population health exam 1
A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: a. parental neglect. b. mental health problems. c. violence potential. d. developmental disorders.
b. mental health problems. Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with their education and social interactions, and keep them from realizing their full potential as adults. Children can develop depression or behavior problems in response to an actual or potential loss.
Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? (Select all that apply.) a. Gaps in continuum of mental health services b. Trust in the health care professionals c. Tolerance for destructive coping behaviors d. Sufficient number of mental health services e. Crisis intervention
a, c, There appears to be a more persistent, endemic level of depression among rural residents. Factors that relate to this level of depression are high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.
What was the initial impact of African American nurses working in the public health setting? (Select all that apply.) a. Study outside the South for Southern nurses was difficult to afford and study leaves from the workplace were rarely granted. b. Public health nursing certificate and graduate education programs were segregated in the South. c. African American nurses in the South were paid less than their white counterparts. d. African American nurses held supervisory roles. e. Nursing education for Southern nurses was provided through free educational grants.
a, b, c African American nurses seeking to work in public health nursing faced many challenges. Nursing education was absolutely segregated in the South until at least the 1960s, and elsewhere was also generally segregated or rationed until the mid-20th century. Even public health nursing certificate and graduate education programs were segregated in the South; study outside the South for Southern nurses was difficult to afford and study leaves from the workplace were rarely granted. The situation improved somewhat in 1936, when collaboration between the US Public Health Service and the Medical College of Virginia (Richmond) established a certificate program in public health nursing for African American nurses for which the federal government paid nurses' tuition. Discrimination continued during nurses' employment: African American nurses in the American South were paid lower salaries than their white counterparts for the same work. In 1930, only six African American nurses held supervisory positions in public health nursing organizations.
A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? (Select all that apply.) a. Session timing b. Small group interaction c. Session space d. Use of films e. Use of games
a, b, c, d, e Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.
There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. Which statements reflect the most significant concerns of nurses in the community-focused setting? (Select all that apply.) a. EBP requires compliance by the client. b. EBP requires little support. c. Lack of resources d. EBP questions long-standing nursing practice. e. EBP demands change.
a, c, d Although a community agency may subscribe in theory to the use of EBP, actual implementation may be affected by the realities of the practice setting. Community-focused nursing agencies may lack the resources needed for its implementation in the clinical setting, such as time, funding, computer resources, and knowledge. Nurses may be reluctant to accept findings and feel threatened when long-established practices are questioned. Cost can also be a barrier if the clinical decision or change will require more funds than the agency has available. Compliance can be a barrier if the client will not follow the recommended intervention.
The public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? (Select all that apply.) a. Evaluating the social, economic, and environmental characteristics of the population b. Assisting communities to implement and evaluate plans and projects c. Questioning the availability of health services to the community d. Building constituencies to work with the community e. Collecting, analyzing, and disseminating information
a, c, e The core public health function of assessment includes the following: Engaging in activities that involve the collection, analysis, and dissemination of information on both the health and health-relevant aspects of a community or specific population· Questioning, for example, whether the health services of the community are available to the population and are adequate to address needs· Monitoring the health status of the community or population and the services provided over time· Evaluating the social, economic, environmental, and lifestyle characteristics and practices of a population as well as the health services and capability available within the community to support good health for the population
A clinic-based public health nurse (PHN) has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level? a. Analysis of the trend in childhood immunization rates for the health district b. Determination of the budgetary impact of the media campaign on the clinic's operations c. Analysis of the immunization clinic appointment rate over the next few months d. Assessment of the immunization status of each child who visits the clinic
a. Analysis of the trend in childhood immunization rates for the health district The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs.
A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. Which strategy would the nurse consider most effective when working with these clients? a. Create a trusting environment and establish a therapeutic relationship. b. Collaborate with the local united way to obtain funding for primary care services. c. Dialogue with local clergy to address the unmet primary care need for homeless persons. d. Form a community partnership to establish a clinic for homeless persons.
a. Create a trusting environment and establish a therapeutic relationship. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.
Which action by the community-oriented nurse best illustrates a partnership for health? a. Helping a group of citizens collect relevant health data and develop interventions related to potential environmental hazards b. Developing a volunteer program for teaching parenting skills c. Assisting a school nurse in conducting vision screening of elementary school children d. Informing a neighborhood council that smoking is its major community health problem
a. Helping a group of citizens collect relevant health data and develop interventions related to potential environmental hazards Healthy People 2030 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term.
