals with the disease and without the disease, review history -Select review cases with the disease and control cases without the disease that are similar -Can help address causality Prospective (longitudinal, cohort, or incidence studies) -Examine the same individual over a period of time for causal factors of disease

Evaluate epidemiological study designs for researching health problems: Observational Studies?

Health Risk: Probability that a specific disease or health problem will occur in a given time frame Risk factor development: -Frequency of disease -Must precede the onset of disease -Association supported by research- Research tells that people who smoke have a greater chance of developing lung cancer Nurse's role: Risk Assessment: -Hazard identification- Lack of physical activity; smoking -Risk description- A sedentary lifestyle is worse than someone who runs a marathon every other week -Exposure assessment- Likelihood of developing it from exposure -Risk estimation Modifiable: -Client controlled Nonmodifiable: -Client has little or no control -(genetic predisposition) --Ex: cervical screenings: females; prostate screenings: males; sickle cell anemia- african americans Risk reduction: -Client participates in behaviors that enable them to react to threats to health Risk communication: -Process of telling the public about possible or actual threats to health -Health care professionals, internet, radio, TV, billboards, restroom doors, etc

Demonstrate an understanding of stratification of risk factors by age, race, and gender?

Health Promotion: -Desire to increase well-being and to reach the best possible health potential -Nutrition, rest and hygiene maximize and protect one's state of health (balanced lifestyle, free from illness) -Clients often seek advice from medical professionals -Often see/hear competing recommendations -National level- Healthy People 2030 (GUIDE FOR HEALTH PROMOTION) Health protection: -Help protect themselves from disease! -Behaviors one participates in to prevent disease, detect early stages of disease, or maximize health when disease is present -Immunizations- Annual flu vaccines -Cancer screening -HIV patients- encourage them to wear condoms

Demonstrate an understanding of the difference between health promotion and health protection?

-Established House on Henry Street in 1893 (along with Mary Brewster) -Played an important role in establishing public health nursing in the United States—later called "Visiting Nurses Association of NYC" -Role of Henry Street Settlement was "one of helping people to help themselves" (Wald, 1871). -The Children's Bureau and the Social Security Act Legislation formed as a result of these efforts -National Organization of Public Health Nurses formed, 1912 (Lillian Wald was first president) -The Public Health Service appointed its first public health nurse, 1913.

Describe Lillian Wald's impact on public health nursing?

1.) Built environment: Buildings, spaces, and products that are created or modified by people, including homes, schools, workplaces, parks/recreation areas, greenways, business areas, and transportation systems. -Could include structural characteristics such as buildings, sidewalks, street lights, playgrounds as well as their condition -Do the clients have access to public or private transportation? (Do they have to walk?) -How might health be affected by an area with overcrowding, high crime rates, lack of street lights/parks? What about the opposite? (Could lead to no exercise) -In addition to the above the nurse must also consider proximity to industrial contamination. How would this affect health? Where would this be more/less likely? ---Making a landfill in the poor side of town where there could be an abundance of non-english speaking immigrants where no one can stand up for them --Poor environment ↑ Noise ↑ Crime ↑ Stress Health concerns ----Noise plus Crime = Stress = Needing a coping mechanism =Smoking, Drinking, Drugs = Health Concerns 2.) Work-related exposure: Occupational exposure to environmental hazards that can cause illness or injury. -Examples? --Can be obvious (acute injury) or go unreported (such as dizziness/HA after leaving work d/t dust/mold in air circulating unit) ----Rashes, Carpeltunnel, Needle Sticks --Can be insidious and not show s/sx until much later in life (mesothelioma) ----20-50 years usually after exposure 3.) Outdoor air quality: The protectiveness of the atmospheric layers, the risks of severe weather, and the purity of the air for breathing purposes. 4.) Healthy home: The availability, safety, structural strength, cleanliness, and location of shelter, including public facilities and family dwellings. This includes indoor air quality. -This refers to not only clean, safe & sturdy homes w/ the absence of pest infestation & air quality issues, but also the availability & location of these homes -Environmental concern examples? (Dilapidated buildings? Running water? Electricity? Mold? Lead paint?) -Pt education for these? -Smoke Alarms and CO2 Alarms; Rats and bugs? Limit Clutter and don't leave food out; No smoking in the house 5.) Water quality: The availability of and accessibility to a clean water supply, the mineral content levels, pollution by toxic chemicals, and the presence of pathogenic microorganisms. 6.) Food safety: The availability, relative costs, variety, safety, and health of animal and plant food sources. 7.) Waste management: The management of waste materials resulting from industrial and municipal processes, human consumption, and efforts to minimize waste production. -Could be industrial, municipal or originating from human consumption -Examples of improper waste management? --Illegal dumping into the oceans; sewage disrepair What are the potential hazards of this? --Can cause the methane in the ozone to break down which could lead to us now receiving harmful rays from the sun

Describe the 7 areas of environmental health, related potential environmental health problems, as well as patient education examples for each?

How does the community health nurse use the nursing process? Multistep process- Planning -Determine intervention levels (suprasystem (all encompassing (funding/approval)), system (Who are you focused on? Population) and subsystem (Individual components (people, individual classes like in Columbus City Schools)) -Plan interventions for each system level using levels of prevention -Validate the practicality of implementing planned interventions -Forms of intervention- education, personal counseling, policy change, or community service -Collaborate with community agencies Interventions: -Population-focused (As a whole) -Variety of strategies- mass media, pamphlets, posters, public forums, and electronic media- social media, websites -Unexpected issues- bad weather, poor attendance, transportation issues -May have to cancel events due to no transportation, bad weather if an event was outside Types of Evaluation Process: EXPERIENCE -How did it go? (Process of doing it) -Positives and negatives of experience (Any bumps in the road from plan we created?) -Plans strengths and weaknesses Product: END RESULT -Did we achieve our desired result? -Adequacy -Efficiency -Appropriateness -Cost-benefit: Return on investment we spent? Meet healthcare objectives

Describe the community health nurse's role in health planning, implementation, and evaluation?

Air Quality: -Can come from factories, power plants & refineries as well as transportation and natural events (volcanoes) -Also contributing is breakdown of protective Ozone layer & depletion of CO2 absorbing forests -Clean air act established standards for pollutants Examples: Texting alerts to notify people about poor air quality for problem populations (COPD, asthma); Will fluctuate day to day Water Quality: -Availability of clean drinking water w/o harmful pathogens/microorganisms or toxins -Examples of instances that would interfere w/ water quality or availability? (Red Tide Ocean) -Monitored by the CDC (90 pollutants that are harmful to humans) -What can be done about large corporations who would rather pay the fine and continue to dump hazardous chemicals into local water supplies? --Letter campaigns --LISTEN TO PEOPLE AND ASSESS --Can go to media because no big corporation wants media coverage --Water Filters? Waste? No smoking in the house? Lead Tests? Herbicides that can end up in runoffs to water supply? Food Quality: Availability of safe, cost effective and healthy contaminant-free food ---Farmers Market Contaminants can include pathogens, pesticides & carcinogenic additives etc. (FDA) --Nitrates have cancer causing agents: Hot dogs, lunchmeat --Chipotle = E. coli; need handwashing -Food desert; Genetically modified foods -Contaminants can be difficult to trace - often begins w/ community health nurse --Round-up; IV drug use; safe needles Pathogens can develop from improper cooking/storage, education is important!

Describe the importance of air, water, and food quality as a determinant of health?

