review 2 community

What do I do with all that data?

Enter data into a database Assess for completion Identify and fill in gaps Synthesize data and find themes Identify resounding community needs Identify Community strengths and resources

secondary data strengths

-database of prior concerns/needs of population -ability to trend health issues over time

A community health nurse is conducting vision screenings at a health fair for an older adult client who has age-related macular degeneration. Which of the following statements should the nurse identify as an indication that the client is adapting to the changes? A.) "I have a prescription bottle magnifier to help me read my pill bottle labels." B.) "I canceled all of my magazine prescriptions since I can't read them." C.) "I purchased green towels to use in my bathroom." D.) "I have learned that I cannot go outside when the sun is bright"

A.) "I have a prescription bottle magnifier to help me read my pill bottle labels."

A nurse in a community health clinic is preparing to administer an immunization to a 5-year-old child. Which of the following actions should the nurse take? A.) Ask the child to pretend to blow up a balloon during the injection B.) Reassure the child that the injection is not going to hurt C.) Ask the child's parent to leave the room during the injection D.) Request that the child count backwards from the number 10 during the injection

A.) Ask the child to pretend to blow up a balloon during the injection The nurse should ask the child to pretend to blow up a balloon during the injection. This serves as a distraction for the child, which decreases pain perception.

A nurse is developing a genogram for a client to determine education needs. Which of the following health risk information should the nurse expect to obtain with this tool? A.) Biological B.) Behavioral C.) Social D.) Economic

A.) Biological

A community health nurse is participating in a quality improvement plan for a local health department. Which of the following techniques should the nurse use for process evaluation of the facility? (Select all that apply). A.) Focus groups B.) Written audits C.) Satisfaction survey D.) Interviews E.) Values self-study

A.) Focus groups B.) Written audits C.) Satisfaction survey D.) Interviews

A community health nurse is planning to establish a community garden to address the lack of nutritious food options in the area. Which of the following actions should the nurse take first to initiate the plan? A.) Identify community members who demonstrate an interest in the project B.) Hold a community information session to inform the residents of the plan C.) Select residents to take on leadership roles in the project D.) Monitor the progress of the project to keep the project on course

A.) Identify community members who demonstrate an interest in the project The first action the nurse should take when using the nursing process is to assess the community. The nurse can establish a local support group who will assist in engaging other community residents with establishing the garden.

An occupational health nurse in a factory is performing a routine tuberculosis screening and identifies an employee who has a positive Mantoux tuberculin test. Which of the following actions should the nurse take? A.) Instruct the employee to prepare a list of close personal contacts B.) Initiate an employee immunization program C.) Instruct the employee to wear an N95 respiratory mask D.) Administer prophylactic penicillin to other employees

A.) Instruct the employee to prepare a list of close personal contacts The nurse should report the name of an employee who has a positive Mantoux tuberculin test to the health department. The health department will follow up with the employee so that close personal contacts can be notified of the potential of exposure

A home health nurse is conducting a follow-up visit for a client who was recently discharged from an acute rehabilitation program for alcohol use disorder. Which of the following actions should the nurse take? A.) Tell the client to take naltrexone daily B.) Instruct the client to take buprenophine for the next 9 to 12 months C.) Teach the client to avoid foods the contain tyramine D.) Schedule transcranial magnetic stimulation (TMS) biweekly

A.) Tell the client to take naltrexone daily The nurse should instruct the client to take naltrexone daily to decrease her cravings for alcohol. Naltrexone is prescribed to assist the client with alcohol withdrawal and prevent relapse.

A nurse is developing a community education program about risk factors for family violence. The nurse should include which of the following circumstances as a risk factor for intimate partner abuse? A.) Attempting to end the relationship B.) Lacking supportive friends outside the relationship C.) Having health issues that limit independence D.) Taking antianxiety or sedative medications

A.)Attempting to end the relationship Clients who are in a relationship with a potential or actual abuser heighten their risk for intimate partner abuse when they attempt to leave the relationship.