The nurse in community health identifies an elder abuse problem related to caregiver stress among families. The nurse further identifies a lack of caregiver support services in the local community. The next step in the community-oriented nursing process would be to: a. analyze the community problem. b. establish goals and objectives. c. establish priorities. d. identify intervention activities.
a. analyze the community problem. After the identification of the community problem(s), the planning phase of the community-oriented nursing process should begin with an analysis of the problem. During the analysis, the nurse seeks to clarify the nature of the problem, its origins and effects, points at which intervention might be undertaken and interested parties/change agents. Analysis often requires identifying direct and indirect contributing factors, outcomes of the problem, and relationships between problems. Once high-priority problems are identified, relevant goals and objectives are developed, followed by the identification of intervention activities.
A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the public health core function of: a. assessment. b. research. c. policy development. d. assurance.
a. assessment. The three public health core functions are assessment, policy development, and assurance. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Assurance is making sure that essential community-oriented health services are available. These services might include providing essential personal health services for those who would otherwise not receive them. Assurance also includes making sure that a competent public health and personal health care workforce is available.
A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: a. cognitive domain. b. events of instruction. c. affective domain. d. principles of effective education.
a. cognitive domain. The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles.
A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: a. community partnerships. b. community health. c. community. d. community client.
a. community partnerships. Community partnership is necessary because when there is community partnership lay community members have a vested interest in the success of efforts to improve the health of their community. Most changes must aim at improving community health through active partnerships between community residents and health workers from a variety of disciplines. Partnership, as defined here, is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health.
A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: a. community-based nursing. b. community-oriented nursing. c. institutional nursing. d. public health nursing.
a. community-based nursing. The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic.
A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: a. community-based nursing. b. community-oriented nursing. c. public health nursing. d. institutional nursing.
a. community-based nursing. The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting.
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. tertiary care. c. secondary care. d. community-based care.
a. community-oriented care. Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings. Community-based care is nursing care that is provided in a setting. A smoking cessation clinic is an example of primary prevention, not secondary or tertiary.
Vulnerable populations may be exposed to more than one hazard at a time. This is known as: a. cumulative risk. b. underserved populations. c. disenfranchised populations. d. resilience.
a. cumulative risk. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).
A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: a. influential with their insider status to engage community members. b. translators to help overcome language barriers. c. natural healers within their community. d. medical professionals within the migrant community.
a. influential with their insider status to engage community members. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. They can also serve as gatekeepers, using their own insider status to engage community members in the assessment process
A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: a. invisible to the community. b. complicated to address. c. resilient to the community. d. costly to serve.
a. invisible to the community. Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are "invisible" to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.
For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: a. limitations in following treatment protocols. b. use and abuse of tobacco, alcohol, and illicit drugs. c. limited number of transient treatment facilities. d. transition to persistent poverty.
a. limitations in following treatment protocols. Homeless people are exposed to the elements, crowded and unsanitary living conditions, malnutrition, lack of sleep and stress. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens.
A nurse in community health working in an inner-city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: a. low-birthweight babies. b. full term. c. at home. d. identical twins or triplets.
a. low-birthweight babies. Poor pregnant women are more likely than other women to receive late or no prenatal care and to deliver low-birthweight babies, premature babies, or babies with birth defects.
Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: a. populations with the highest rate of diabetes. b. new technology for diabetic care. c. drug treatments for diabetes. d. educational materials for individuals with diabetes.
a. populations with the highest rate of diabetes. The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting.
While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This type of data can best be described as: a. primary data b. secondary data c. unique data d. tertiary data
a. primary data Measures of health status take more than one form. Numerical data put out by a recognized agency (such as the U.S. Census Bureau or Centers for Disease Control and Prevention, or Robert Woods Johnson Foundation) are referred to as secondary data (collected by someone else). Secondary data are obtained through existing reports on the community including census, vital statistics, and numerical reports (e.g., morbidity and mortality information or information from reference books). Information that is gleaned from telephone surveys, personal interviews, or focus groups conducted by those who are assessing the community, or derived from personal connections or key informants, are considered primary data. Primary data are collected directly through interaction with community members, which may include community leaders or interested stakeholders. Community Assessment requires both types of data and are included when analyzing the assessment data for a comprehensive view of the community.