-Subjective Data collection: Surveys (Where do you hang out?) -Identify aggregate: Asking everyone -Engage community in process: Encouraging to participate in change (townhall meetings) -Identify data needed and method to collect -Conduct needs assessment: What health concerns are in your community? -Analyze data (Once it is all collected) -Identify needs based on data -Develop an action plan Needs Assessment: 1.) Expressed need- demand for services -Community is asking for the service (transportation is an example) 2.) Normative- lack, deficit, or inadequacy (need) -May not even realizes they are in need 3.) Perceived need from audience- population wants and preferences -May help the community/make them feel better 4.) Relative need- health disparities, inequalities between groups within the population -Needs of one population being met but not the needs of another -Ex: Not a lot of providers on the East side of Chillicothe; they had the insurance but no provider to provide care

Describe the process of conducting a community assessment?

Health Planning Model: Applies nursing process to an aggregate -Based on group intervention model -Improve aggregate health -Similar to the nursing process I. Assessment -A. Specify the aggregate level for study (e.g., group, population group, or organization). Identify and provide a general orientation to the aggregate (e.g., characteristics of the aggregate system, suprasystem, and subsystems). Include the reasons for selecting this aggregate and the method for gaining entry. --A. Describe specific characteristics of the aggregate. 1. Sociodemographic characteristics: Including age, sex, race or ethnic group, religion, educational background and level, occupation, income, and marital status. 2. Health status: Work or school attendance, disease categories, mortality, health care use, and population growth and population pressure measurements (e.g., rates of birth and death, divorce, unemployment, and drug and alcohol abuse). Select indicators appropriate for the chosen aggregate. 3. Suprasystem influences: Existing health services to improve aggregate health and the existing or potential positive and negative impact of other community-level social system variables on the aggregate. Identify the data collection methods. -B. Provide relevant information from the literature review, especially in terms of the characteristics, problems, or needs within this type of aggregate. Compare the health status of the aggregate with that of similar aggregates, the community, the state, and the nation. -C. Identify the specific aggregate's health problems and needs on the basis of comparative data collection analysis and interpretation and literature review. Include input from clients regarding their need perceptions. Give priorities to health problems and needs, and indicate how to determine these priorities. II. Planning -A. Select one health problem or need, and identify the ultimate goal of intervention. Identify specific, measurable objectives as mutually agreed on by the student and aggregate. -B. Describe the alternative interventions that are necessary to accomplish the objectives. Consider interventions at each system level where appropriate (e.g., aggregate/target system, suprasystem, and subsystems). Select and validate the intervention(s) with the highest probability of success. Interventions may use existing resources, or they may require the development of new resources. III. Intervention -A. Implement at least one level of planned intervention when possible. -B. If intervention was not implemented, provide reasons. IV. Evaluation -A. Evaluate the plan, objectives, and outcomes of the intervention(s). Include the aggregate's evaluation of the project. Evaluation should consider the process, product, appropriateness, and effectiveness. B. Make recommendations for further action based on the evaluation, and communicate them to the appropriate individuals or system levels. Discuss implications for community health nursing.

Describe the steps in the Health Planning Model?

Risk assessment: evaluating what's going on; what might make us more susceptible; looking at what types of things going on in environment that leads to something -Food safety: who's preparing foods -Water safety: flooding, well fields get flooded so then need to boil water Community health nurses role is helping identify risks and what to communicate; policy development -TALKING WITH COMMUNITY MEMBERS; LISTEN TO THEM Example: -Flooding in mississippi: water system issues; risk assessment: what can poor water quality lead to? Hygiene issues -The Government stepped in and provided pumps for water pressure; can the pipes handle the water pressure after not having it? Will the pipes burst? If it does now they have no pressure Example: -Asthma: seasonal allergies, pollution, mold, cigarette smoke, -This pop has a high risk for asthma attacks and assessing school system and checking for school humidity

Develop an understanding of the risk assessment and risk management role of nurses?

Calorie balance- calories in= calories out Portion distortion- eating larger amounts than usual due to being served larger portion size -BMI 25-29.9 is overweight, 30+ is obese Prevalence- non-Hispanic blacks, Hispanics, non-Hispanic whites; in women, obesity rates go up when income or education levels decrease -Lower income families less like to eat fruits and veggies -Obesity related to stroke, heart disease, diabetes, and some cancers; higher healthcare costs -CDC and USDA -Support groups, mobile apps

Diet and Health?

Upstream: Interventions focus on health promotion and illness prevention (Proactive instead of reactive) Upstream thinking: modifying factors that influence health to avoid problem/illness -Environmental: Decrease pollution; increase green space; no smoking in restaurants -Economic: Increase medicaid level/people (for decreased poverty level -Social: Interactions; Addressing social infection of alcohol -Political: Increasing age limit to buy cigarettes; Invest in sidewalks for children to walk to school Downstream: Interventions that can help the individual that already suffers from a disease; FISH THEM OUT OF THE RIVER; (what we've learned so far) Downstream health care: illness care at hospitals, urgent cares, emergency rooms, and doctor's offices

Differentiate between upstream interventions (Macroscopic), (what pushed them into the river) which are designed to alter the precursors of poor health, and downstream interventions (microscopic), which are characterized by efforts to modify individuals' perceptions of health. (Fish out of the river)?

-The health status of a community is associated with a number of factors, such as health care access, economic conditions, social and environmental issues, and cultural practices, and it is essential for the community health nurse to understand the determinants of health and recognize the interaction of the factors that lead to disease, death, and disability. Biology: -genetic makeup, family history and physical/mental health problems -Ex: Sickle cell anemia common in African Americans; Depression/Bipolar Disorder have a genetic predisposition Behavior: -individual responses to internal stimuli (feelings/thoughts) and external conditions (Actions from environment) -May influence each other: --Increase risk for disease --Increase chance of screenings and healthy lifestyle Social environment: -interactions with family, friends, coworkers and community members. -Social institutions- law enforcement, faith community, and government agencies -Relationships that are built with people -economic stability: job? (can get health insurance through it) Physical environment: -What surrounds us; using your senses, can have positive or negative influence -neighborhood and built environment: transportation: can we get to work or healthcare? -No water supply= bad -Green space= good Policies and interventions: -Profound effect on health of individuals, groups, and communities -What healthcare options are available? Access to care: essential to decrease health disparities and improve quality of life -Everyone needs access to healthcare -health and healthcare: food, diet, lifestyle choices, already has an illness? (increase cost; choose between prescriptions or food); town with hospital? Doctor's office? -Education: higher= better access to healthcare services and level of importance

Discuss determinants of health and indicators of health and illness from a population perspective?

Environment- biological, social -Rate of disease changes when balance is altered -Physical environment: Geology, climate -Biological environment: --Human populations: Density --Flora: Sources of food, influence on vertebrates and arthropods, as a source of agents --Fauna: Food sources, vertebrate hosts, arthropod vectors -Socioeconomic environment: --Occupation: Exposure to chemical agents --Urbanization and economic development: Urban crowding, tension and pressures, cooperative efforts in health and education --Disruption: Wars, floods -Nurse's role- assess health problem, determine protective factors, evaluate factors that affect host vulnerability

Identify epidemiological models used to explain disease and health patterns in populations: Epidemiological Triangle: ENVIRONMENT?

-Why is it important? -Guideline for public health agencies. What are we to do? and how will it help us? -Framework for community and public health nursing practice Contains three important elements: 1.) It is population based 2.) It contains three levels of practice (community, systems, and individual/family) 2a.) Community: Interventions may be directed at an entire population within a community --Example: A community- and/or population-level intervention for "screening" would be public health nurses working with area high schools to give each student a profile of his or her health to promote nutritional and physical activity lifestyle changes to improve the student's health. 2b.) Systems: Interventions may be directed toward a system that would affect the health of the population --Example: A systems-level intervention within "disease investigation" might be the community health nurse working with the state health department and federal vaccine program to coordinate a response to an outbreak of measles in a migrant population. 2c.) Individual/Family: Interventions may be directed at the individuals and/or families within the population --Example: An individual-level implementation of the intervention "referral and follow-up" would occur when a nurse receives a referral to care for an individual with a diagnosed mental illness who would require regular monitoring of his or her medication compliance to prevent rehospitalization. 3.) It identifies and defines 17 public health interventions

Discuss the Public Health Intervention Wheel?

Major features of a community: 1.) Aggregate of people: The "who": personal characteristics and risks -May be organized or recognized as a community -Community of solution- common problem unites individuals 2.) Location in space and time: The "where" and "when": physical location frequently delineated by boundaries and influenced by the passage of time -Geopolitical borders versus geographic community -Built environment: What's going on around the environment -Census tracts- funding -How is the money funded for a movement? Usually based on the number of people that live there 3.) Social system: The "why" and "how": interrelationships of aggregates fulfilling community functions -Relationships between community members: Get along? -Prevalent health problems can impact the system: Health problems?

Discuss the major dimensions of a community?

Tobacco Use: -Education! People usually don't start smoking after age 25 so educate young to try and prevent -Mass media campaigns -Higher tobacco prices -Smoke-free laws and policies -Evidence-based school programs -Sustained community-wide efforts Cardiovascular Disease: -Eat plenty of fresh fruits and vegetables and fewer processed foods. -Eat a healthy, balanced diet -Be more physically active -Keep to a healthy weight -Give up smoking -Reduce your alcohol consumption -Keep your blood pressure under control Obesity: -Health policy changes -Vending machines in schools with healthier choices -School lunch program modifications -Target corporations that profit from obesity

Discuss upstream action examples to prevent obesity, tobacco use and cardiovascular disease?

b.) administering vaccines to children before kindergarten. Primary prevention activities prevent a problem before it occurs; an immunization is given to prevent a disease before it occurs. Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis, such as checking the skin for signs of skin cancer or identifying and treating individuals who have been exposed to contagious diseases. Aims of tertiary prevention are to keep health problems from getting worse, reduce the effects of disease and injury, and restore individuals to their optimal level of functioning. Examples of tertiary prevention include teaching prevention of complications from disease or referring a patient with a stroke for rehabilitation.

Disease prevention activities protect people from disease and the effects of disease. An example of primary disease prevention is: a.) teaching people with diabetes how to prevent complications. b.) administering vaccines to children before kindergarten. c.) checking the skin of farm workers for signs of skin cancer. d.) identifying and testing individuals exposed to someone with tuberculosis.

a.) supporting political activities to improve social and environmental conditions of immigrant families. These early public health nurses saw that neither administering bedside clinical nursing, including obtaining and administering medication, nor teaching family members to deliver care in the home adequately addressed the true determinants of health and disease. They resolved that collective political activity should focus on advancing the health of aggregates and improving social and environmental conditions by addressing the social and environmental determinants of health. Wald and colleagues (1971) impacted the health of the community by organizing the community, establishing school nursing, and taking impoverished mothers to testify in Washington, DC.

Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by: a.) supporting political activities to improve social and environmental conditions of immigrant families. b.) administering bedside nursing care to immigrants and their families. c.) teaching the immigrant family members to provide health care in the home. d.) obtaining and administering medications to the immigrants and their family members.

b.) help construct benchmarks to gauge achievement of program objectives. Inherent in the planning phase of the nursing process is a plan for the intervention and its evaluation. Epidemiologic data can be useful as a basis for determining success. By comparing baseline data, national and local data, and other relevant indicators, the nurse can construct benchmarks to gauge achievement of program objectives. The other options are useful in the assessment phase of the nursing process.

Epidemiologic data can be useful in the planning phase of the community assessment process because they: a.) help discover the patterns of health and illness distribution in a population. b.) help construct benchmarks to gauge achievement of program objectives. c.) identify the aggregate at risk. d.) explain the nature of the health problem.

Definitively establishing causality—particularly in chronic disease—is a challenge. The following six criteria establish the existence of a cause-and-effect relationship: 1.) Strength of association: Rates of morbidity or mortality must be higher in the exposed group than in the non exposed group. Relative risk ratios, or odds ratios, and correlation coefficients indicate whether the relationship between the exposure variable and the outcome is causal. For example, epidemiological studies demonstrated a higher relative risk for heart disease among smokers than among nonsmokers. 2.) Dose-response relationship: An increased exposure to the risk factor causes a concomitant increase in disease rate. Indeed, the risk of heart disease mortality is higher for heavy smokers than for light smokers. 3.) Temporally correct relationship: Exposure to the causal factor must occur before the effect, or disease. For heart disease, smoking history must precede disease development. 4.) Biological plausibility: The data must make biological sense and represent a coherent explanation for the relationship. Nicotine and other tobacco-derived chemicals are toxic to the vascular endothelium. In addition to raising low-density lipoprotein (LDL) and decreasing high-density lipoprotein (HDL) cholesterol levels, cigarette smoking causes arterial vasoconstriction and platelet reactivity, which contribute to platelet thrombus formation. 5.) Consistency with other studies: Varying types of studies in other populations must observe similar associations. Numerous studies using different designs have repeatedly supported the relationship between smoking and heart disease. 6.) Specificity: The exposure variable must be necessary and sufficient to cause disease; there is only one causal factor. Although specificity may be strong causal evidence in the case of infectious disease, this criterion is less important today. Diseases do not have single causes; they have multifactorial origins.

Evaluate epidemiological study designs for researching health problems: cause-and-effect relationship?

b.) improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident. One of the new objectives for Healthy People 2020 focuses on preparedness for major health incidents. Achieving access to preventive services of all Americans and reducing health disparities among Americans were goals of Healthy People 2000, and increasing the independence of older Americans was a goal of the original 1979 Healthy People version.

Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to: a.) achieve access to preventive services of all Americans. b.) improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident. c.) reduce health disparities among Americans. d.) increase independence of older Americans.

Built environment: -Drunk driving -Secondhand smoke -Noise exposure -Urban crowding -Technological hazards Work-related exposure: -Asbestos exposure -Agricultural accidents -Excessive exposure to x-rays Outdoor air quality: -Gaseous pollutants -Greenhouse effect -Destruction of the ozone layer -Aerial spraying of herbicides and pesticides -Acid rain -Nuclear facility emissions Healthy home: -Homelessness -Rodent and insect infestation -Presence of lead-based paint -Sick building syndrome -Unsafe neighborhoods -Radon gas seepage in homes and schools Water quality: -Contamination of drinking supply by human waste -Oil spills in the world's waterways -Pesticide or herbicide infiltration of groundwater -Aquifer contamination by industrial pollutants -Heavy metal poisoning of fish Food safety: -Malnutrition -Bacterial food poisoning -Food adulteration -Disruption of food chains by ecosystem destruction -Carcinogenic chemical food additives Waste management: -Use of nonbiodegradable plastics -Poorly designed solid-waste dumps -Inadequate sewage systems -Transport and storage of hazardous waste -Illegal industrial dumping -Radioactive hazardous wastes

Examples of Environmental Health Problems?