When determining whether a geographic area is rural or urban, the nurse should recognize that: a. rural and urban areas, by relative nature, occur on a continuum. b. rural regions have fewer than six persons per square mile. c. rural residents feel isolated. d. rural areas are recreational, retirement, or resort communities.
a. rural and urban areas, by relative nature, occur on a continuum. Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, and to a large metropolitan area with a core inner city.
A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': a. underutilization of the mental health system. b. reduced social contacts. c. dependence on their primary-care provider. d. normal sensory losses.
a. underutilization of the mental health system. Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.
What does a community-oriented nurse newly assigned to a rural community learn about the characteristics of rural and small-town life? (SATA) a. Fractured family and social systems b. Role of churches as socialization centers c. Work of many residents in high-risk occupations d. Openness to people new to the community e. Informal social and professional relationships
b, c, e The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").
Which of the following barriers are specific to the educator? (Select all that apply.) a. Low literacy b. Limited experience with the topic c. Lack of experience with gaining participation d. Fear of public speaking e. Lack of motivation
b, c, d Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes.
Evidence-based public health utilizes which of the following guidelines? (Select all that apply.) a. Decision making for the community served b. Conducting sound evaluations c. Disseminating what has been learned d. Application of program planning frameworks e. Judicious use of the Internet for use of evidence
b, c, d Evidence-based public health is defined as a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. An expanded definition of evidence-based public health includes making decisions on the basis of the best available evidence, using data and information systems, applying program planning frameworks, engaging the community in decision making, conducting evaluations, and disseminating what has been learned.
Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Reduced eligibility for entitlement/assistance programs b. Higher incidence of acute and chronic disease c. Lack of awareness of care options d. Crisis-oriented health care, usually in emergency departments e. Higher risk of physical trauma
b, c, d, e Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis-oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.
Which of the following factors assisted such community-oriented nursing pioneers as Lillian Wald to develop approaches and programs to solve the health care and social problems of the late 1800s? (Select all that apply.) a. Establishment of the Town and Country Nursing Services in large cities b. Establishment of settlement houses c. Middle and upper class fear of diseases d. Lack of public interest in limiting disease e. Community health's focus on teaching and prevention
b, c, e In the 1890s the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charity, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to improved sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing, such as Lillian Wald, took advantage of the public's concern and existing practice models to solve health care and social problems that reduced the incidence of acute communicable diseases in immigrant communities.
Which of the following best support the concept of community-oriented nursing practice? (Select all that apply.) a. Wound care for a homebound individual b. Nutrition education programs for teenagers and their families c. Hospice home care for a terminally ill individual and family d. Direct nursing care of individuals with tuberculosis (TB) e. Nursing interventions to stop elder abuse
b, d, e In community-oriented practice, the nurse and community seek healthful change together. Their common goal involves an ongoing series of health-promoting changes rather than a fixed state. The most effective means of completing healthy changes in the community is through this same partnership. Nurses who have a community orientation are often considered unique because of their target of practice.
Congress-supported categorical funding has produced what negative effect on the delivery of health care services? a. End of insurance company support for visiting nurses b. A reduction in comprehensive community health programs c. Beginning of 2-year associate's degree programs in nursing d. Rise in hospital-based care
b. A reduction in comprehensive community health programs The shift in Congress to categorical funding provides federal money for priority diseases or groups rather than for a comprehensive community health program. Thus local health departments design programs to fit the funding priorities. This has included maternal and child health services and crippled children (1935), venereal disease control (1938), tuberculosis (1944), mental health (1947), industrial hygiene (1947), and dental health (1947). This type of funding pattern continues today.
A community-oriented nurse wants to begin a program to reduce health inequality. What action by the nurse would be most successful? a. Use a successful model and divide the tasks among volunteers in the community. b. Gather a group of acute and community health care providers to brainstorm solutions. c. Conduct research on the prominent causes of inequity within the community. d. Invite a cross section of health professionals and lay people to join the action team.
b. Gather a group of acute and community health care providers to brainstorm solutions. A cross-sectoral approach would be the best way to work on this problem. This means that nurses and other health professionals must partner with stakeholders outside of traditional public health and health care delivery systems to design multi-level solutions for improving health. Effective cross-sectoral work is collaborative. When diverse people and organizations collaborate, they work together in inter-connected ways to achieve a common goal.