-Theory-based practice guides data collection and interpretation in a clear and organized manner; therefore it is easier for the nurse to diagnose and address health problems. Through the process of integrating theory and practice, the student can focus on factors that are critical to understanding the situation. The student also has an opportunity to analyze the realities of nursing practice in relation to a specific theoretical perspective, in a process of ruling in and ruling out the fit of particular concepts -Use nursing theory to help us guide our practice, gives validity to the profession of nursing, reason we do the steps we do; FRAMEWORK, what nurses do but someone just put it down of paper

Explain how theory-based practice achieves the goals of community/public health nursing by protecting and promoting the public's health?

c.) Recognize that it would help achieve environmental justice. Executive Order 12898 (signed by President Clinton in 1994 with a memorandum signed by President Obama in 2008) required all federal agencies to develop comprehensive strategies to identify and address environmental justice. The focus of Executive Order 12898 is not to decrease urban sprawl. Sick building syndrome describes a phenomenon in which public structures and homes cause occupants to experience a variety of symptoms, such as headache, fatigue, and exacerbation of allergies. Executive Order 12898 is not citable as law to decrease carbon dioxide emissions.

How would a community health nurse use Executive Order 12898? a.) Recognize that its focus is to decrease urban sprawl. b.) Use its definition of sick building syndrome in completing an environmental assessment. c.) Recognize that it would help achieve environmental justice. d.) Cite it as a law to decrease carbon dioxide emissions for industries regulated by the Environmental Protection Agency.

-Macro-level socioenvironmental factors play a role in disease origin/spread -Look at social institutions and processes as possible risk factor for disease -Help focus intervention efforts, especially prevention interventions -Everything around could be a risk factor

Identify epidemiological models used to explain disease and health patterns in populations: Ecosocial perspective?

Agent- disease producing organism or toxin -Agents of Disease—Etiological Factors Nutritive elements: -Excesses: Cholesterol -Deficiencies: Vitamins, proteins Chemical agents: -Poisons: Carbon monoxide, carbon tetrachloride, drugs -Allergens: Ragweed, poison ivy, medications Physical agents: -Ionizing radiation: Sun exposure, medical imaging -Mechanical: Repetitive motion injury Infectious agents: -Metazoa: Hookworm, schistosomiasis, onchocerciasis -Protozoa: Amebae, malaria -Bacteria: Rheumatic fever, lobar pneumonia, typhoid, tuberculosis, syphilis -Fungi: Histoplasmosis, athlete's foot -Rickettsia: Rocky Mountain spotted fever, typhus, Lyme disease -Viruses: Measles, mumps, chickenpox, smallpox, poliomyelitis, rabies, yellow fever, human immunodeficiency virus

Identify epidemiological models used to explain disease and health patterns in populations: Epidemiological Triangle: AGENTS?

A.) Education alone will not motivate people to change B.) The client may not change if they do not think hypertension is serious D.) The client's priorities will influence the likelihood oof changing behaviors

Kahoot Question #4: Select all that apply

A.) What do you like to do for fun? B.) Residence C.) Past work D.) Environmental concerns

Kahoot Question #5:

A.) Ethnicity of community members (Community vitality) C.) Natural community boundaries (Physical environment) E.) Presence of public protection (safety)

Kahoot Question #7: Select all that apply

Host- human that can get the disease; genetic makeup, personality, and immunity Host Factors (i.e., intrinsic factors)— Susceptibility or Response Influence Exposure to Agent -Genetic: Cystic fibrosis, Huntington disease -Age: Alzheimer disease -Sex: Rheumatoid arthritis -Ethnic group: Tay-Sachs disease, sickle cell disease -Physiological state: Fatigue, pregnancy, puberty, stress, nutritional state -Prior immunological experience: Hypersensitivity, protection --Active: Prior infection, immunization --Passive: Maternal antibodies, gamma globulin prophylaxis -Intercurrent or preexisting disease: Diabetes, liver dysfunction, hypertension -Human behavior: Personal hygiene, food handling, diet, interpersonal contact, occupation, recreation, use of health resources, tobacco use

Identify epidemiological models used to explain disease and health patterns in populations: Epidemiological Triangle: HOST?

Person: "Who" factors, such as demographic characteristics, health, and disease status Place: "Where" factors, such as geographic location, climate and environmental conditions, and political and social environment Time: "When" factors, such as time of day, week, or month and secular trends over months and years

Identify epidemiological models used to explain disease and health patterns in populations: Person-Place-Time Model?

-Many disease processes are complex and influenced by a variety of variables. -Myocardial infarction example provided

Identify epidemiological models used to explain disease and health patterns in populations: Web of causation?

All the physical, chemical and biological factors external to a person Global environmental concerns: -Soil, water, air & food contamination -Climate change -Ozone layer destruction -Rainforest destruction -Ocean contamination Local environmental concerns: -Exposure to chemicals & radiation (factories, toxic waste dump) -Traffic congestion -Overcrowding -Limited access to safe, clean and stable housing -Unsafe neighborhoods w/ limited walkability Since the beginning of the twenty-first century, it has become apparent that the world must address urgent environmental difficulties, including extinction of some species, diminishing rainforests, proliferation of toxic waste dumps, progressive destruction of the ozone layer, shortage of landfill sites, consequences of climate change, threats of terrorism, development of deadly chemical and ballistic weapons, adulteration of food by pesticides and herbicides, oceanic contamination through toxic dumping and petroleum spills, overcrowding of urban areas, and traffic congestion.

Identify social, cultural, economic, and political factors that contribute to pollution and affect environmental problems?

Windshield Survey: -Driving or walking through the community -Observe people and their roles in the community -Busy in the afternoon? Parks? Dressed? Roles? Police? Windows boarded? Census data- every 10 years -Government asks by sending out letters for people to respond; if they don't, they go door to door -Who's living in the house? Education level? Vital Statistics: kept by the local gov's (public health dept) -Births: How much the population is increasing -Deaths: How much the population is decreasing -Marriages/Divorces: Because they can affect health with stress Key informants- leader in the community -Informal: lived in the community for a long time and knows everything that ahs went on (ex: church pastor)

Identify sources of information about a community's health?

For example, a community health nurse working with incarcerated women in a prison needs to work at the three levels of the system to assist women planning to reunite with their children at release. -The system is the group of women, the subsystem consists of the individual women, and the suprasystem would be the department of corrections and/or the state's department of social services.

Identify the appropriate prevention level and system level for nursing interventions in families, groups, aggregates, and communities?

c.) Insufficient knowledge about the disease and methods of prevention The "related to" phrase describes the cause of the health problem and directs the focus of the intervention. "Risk for undetected testicular cancer" is the identified problem. "Young men" is the identified aggregate. "Insufficient knowledge" is the "related to" phrase.

Identify the etiologic or causal statement component of the following community diagnosis: "There is an increased risk for undetected testicular cancer among young men related to insufficient knowledge about the disease and the methods for preventing and detecting it at an early stage as demonstrated by high rates of late initiation of treatment." a.) Risk for undetected testicular cancer b.) Young men c.) Insufficient knowledge about the disease and methods of prevention d.) High rates of late initiation of treatment

c.) John Snow. John Snow is recognized as the researcher who applied epidemiologic methods in the investigation of a cholera epidemic in London in the 1850s. Joseph Lister is considered the pioneer of antiseptic surgery. William Farr was a 19th century British epidemiologist who is regarded as a founder of medical statistics. Edward Jenner developed the smallpox vaccine.

In the 1850s, a researcher studied a cholera epidemic among people living in different sections of London. The researcher who used epidemiologic methods to study the epidemic and used rates as an epidemiologic tool was: a.) Joseph Lister. b.) William Farr. c.) John Snow. d.) Edward Jenner.

c.) 50% According to Cassidy, Trujillo, and Orleans (2015), 50% of all premature deaths in the United States are a result of individual behaviors and environmental factors. According to Mokdad, Marks, Stroup, and Gerberding (2004), tobacco use leads the list of "actual causes of death" at almost 20% of annual deaths in the United States.

It has been estimated that individual behaviors and environmental factors are responsible for what percentage of all premature deaths in the United States? a.) 20% b.) 40% c.) 50% d.) 70%

c.) sociocultural issues. The Code of Ethics of the American Nurses Association (2015) promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. Community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing sociocultural issues, such as human rights, homelessness, violence, and stigma of illness. Directing care toward socioeconomic issues, psychosocial issues, or developmental issues focuses on individuals, families, or groups, which in turn contributes to the health of the total population.

Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2015), community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing: a.) socioeconomic issues. b.) psychosocial issues. c.) sociocultural issues. d.) developmental issues.

-Factors that influence individuals to pursue health promotion, activities. -The HPM depicts the complex multidimensional & factors with which people interact as they work to achieve optimum health. -This model contains seven variables related to health behaviors, as well as individual characteristics that may influence a behavioral outcome. -Pender's model does not include threat as a motivator, as threat may not be a motivating factor for clients in all age groups, EXAMPLE: -The experience of having relatives who died of heart disease and cancer has probably increased her desire to engage in health behavior. -Similarly, her busy schedule and lack of communication with her doctor may be reflected in her failure to obtain screenings or immunizations. -Jamie has a habit of engaging in exercise and a high self-efficacy related to her success with exercise in the past. -Jamie feels better after exercise, and she receives positive comments from significant others regarding her appearance, also increasing her motivation to exercise -Jamie works out in a lovely gym and is very committed to her workout routine. -Jamie has found that working out first thing in the morning minimizes the competing demands that may keep her from exercising.

Pender's Health Promotion Model?

b.) a mobile immunization clinic. c.) condemning or repairing unsafe housing. e.) airing a weekly public service announcement to remind women to do breast self-examination. A mobile immunization clinic, repairing unsafe housing, and airing weekly public service announcements all target the larger population of a community. Providing well-infant care and encouraging family planning target individuals.

Public health efforts focus on prevention and promotion of population health. The local level of the health care system provides direct services to community members through community and personal health services. An example of a health service that targets the larger community, rather than individuals, is (Select all that apply.) a.) providing well-infant care. b.) a mobile immunization clinic. c.) condemning or repairing unsafe housing. d.) encouraging family planning. e.) airing a weekly public service announcement to remind women to do breast self-examination.

d.) nursing interventions. Interventions should be included from a range of strategies, including mass media (public service announcements, radio, television, billboards), general information dissemination (e.g., pamphlets, DVDs, CDs, posters), electronic information dissemination (e.g., websites, blogs, tweets, video stream), and public forums (e.g., town meetings, focus groups, discussion groups). Intervention levels apply to aggregates, communities, or individuals. Assessment includes the collection of data to determine the needs of the community or aggregate. Evaluation determines the success or failure of a project. Methods may include verbal or written feedback, surveys, or other tools that measure whether objectives were met.

Public service announcements, dissemination of pamphlets, and focus groups are examples of measures that can be used by the community health nurse. These are also known as: a.) levels of intervention. b.) nursing assessment. c.) evaluation methods. d.) nursing interventions.

b.) health protection. Health protection refers to behaviors in which the individual engages with the intent to prevent disease, detect disease in early stages, or maximize health. Immunizations and physical examinations are examples. Green and Kreuter (1991) define health promotion as "any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health." Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis, such as checking the skin for signs of skin cancer or identifying and treating individuals who have been exposed to contagious diseases. Health maintenance occurs when the individual has changed overt behavior for more than 6 months and strives to prevent relapse.

Receiving immunizations, regular health screenings, and physical examinations is an example of: a.) health promotion. b.) health protection. c.) secondary prevention. d.) health maintenance.

Hill burton act: -The Hill-Burton Act provided construction-related planning, but it did not address coordination and care delivery directly. -This legislation was more comprehensive and established regional medical programs (RMPs). Affordable care act: -The ACA is a national health insurance program that requires all citizens to be covered by one or a combination of insurance programs. -This act put individuals, families, and small business owners in control of their health care. It reduced premium costs for millions of working families and small businesses by providing hundreds of billions of dollars in tax relief—the largest middle-class tax cut for health care in history. -It also reduced what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense. -It kept insurance companies honest by setting clear rules that rein in the worst insurance industry abuses. And it prohibited insurance companies from denying insurance coverage because of a person's pre-existing medical conditions while giving consumers new power to appeal insurance company decisions that deny doctor-ordered treatments covered by insurance.

Recognize major health planning legislation?

a.) Reducing premium costs for millions of working families and small businesses b.) Capping out-of-pocket expenses c.) Prohibiting denial of coverage because of a preexisting condition d.) Covering the cost of preventive care Provisions from the Affordable Care Act of 2010 included: Reducing premium costs for millions of working families and small businesses by providing hundreds of billions of dollars in tax relief—the largest middle-class tax cut for health care in history.Reducing what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense.Keeping insurance companies honest by setting clear rules that rein in the worst insurance industry abuses.Prohibiting insurance companies from denying insurance coverage because of a person's preexisting medical conditions while giving consumers new power to appeal insurance company decisions that deny doctor-ordered treatments covered by insurance (U.S. Department of Health and Human Services, 2017).Regional Medical Programs were intended to establish regional cooperative arrangements among medical schools, research institutions, and hospitals to improve the health manpower and facilities available to the communities.

The Affordable Care Act of 2010 included several elements that involve health planning. These elements include (Select all that apply.) a.) Reducing premium costs for millions of working families and small businesses b.) Capping out-of-pocket expenses c.) Prohibiting denial of coverage because of a preexisting condition d.) Covering the cost of preventive care e.) Establishing regional cooperative arrangements among medical schools, research institutions, and hospitals to improve the health manpower and facilities available to the communities.

a.) Descriptive epidemiology seeks to answer questions about the amount of disease in a given population. d.) Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population. The study of the amount and distribution of disease constitutes descriptive epidemiology. Patterns identified through descriptive epidemiology may indicate possible causes. When these possible causes are investigated with different and more advanced epidemiologic methods, this is analytic epidemiology.

The public health nurse is working with a specific population and is preparing to participate in a descriptive epidemiology study. Which of the statements apply to descriptive epidemiology? (Select all that apply.) a.) Descriptive epidemiology seeks to answer questions about the amount of disease in a given population. b.) Descriptive epidemiology seeks to answer questions about the cause of disease in a given population. c.) Descriptive epidemiology seeks to answer questions about the cure for disease in a given population. d.) Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population.

a.) put individuals, families, and small business owners in control of their health care. The act put individuals, families, and small business owners in control of their health care. The Hill-Burton Act provided federal aid to states for hospital facilities, resulting in improved quality of care in rural areas and systematic statewide planning. Implementation of health maintenance organizations was not required by the Affordable Care Act.