A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population? a. Seasonal farmworkers b. Migrant farmworkers c. Underinsured d. Undocumented aliens
b. Migrant farmworkers A migrant farmworker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farmworkers work cyclically in agriculture but do not migrate.
A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? a. Participation b. Repetition c. Integration d. Sequencing
b. Repetition Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.
Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: a. tertiary health nursing. b. community-based nursing. c. public health nursing. d. community-oriented nursing.
b. community-based nursing. In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community.
The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who makes introductions between the nurse and the neighborhood residents who will partner together. The role of the pastor in this example is: a. community health worker (CHW). b. gatekeeper. c. stakeholder. d. professional service provider.
b. gatekeeper. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Gatekeepers can confer credibility to the nurse. In this case, the gatekeeper has introduced the nurse to the local residents.
A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: a. resilience. b. health disparities. c. disenfranchisement. d. loss of independence.
b. health disparities. Vulnerable populations often have worse health outcomes than other people in terms of morbidity and mortality. These groups have a high prevalence of chronic illnesses, such as hypertension, and high levels of communicable diseases, including tuberculosis (TB), hepatitis B, and sexually transmitted diseases (STDs), as well as upper respiratory tract infections, including influenza. They also have higher mortality rates than the general population because of factors such as poor living conditions, diet, and health status, as well as crime and violence, including domestic violence. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.
Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: a. adult immunization rates. b. maternal/infant morbidity rates. c. obesity rates. d. chronic respiratory illness rates.
b. maternal/infant morbidity rates. HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.
A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: a. use seat belts. b. perceive their overall health as less favorable. c. engage in preventive behaviors. d. engage in physical activity during leisure time.
b. perceive their overall health as less favorable. In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.
A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: a. resilience. b. vulnerability. c. risk. d. poverty.
b. vulnerability. Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.
A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: a. disenfranchised populations. b. vulnerable populations. c. vulnerability. d. disadvantaged populations.
b. vulnerable populations. Vulnerable populations are those groups who have an increased risk to develop adverse health outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup.
Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Worse health outcomes despite access b. Multiple risk factors but equal health outcomes c. No difference in access or outcomes d. Better access to health care services but poor health outcomes e. Greater likelihood of exposure to risk factors
c, e Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.
Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP? a. Making decisions on behalf of the community b. Creating the role of a knowledge manager c. Adopting quality indicators for evaluating websites claiming to contain EBP d. Avoiding the issue of community politics
c. Adopting quality indicators for evaluating websites claiming to contain EBP Although the Internet is one source of evidence data, there may be a lack of quality indicators to evaluate the myriad of websites claiming to contain evidence-based information. It is essential to evaluate the quality of the information on the website, whether it comes from a reputable agency or scholar, and whether the source of the website has a financial interest in the acceptance of the evidence presented.
Community-oriented nurses use EBP most effectively when they do which of the following? a. Make client care decisions using the latest nursing research findings. b. Work with physicians to design client care guidelines for community clinics. c. Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. d. Base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied.
c. Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. EBP uses interventions based on the best available evidence from a variety of sources, including research studies, evidence from nursing experiences and expertise, and evidence from community leaders. EBP also addresses client preferences and values, including clients in decisions, and focuses on developing true partnerships in which power and decision making are shared between health care providers and the community to make culturally and financially appropriate interventions.
In the United States, the current system of the local government's responsibility for providing care for the disenfranchised emerged from: a. Florence Nightingale. b. Federal Emergency Relief Administration (FERA). c. Elizabethan Poor Law. d. Public Health Service (PHS).
c. Elizabethan Poor Law. Colonial Americans established systems of care for the sick, poor, aged, mentally ill, and dependent based on the model of the Elizabethan Poor Law. Early county or township government was responsible for the care of all dependent residents, and they were strict about caring for their own residents. In 1918, the US Public Health Service (USPHS) established a division of public health nursing to work in the war effort. The Federal Emergency Relief Administration (FERA) was established during the depression to support nurse employment through increased grants-in-aid for state programs of home medical care.
The historical nursing figure who contributed to establishing the foundation for current community health and nursing in community health by working in military field hospitals using a population-based approach that improved nursing care and environmental conditions was: a. Frances Root. b. Mary Breckinridge. c. Florence Nightingale. d. Lillian Wald.
c. Florence Nightingale. During the Crimean War (1854-1856), the British military established hospitals for sick and wounded soldiers in Scutari in Asia Minor. The care of the soldiers was poor, with cramped quarters, poor sanitation, lice and rats, not enough food, and inadequate medical supplies. When the British public demanded improved conditions, Florence Nightingale asked to work in Scutari. Because of her wealth, social and political connections, and knowledge of hospitals, the government sent her with a contingent of ladies, hired nurses, and hired servants to Scutari. Using simple epidemiology measures, she documented decreased mortality rates from the beginning of the war to the end of the war. Florence Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care.
A nurse has established a community group. The nurse evaluates that one member performs maintenance functions for the group by acting in which way? a. Donating pens, paper, and toner cartridges to the group b. Arranging media coverage of community group meetings c. Helping individuals in the group resolve conflicts d. Directing group members to perform specific functions
c. Helping individuals in the group resolve conflicts Groups have both task and maintenance functions. A task function is anything a member does that deliberately contributes to the group's purpose. Of equal importance are abilities to affirm and support individuals in the group. These functions are called maintenance functions because they help other members stay with the group and feel accepted. Other maintenance functions are the ability to help people resolve conflicts and create social and environmental comfort.
The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? a. Evaluation level b. Assessment level c. Implementation level d. Design level
c. Implementation level Although deinstitutionalization was noble in conception, it was bankrupt in implementation. Families and communities were not prepared to take on the treatment responsibilities they had to assume, and little education was available. Either care settings such as nursing homes, personal care settings, supervised apartments, rooming houses, single-occupancy hotels, and other similar settings were not available, or people were not educated or prepared to deal with this population.
A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: a. see how many plan to attend. b. secure a good space for a group meeting. c. assess the literacy level of the group. d. see whether the group is ready to learn.
c. assess the literacy level of the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.
A state agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored elder care programs. The public health core function applied is: a. policy development. b. primary prevention. c. assurance. d. public transportation.
c. assurance. The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. The assurance function makes sure that the activities assigned during the policy development or planning phase are carried out. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Primary prevention does not focus on provision of services and a part of assurance is assisting communities to obtain necessary services such as transportation.
When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: a. policy development. b. research. c. assurance. d. assessment.
c. assurance. When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of assurance. Assessment occurs when the nurse uses evidence-based practice for new insights and innovative solutions to health problems. When the nurse develops policies and plans using evidence-based practice that supports individual and community health efforts, the public health function of policy development is being addressed.
A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: a. changing to home education. b. keeping up her grades. c. carrying heavy book bags. d. decreasing fluid intake to avoid nausea.
c. carrying heavy book bags. If teens return to school, it is important for the nurse to discuss these needs: (1) using the bathroom frequently, (2) carrying and drinking more fluids or snacks to relieve nausea, (3) climbing stairs and carrying heavy book bags, and (4) fitting comfortably behind stationary desks.
The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also: a. accessible and diverse. b. reasonable and deliverable in a timely fashion. c. culturally and financially appropriate. d. competent and compliant.
c. culturally and financially appropriate. Applied to nursing, evidence-based practice includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders. Culturally and financially appropriate best practices need to be identified when working with communities instead of individuals. The use of evidence to determine the appropriate use of interventions that are culturally sensitive and cost effective is a must.
The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: a. problem analysis. b. needs assessment. c. evaluation phase. d. implementation phase.
c. evaluation phase. Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the accomplishment of objectives and the effects of the intervention activities have to be assessed. The nurse will evaluate whether the objectives were met and whether the intervention activities were effective.
A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: a. outreach efforts to enroll eligible children in Medicaid. b. prospective payments for child services. c. funds to insure currently uninsured children. d. direct financial subsidies for children.
c. funds to insure currently uninsured children. Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductions.
Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: a. race and ethnicity. b. dependency cycle. c. health literacy. d. income level.
c. health literacy. A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.