The rationale behind the Affordable Care Act was to: a.) put individuals, families, and small business owners in control of their health care. b.) increase federal aid to states for hospital facilities. c.) improve the quality of care in rural areas and introduce systematic statewide health care planning. d.) force the implementation of health maintenance organizations.

a.) writing a community diagnosis. b.) evaluating the outcomes. c.) collecting assessment data. e.) planning community interventions. The steps of the community assessment process for community health nurses are collecting the assessment data, synthesizing assessment data into diagnostic statements about the community's health, planning interventions, and evaluating the outcomes. Identifying the cause of the problem helps with planning the interventions.

The steps in the community assessment process for community health nurses are (Select all that apply.) a.) writing a community diagnosis. b.) evaluating the outcomes. c.) collecting assessment data. d.) identifying the cause of the problem. e.) planning community interventions.

-attempts to predict a person's intention to perform or not to perform a certain behavior. Based on the assumption that all behavior is determined by one's behavioral intentions. These intentions are determined by one's attitude regarding a behavior and the subjective norms associated with the behavior. One's attitude is determined by one's beliefs about the outcomes of performing the behavior, weighed by one's assessment of the outcomes. EXAMPLE: -Jamie must believe strongly that exercise will have positive results, as she rises early and takes time from her busy schedule to work out daily. -Conversely, Jamie may believe strongly that routine immunizations or health screenings will have a negative result. -If Jamie believes that her husband or children think that she should get a mammogram, and if she is motivated to comply with their wishes, Jamie will have a positive subject norm regarding getting a mammogram.

Theory of Reasoned Action?

a.) Primary Primary prevention occurs when intervention activities take place before disease development. Immunization is an example of primary prevention that provides specific protection. Secondary prevention occurs after pathogenesis, namely screening and physical examinations that are aimed at early diagnosis. Tertiary prevention focuses on rehabilitation and limitation of disability. Pathogenic does not describe a type of prevention.

Through epidemiologic investigations, effective prevention measures are often identified. When the nurse is engaged in providing prevention for the community before disease has developed, the prevention activities meet the definition for what level of prevention? a.) Primary b.) Secondary c.) Tertiary d.) Pathogenic

Smoking is leading cause of preventable death -Causal factors in many cancers Significant economic impact- healthcare dollars, lost productivity Prevalence highest among: American Indians, Alaska Natives and Caucasians; live below poverty level; people with disabilities; and gay, lesbian, and bisexual as compared to relative peer groups -Hard habit to break, nicotine is highly addictive; withdrawal symptoms Smoking cessation help available-Quit line, CDC, ACS, and ALA -Few people start a smoking habit after age 25 -Smokeless tobacco use usually begins in middle school -Screen for tobacco use at every visit. Look for teachable moments

Tobacco and Health?

-based on the assumption that behavior change takes place over time, progressing through a sequence of stages. It also assumes that each of the stages is both stable and open to change. In other words, one may stop in one stage, progress to the next stage, or return to the previous stage. Stages of Change: Precontemplation: The individual has no intention to take action toward behavior change in the next 6 months. May be in this phase because of a lack of information about the consequences of the behavior or failure on previous attempts at change. Contemplation: The individual has some intention to take action toward behavior change in the next 6 months. Weighing pros and cons to change. Preparation: The individual intends to take action within the next month and has taken steps toward behavior change. Has a plan of action. Action: The individual has changed overt behavior for less than 6 months. Has changed behavior sufficiently to reduce risk of disease. Maintenance: The individual has changed overt behavior for more than 6 months. Strives to prevent relapse. This phase may last months to years. Decisional Balance: Pros: The benefits of behavior change Cons: The costs of behavior change

Transtheoretical Theory?

a.) Helping people learn from their own experiences and analyzing the world with the intention to change it Nursing's role in the community is to create a context from which people can learn and identify health-damaging problems from within their environment. It is essential that the affected people participate in the process of identifying and working to solve environmental problems. The other options do not allow the people to participate in the process that affects their ability to learn and thus make change.

When assisting specific aggregates, which should be included in the community health nurse's outcomes? a.) Helping people learn from their own experiences and analyzing the world with the intention to change it b.) Honesty, fairness, and mutuality in the interactions c.) Intervening in mutual exchanges with community members and citing the current literature d.) Asking critical questions of the aggregates involved

For example, analyzing the ratio of health care providers to population size helps determine the system's ability to provide care. -The clients' reasons for seeking care, the clients' payment methods, and the clients' satisfaction with care are also informative. Regardless of whether community health nurses or other health services professionals collect these data, the information is essential for those who strive to improve clients' access to quality health care. Ultimately, nurses must apply epidemiological findings in practice. It is essential that they incorporate study results into prevention programs for communities and at-risk populations. -Furthermore, the philosophy of public health and epidemiology dictates that nurses extend their application into major health policy decisions, because the aim of health policy planning is to achieve positive health goals and outcomes for improved population health. A goal of policy development is to bring about desirable social changes. Epidemiological factors, history, politics, economics, culture, and technology influence policy development. The complex interaction of these factors may explain the challenges with application of epidemiological knowledge. Lung disease in the United States exemplifies the incomplete progress in implementing effective health policy. In the early 1950s, studies identified and conclusively linked cigarette smoking to lung cancer and heart disease. Beginning in the 1950s, public policies to address this health threat have included cigarette taxes, cigarette package warning labels, smoking restrictions in public areas, the institution of smoke-free workplaces, and restrictions on selling tobacco to minors. Despite the successes of the past 60 years, approximately 20% of Americans continue to smoke, with rates particularly high among young adults, suggesting a continued need for focused and effective public health policy. Community health nurses should exercise "social responsibility" in applying epidemiological findings, but doing so will require the active involvement of the consumer. Community health nurses collaborating with community members can combine epidemiological knowledge and aggregate-level strategies to effect change on the broadest scale.

Use epidemiological methods to describe the state of health in a community or aggregate?

d.) alter the precursors of poor health. Critical theory is used to help community health nurses think about social, cultural, economic, and political factors of health, thereby assisting them to attack the problem at its source and alter community-wide precursors of poor health. The community health nurse can develop a community nursing diagnosis and design interventions by using the nursing process.

Using critical theory when exploring issues of environmental health ultimately allows the nurse to: a.) develop a community diagnosis. b.) raise additional questions related to environmental health and safety. c.) design community health interventions. d.) alter the precursors of poor health.

a.) guide data collection and interpretation in a clear and organized manner. c.) improve community health nursing practice. e.) focus the student on factors that are critical to understanding the situation. Theory-based practice guides data collection and interpretation in a clear and organized manner. Although using theory makes it easier to plan standardized care for aggregates, the goal of theory is to improve nursing practice, thereby ensuring quality care. Through the process of integrating theory and practice, the student can focus on factors that are critical to understanding the situation. The lack of uniformity in theory definitions reflects the evolution of thought and the individual differences in the understanding of relationships among theory, practice, and research.

Using theory to guide community health nursing practice serves to (Select all that apply.) a.) guide data collection and interpretation in a clear and organized manner. b.) provide uniformity in community health nursing practice. c.) improve community health nursing practice. d.) validate traditional community health nursing beliefs. e.) focus the student on factors that are critical to understanding the situation.

Subgroups of populations (teen moms; non-stable housing groups while looking at elementary school kids attending school) -Are subgroups or subpopulations that have some common characteristics or concerns EXAMPLE: Pregnant teens within a school district

What are Aggregates?

A group or collection of individuals interacting in social units and sharing common interests, characteristics, values, and goals. -People in the same geopolitical area EXAMPLE: Residents of a small town

What are Communities?