The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of this rise in cases and schedules a case mapping of local: a. bars frequented by migrant workers. b. restaurants frequented by migrant workers. c. housing for migrant workers. d. farm fields employing migrant workers.
c. housing for migrant workers. When migrant workers reach a worksite, housing may not be available, it may be too expensive, or it may be in poor condition. Housing conditions vary among states and localities. Housing for migrant farmworkers may be in camps with cabins, trailers, or houses. Some even live in cars or tents if necessary. National data about the type and quality of housing occupied by farmworkers are limited; however, data indicate that the housing is generally crowded by federal standards. Poor-quality and crowded places of residence can contribute to health problems such as tuberculosis (TB), gastroenteritis, and hepatitis and to exposure to high levels of lead.
In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: a. program characteristics are assessed for their effectiveness in making the school population healthier. b. treatment is initiated for a child with an identified learning disability. c. individual results are compared with established standards for children of the same age group. d. referral is provided for a child identified with delayed psychomotor development.
c. individual results are compared with established standards for children of the same age group. Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal.
Mary Breckinridge established the Frontier Nursing Service (FNS) in 1925. One of Breckinridge's primary contributions to health care in the United States was: a. occupational health nursing. b. the Federal Emergency Relief Administration (FERA). c. introduction of the first nurse-midwives. d. the nursing process.
c. introduction of the first nurse-midwives. The unique pioneering spirit of the Frontier Nursing Service (FNS) influenced the development of public health programs to improve the health care of the rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckinridge, the founder of the FNS, introduced the first nurse-midwives into the United States.
In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: a. a holistic treatment plan. b. individual dietary interventions for cardiovascular disorders. c. the prevalence rate of cardiovascular disorders among various groups. d. a specific clinical diagnosis.
c. the prevalence rate of cardiovascular disorders among various groups. Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status.
A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? a. Assessment b. Geriatrics c. Tertiary prevention d. Case management
d. Case management Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models to address some of those deficits and resolve rural health disparities.
Which of the following statements accurately reflects the current status of nursing in community health? a. Comprehensive reform of health care is required. b. People no longer believe they can protect themselves. c. Community health serves only clients with chronic conditions. d. Each type of nurse is needed in today's communities.
d. Each type of nurse is needed in today's communities. Many nurses work in the community. Some bring a public health population-based approach and have as their goal preventing illness and protecting health. Other nurses have a community-oriented approach and deal primarily with the health care of individuals, families, and groups in the community. Still other nurses bring a community-based approach that focuses on "illness care" of individuals and families in the community. Each type of nurse is needed in today's communities. The latter two groups are growing and will continue to do so, because so much health care is being provided in community rather than inpatient settings. What is necessary is the extension of public health services to prevent illness, promote health, and protect the public. Without this extension, a large gap would exist in the design of a comprehensive program for health care.
A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? a. Events of instruction b. Cognitive domain c. Principles of effective instruction d. Psychomotor domain
d. Psychomotor domain The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation.
When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is: a. contains cost and reduces legal liability. b. applied as a universal remedy. c. limited to research findings. d. acceptable to the community.
d. acceptable to the community. Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities. Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.
A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: a. an operational approach. b. a pedagogical approach. c. a behavioral approach. d. an andragogical approach.
d. an andragogical approach. Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.
The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: a. give a short paper-and-pencil quiz. b. provide an online test module. c. ask whether there are any questions. d. ask for a return demonstration.
d. ask for a return demonstration. Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.
Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: a. target population. b. setting of practice. c. group. d. community.
d. community. In most definitions the concept of community includes people, place/time, and function. Nurses in community health practice regularly need to examine how the personal, geographic, and functional dimensions of community shape their nursing practice with individuals, families, and groups. They can use both a conceptual definition and a set of indicators for the concept of community in their practice. The community is first the setting for practice for the nurse practicing health-promotion and disease-prevention interventions with individuals, families, and groups. Second, the community is the target of practice for the public health nurse whose practice is focused on the broader community rather than on individuals.
A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: a. frequent colds and infections. b. ear infections. c. irritability. d. developmental delays.
d. developmental delays. Young children are at highest risk for the effects of poverty, especially lack of adequate nutrition and brain development, exposure to environmental toxins, trauma, abuse, and lower quality daily care.