Common personal or environmental characteristics (Larger groups = OHIOANS; 15 year old girls)) -Typically used to denote a group of people with common personal or environmental characteristics. EXAMPLE: All elders in a rural region

What are Populations?

-The model evolved from the premise that the world of the perceiver determines action. -The HBM is based on the assumption that the major determinant of preventive health behavior is disease avoidance. Got it, How bad?; Willing to modify to prevent disease from occurring/worsening?; MICROSCOPIC Disease avoidance- determinant of health behaviors The client either "acts" or "fails to act" Assumptions- all clients have the same access to health resources and free will Cues to action- Social media; billboards; mailers Perceived seriousness Perceived susceptibility- Used this for COVID, "I'll be fine, I'm young and not old which is basically all it's affecting" Nurses' role- change client perceptions; WANT THEM TO RECOGNIZE HOW DISEASE PROCESS COULD AFFECT THEM EXAMPLE: -Jamie may not perceive that she is susceptible to heart disease or breast cancer, or she may not perceive that their is a benefit of screening, or of treatment for heart disease or cancer- thus her failure to take up screening for these disease -Perceived susceptibility: One's belief regarding the chance of getting a given condition. -Perceived severity: One's belief regarding the seriousness of a given condition. -Perceived benefits: One's belief in the ability of an advised action to reduce the health risk or seriousness of a given condition. -Perceived barriers: One's belief regarding the tangible and psychological costs of an advised action. -Cues to action: Strategies or conditions in one's environment that activate readiness to take action. -Self-efficacy: One's confidence in one's ability to take action to reduce health risks

What his the Health Belief Model?

Pleads someone's cause or acts on someone's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf.

What is Advocacy?

Promotes and develops alliances among organizations or constituencies for a common purpose.

What is Coalition building?

a.) Who is affected by the problem? Dialogue from critical thinking should facilitate community involvement and is not focused on a single individual. Asking about role or diagnosis does not facilitate community involvement.

When building a collective strategy by framing an environmental problem, the community health nurse should ask which question? a.) Who is affected by the problem? b.) What individual should I talk to? c.) What nursing diagnosis is involved? d.) What is my role?

MACROSCOPIC Problems and inequalities of health connected to past social arrangements and cultural values of a society -The critical theoretical perspective assumes that health and illness entail societal and personal values and that these values have to be made explicit if illness and health care problems are to be satisfactorily dealt with. This perspective is informed by the following values and assumptions: --• The problems and inequalities of health and health care are connected to the particular historically located social arrangements and the cultural values of society. --• Health care should be oriented toward the prevention of disease and illness. --• The priorities of any health care system should be based on the needs of the clients/population and not the health care providers. --• Ultimately, society itself must be changed for health and medical care to improve. -Health care goal- prevention of disease and illness -Health care system priorities should be client/population-centered -Society must change for health and medical care to improved --Health care is used as a form of social control Medicalization- condition or behaviors is categorized as medical condition --Lobectomy for mental illness; homosexuality shock treatments --Society used to perceive these as unacceptable behaviors so they used medical procedures to try and "treat them"

What is Critical theoretical perspective- socialization?

Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and other risks, and determines control measures. -Example: The public health nurse is visiting with a school nurse about a recent outbreak of HEP A in the school, which of these would the nurse be doing? = disease and health event investigation

What is Disease and health event investigation?

Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

What is Health teaching?

MACROSCOPIC -Directs attention upstream -Provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level. Nancy Milio outlined six propositions that relate an individual's ability to improve healthful behavior to a society's ability to provide accessible and socially affirming options for healthy choices. -Milio used these propositions to move the focus of attention upstream by challenging the notion that a main determinant for unhealthful behavior choice is lack of knowledge. -Milio (1976) proposed that health deficits often result from an imbalance between a population's health needs and its health-sustaining resources. She stated that the diseases associated with excess (e.g., obesity and alcoholism) afflict affluent societies and that the diseases resulting from inadequate or unsafe food, shelter, and water afflict the poor. Six propositions: 1.) Population health affected by available critical health resources 2.) Health behaviors of populations selected from limited choices 3.) System's decisions and policies dictate options available to individuals and populations. Therefore influence choices individuals make (COVID SHUTDOWN; Shut down= stop the spread= BC worried about the healthcare system collapsing bc had a lot of new illness on top of the normal illnesses) 4.) Individual choices related to health-promotion or health-damaging behaviors are influenced by efforts to maximize valued resources (Stopped elective surgeries; virtual visits) 5.) Social change may arise when a significant amount of the population alters their patterns of behavior. (Saw significant decrease in cases from shut down) 6.) Some people/populations won't change despite being aware of what they need to do to improve or maintain their health. Education will not be effective in changing behaviors in this population (People who didn't social distance) -Influence community health through public policy- Rules we put into place to help guide/influence public health -Health deficits related to imbalance between population's health needs and available health resources -Nurses' role- understand health behaviors in the context of their society/community

What is Milio's framework of prevention?

MICROSCOPIC -Identify self-care deficits (who needs nursing care) -Explain why self-care is important -Specifies nursing's role in delivery of care and how nurses help people Ex: Hygiene, compliance (visits, meds), ambulation (move)

What is Orem's Self-Care Deficit Theory?

Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions.

What is Surveillance?

The existence of disease in a large proportion of the population—a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A) (COVID-19)

What is a Pandemic?

Diseases that are always present in a population (e.g., colds and pneumonia)

What is an Endemic?

Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles) -Addiction

What is an Epidemic?

d.) Nicotine Nicotine addiction is the most common form of chemical dependence in the United States. Smokers who try to quit experience withdrawal symptoms, including anxiety, irritability, increased appetite, and difficulty concentrating. Alcohol use is very common in our society, but it is not the most common form of chemical dependence. Cocaine and marijuana are not the most common forms of chemical dependence in the United States.

What is the most common chemical dependence in the United States? a.) Alcohol b.) Cocaine c.) Marijuana d.) Nicotine

d.) National Health Planning and Resources Development Act The National Health Planning and Resources Development Act addressed the need for the provider and consumer to be involved in the planning and improving of health services as well as placing the system of private practice examination. The Partnership for Health Program provided federal grants to states to establish and administer a local agency program to enact local comprehensive health care planning. The Hill-Burton Act was passed by Congress to address the need for better hospital access. The Regional Medical Programs intended to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals.

What legislation resulted in increased consumer involvement in the U.S. health care system and a review of the allocation of health care resources? a.) Partnership for Health Program b.) Hill-Burton Act c.) Regional Medical Services Programs d.) National Health Planning and Resources Development Act

b.) Cigarette smoking d.) Sexual practices e.) Diet Modifiable risk factors are those aspects of a person's health risk over which he or she has control. Examples include smoking, leading a sedentary or active lifestyle, the type and amount of food eaten, and the type of activities in which he or she engages. Gender is not changeable. Air pollution can contribute to some disease processes, but it is not considered to be a direct risk factor.

Which is an example of a modifiable risk factor? (Select all that apply.) a.) Air pollution b.) Cigarette smoking c.) Gender d.) Sexual practices e.) Diet

c.) Web of causation Chronic disease is marked by a complexity of relationships among causal factors. The web of causation model illustrates the interrelationships. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. The epidemiological triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent. The wheel model is an example of a model that stresses the multiplicity of host and environmental interactions.

When chronic disease became a more important cause of death in developed countries, different epidemiologic models were developed to study the many factors involved in the development of these health conditions. Which is an example of such a model? a.) Person-place-time model b.) Epidemiologic triangle c.) Web of causation d.) Wheel model

a.) changes in diet. b.) environmental alterations. d.) increased population density. e.) occupational hazards. Epidemiologic studies suggest that common risk factors that contribute to chronic health conditions are changes in diet (e.g., increases in refined sugar and fats and lack of fiber), environmental alterations (e.g., use of motorized transportation and climate-controlled living and work sites), and occupational hazards. An increase in population and population density also increase mental and behavioral disorders. Economic improvements in nonindustrialized communities would decrease the risk of disease. Economic changes in nonindustrialized communities are not listed as a common risk factor that contributes to chronic health conditions.

When nonindustrial cultures adopt Western customs and transition into urban environments, Western diseases begin to appear. Epidemiologic studies suggest that common risk factors that contribute these health conditions include: (Select all that apply.) a.) changes in diet. b.) environmental alterations. c.) economic changes. d.) increased population density. e.) occupational hazards.

c.) specifies the aggregate that will benefit from the nurse's plan. The "among" phrase specifies the aggregate that will be the beneficiary of the nurse's action plan. The identification of the health problem represents a synthesis of all assessment data. The "related to" phrase describes the cause of the health problem and directs the focus of the intervention. The health indicators are the supporting data. The "related to" phrase describes the cause of the health problem and directs the focus of the intervention.

When writing a community diagnosis, the community health nurse notes that the "among" phrase: a.) presents a synthesis of all assessment data. b.) provides the supporting data. c.) specifies the aggregate that will benefit from the nurse's plan. d.) describes the cause of the health problem and directs focus of interventions.

d.) Physical environment The physical environment refers to the things that can be experienced with the senses. The physical environment can affect health negatively or positively. Biology is an individual's genetic makeup, family history, and any physical and mental health problems developed in the course of life. Behaviors are the individual's responses to internal stimuli and external conditions. Social environment includes interactions and relationships with family, friends, coworkers, and others in the community.

Which "determinants of health" refers to factors that are experienced with the senses-things that can be seen, touched, heard, and smelled? a.) Biology b.) Behaviors c.) Social environment d.) Physical environment

a.) Biology Biology refers to an individual's genetic makeup, family history, and physical and mental health problems experienced over the course of life. Behaviors are the individual's responses to internal stimuli and external conditions. Social environment includes interactions and relationships with family, friends, coworkers, and others in the community. The physical environment refers to the things that can be experienced with the senses. Biology is an individual's genetic makeup, family history, and any physical and mental health problems developed in the course of life.

Which "determinants of health" would include predisposition to prostate cancer and a history of depression? a.) Biology b.) Behaviors c.) Social environment d.) Physical environment

b.) concerned with reducing teenage suicides. A community of solution forms when a common problem unites individuals. The group members may have little in common other than the desire to address the problems that bring them together. A geographic community is a group that lives within a specific geographic location. Other types of communities may be defined by members of the same ethnic background or members that share the same interests, such as hiking.

Which group is an example of a community of solution? A group: a.) that lives within a specific geographic location. b.) concerned with reducing teenage suicides. c.) with the same ethnic background. d.) in which all members enjoy hiking.

c.) Involve citizens in decision-making processes about proposed activities that could pose an environmental threat. Community health nurses have a mandate to assist vulnerable aggregates who have fewer options in protecting themselves from pollution, inadequate housing, toxic poisoning, unsafe products, and other hazards. An appropriate nursing intervention would be to involve citizens in decision-making processes about proposed activities that could pose an environmental threat. Evaluating ongoing health interventions, documenting participation levels of families, and screening at-risk populations are important evaluation methods for determining the needs of the community but are not the most appropriate intervention.

Which intervention would be the most appropriate to implement for a community that has a high risk for environmental health hazards? a.) Facilitate the evaluation of ongoing community health interventions. b.) Document participation levels of families in environmental issues. c.) Involve citizens in decision-making processes about proposed activities that could pose an environmental threat. d.) Screen at-risk populations for asthma and test blood levels for air pollutants.

c.) An RN reviewing school clinic records to determine which children are not up to date on their immunizations "Community health nursing" focuses on groups of people, with the primary responsibility being the population as a whole (as with a school). Care typically focuses on health promotion and illness prevention, such as the nurse who reviews school clinic records to determine which children are not up to date on their immunizations. "Community-based nursing" is setting specific and emphasizes care to individuals, often in homes and ambulatory clinics, and typically addresses acute and chronic health conditions. The other options are examples of nurses providing care to individuals.DIF: Cognitive level: Application

Which is an example of "community health nursing" rather than "community-based nursing"? a.) An RN assisting a doctor in a pediatrician's office b.) An RN visiting a home-bound patient to monitor for congestive heart failure c.) An RN reviewing school clinic records to determine which children are not up to date on their immunizations d.) An RN dispensing medications in a nursing home

c.) Focus groups Focus groups are effective for remote and vulnerable segments of a community and for those with underdeveloped opinions. These sessions can produce greater interaction and expression of ideas than surveys and may provide more insight into an aggregate's opinions. The community health nurse may gather some data by interviewing key informants in the community. Informants may be knowledgeable residents, elected officials, or health care providers. A community forum may be held to discuss selected questions. A telephone survey may be useful for selected questions.

Which method of gathering data is most effective for remote and vulnerable segments of a community and for those communities with underdeveloped opinions? a.) Interviewing community informants b.) Community forum c.) Focus groups d.) Telephone surveys

c.) Florence Nightingale Most nursing scholars identify Florence Nightingale as the first nurse theorist. Lillian Wald helped establish community health nursing in the United States. Nancy Milio created the framework for prevention theory. Dorthea Orem conceptualized the self-deficit theory.

Which nurse leader formulated the first theory-based conceptual model for nursing care? a.) Nancy Milio b.) Lillian Wald c.) Florence Nightingale d.) Dorthea Orem

c.) The nurse's preferences Factors that assist the nurse in determining priorities for aggregate health care include the aggregate's preferences; the number of people affected; the severity of the health problem; and the available solutions, resources, time, and individuals with skills to help solve the problem. Often the nurse will prefer to provide information and interventions that he or she is most comfortable with, but that may not be what is needed most.

Which of following factors is not necessary to consider when determining priorities for health problem interventions? a.) The aggregate's preferences b.) The number of individuals affected by the health problem c.) The nurse's preferences d.) The availability resources

b.) Vital statistics The official registration records of births, deaths, marriages, divorces, and adoptions form the basis of data in vital statistics. When compared with previous years, vital statistics provide indicators of population growth or reduction. Census tracts facilitate the organization of resident information in specific community geographic locales. National Health Survey Data describes health trends in a national sample. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns.

Which source of information about a community's health would give the community health nurse information about births, deaths, and marriages and aid in providing indicators of population growth or reduction? a.) Census tracts b.) Vital statistics c.) National Health Survey data d.) Needs assessment

c.) It focuses the nurse on short-term, individual-based nursing interventions. The upstream model uses the analogy of a river flowing upstream toward the bigger picture to focus community health nursing practice. This differentiates population-focused and individual-focused nursing interventions. The community health nurse needs to have a "critical eye" for the bigger picture to focus time, energy, and resources and provide quality care.

Which statement is not true about the "thinking upstream" model of community health nursing practice? a.) It is a conceptual model to assist the nurse in community health planning. b.) It helps to focus the time, energy, and programmatic resources available to community health nursing clients. c.) It focuses the nurse on short-term, individual-based nursing interventions. d.) It focuses the nurse on long-term, "bigger picture" issues related to community health practice, such as social justice or power.