The highest level of evidence gathering in evidence-based practice is: a. expert opinions. b. case-controlled reports. c. clinical knowledge and judgment. d. double-blind randomized clinical trials.
d. double-blind randomized clinical trials. A hierarchy of evidence, ranked in order of decreasing importance and use, has been accepted by many health professionals. The double-blind randomized controlled trial (RCT) generally ranks as the highest level of evidence. Some nurses would argue that this hierarchy ignores evidence gained from clinical experience. However, the definition of evidence-based nursing presented above indicates that clinical expertise as evidence, when used with other types of evidence, is used to make clinical decisions.
A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: a. delinquent behavior. b. drug use. c. Migrant Education Program. d. field work.
d. field work. Children of migrant farmworkers may need to work for the family's economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore, children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.
An undocumented migrant farmworker has been diagnosed with tuberculosis (TB). The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is: a. affordable care. b. language barriers. c. discrimination. d. fragmented services.
d. fragmented services. Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.
The term "instructive district nursing" was coined in the 19th century to describe the relationship of nursing to: a. settlement houses. b. visiting nurse services. c. home health care. d. health education.
d. health education. In 1886 in Boston, two women, to improve their chances of gaining financial support for their cause, coined the term "instructive district nursing" to emphasize the relationship of nursing to health education. Other nurses established settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. Home health and visiting nursing evolved at a later time.
Community-oriented nursing in the 21st century has been influenced by historical events and government initiatives that support the approach of: a. illness care. b. preventing acute illness. c. caring for the disenfranchised. d. keeping the public healthy.
d. keeping the public healthy. The Healthy People initiative, recent disasters and acts of terrorism, and most recently the COVID-19 pandemic have brought renewed emphasis on prevention to public and community health nursing. During the late 20th and early 21st centuries, challenges have continued to trigger growth and change in nursing in the community. Nurses continue to care for the vulnerable populations, provide illness care, and prevent acute illness while delivering care that is safe and high in quality.
In 1902 Lillian Wald introduced the concept of school nursing to address the problem of student absenteeism by: a. enforcing the Department of Health's rules and regulations. b. focusing on excluding infectious children from the school environment. c. requiring parents to pay a fee for sending a sick child to school. d. providing follow-up care for the absent child at their home.
d. providing follow-up care for the absent child at their home. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one was focused on providing or obtaining medical treatment so that absent children could return to school. Lillian Wald introduced an English innovation by providing nurses for schools. The first school nurses made home visits to teach parents and provide follow-up care to children absent from schools. The school nurses found that many children were absent from school because they did not have shoes or clothing; many were hungry, and others had to take care of the younger children in the family
One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and: a. research design. b. evidence gathering. c. research funding. d. research use.
d. research use. EBP represents a cultural change in practice. It provides an environment to improve both nursing practice and client outcomes. Several factors have been identified in the literature that support implementation of EBP or that will need to be overcome for nursing and other disciplines to successfully implement EBP. These factors include knowledge of research and current evidence and the ability to interpret evidence, among other factors. Gathering of evidence, research design, and funding are not associated with the slower development of EBP for nursing.
The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: a. schedule appointments for appropriate immunizations for the children. b. establish a long-term trust relationship to prevent disappointment. c. conduct a comprehensive assessment and formulate a plan for treatment. d. use every opportunity to provide comprehensive services.
d. use every opportunity to provide comprehensive services. Comprehensive services are health services that focus on more than one health problem or concern. For example, some nurses use stationary or mobile outreach clinics to provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities. A single client visit may focus on an acute health problem such as influenza, but it also may include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions in environmental hazards and violence and assurance of safe food and water.
Two nurses in community health schedule a day to ride through a low-income community to better understand the community and what factors affect the health of that community. This direct data collection method is often referred to as: a. composite database. b. secondary analysis. c. participant observation. d. windshield survey.
d. windshield survey. Five useful methods of data collection are informant interviews, participation observation, windshield survey, secondary analysis of existing data, and surveys. Windshield surveys are the motorized equivalent of simple observation. While driving a car or riding public transportation, the nurse can observe many dimensions of a community's life and environment through the windshield. A basic method is participant observation, the deliberate sharing, if conditions permit, in the life of a community. In secondary analysis, the nurse uses previously gathered data, such as minutes from community meetings.