Upgrade to remove ads Only $1/month A school nurse is educating a group of high school student about recommended dietary guidelines. Which of the following statements by a student indicates an understanding of the teaching? A.) "I can consume up to 25% of my daily calories from saturate fatty acids. B.) "I should consume less than 300mg / day of dietary cholesterol. C.) "I can increase my daily consumption of foods that contain refined grains." D.) "I should consume 800mg / day of dietary calcium."

B.) "I should consume less than 300mg / day of dietary cholesterol

A nurse is conducting a home visit for an older adult client. The nurse should identify which of the following findings as an indicator of possible neglect? A.) Lives alone B.) Taking outdated prescriptions C.) Has a BMI of 25 D.) Presence of alcohol in the home

B.) Taking outdated prescriptions

A community heath nurse identifies an increase in the occurrence of osteoporosis-related fractures in women experiencing menopause. Which of the following primary prevention strategies should the nurse implement? A.) Advise the women to keep their immunizations updated. B.) Encourage the women to participate in weight-bearing activities C.) Educate the women about the importance of limiting sun exposure D.) Instruct at-risk women to increase their intake of foods high in vitamin E.

B.)Encourage the women to participate in weight-bearing activities

A home care nurse is visiting an older adult and notes that unwashed dishes are piled up and newspapers cover the front steps. Which of the following questions should the nurse to ask the client to determine if he is socially isolated? A.) "Why haven't you brought in your newspapers?" B.) "Do you need help completing your housework?" C.) "How often do you have visitors come to see you?" D.) "Have you considered moving to an assisted living facility?"

C.) "How often do you have visitors come to see you?"

A nurse is giving a presentation about family violence at a local community center. Which of the following information should the nurse include? A.) Minority populations may be at greater risk for abuse. B.) Intimate partner abuse occurs more frequently in lower socioeconomic households C.) Child abuse is more common in homes where intimate partner abuse is present D.) Children who are abused are less likely to become abusers

C.) Child abuse is more common in homes where intimate partner abuse is present

A community health nurse is caring for an adolescent who is seeking help for an unplanned pregnancy. Which of the following actions should the nurse take first? A.) Recommend that the adolescent meet with the school guidance counselor to discuss educational options B.) Request permission to interview the father of the child to obtain a medical history C.) Help the client obtain a provider for prenatal care D.) Provide information on parenting classes so the client can learn about caring for a newborn

C.) Help the client obtain a provider for prenatal care

A nurse is providing education regarding lead exposure to a group of clients who live in a housing development built in 1968. Which of the following client statements indicates an understanding of the teaching? A.) "I will use a dry-sanding technique when preparing to repaint my front door." B.) "I will vacuum our wood floors every week." C.) I will increase the amount of red meat and milk in my child's diet." D.) "I will use hot tap water to prepare my baby's formula."

C.) I will increase the amount of red meat and milk in my child's diet." Children should receive adequate amounts of iron and calcium in their diets to prevent lead absorption from their environment

A nurse is assessing a new client at a public health clinic. Which of the following areas should the nurse address as part of the culutral assessment? A.) Immunization status B.) Sexual activity C.) Illness practices D.) Food allergies

C.) Illness practices

A community heath nurse is conducting a needs assessment of a community. The nurse should identify that which of the following methods will yield direct data? A.) Health surveys B.) Medical records C.) Informant interviews D.) Morbidity / Mortality Statistics

C.) Informant interviews Informant interviews of the community's leaders will provide direct data. This information can help the nurse identify services needed by the community.

A community health nurse is providing teaching about health promotion to a group of adolescents. Which of the following topics is the most important for the nurse to include in an attempt to lower adolescent mortality rates? A.) Underage smoking B.) Safer sex practices C.) Safety belt use D.) Heart-healthy diet

C.) Safety belt use Automobile crashes are currently the leading cause of death among adolescents. Therefore, this topic is most important to discuss.

A nurse at a county health department is caring for a client who is at 28 weeks of gestation. The nurse should identify which of the following characteristics as a risk for potential future abuse of the newborn? A.) The client recently married the father of her unborn baby B.) The client works part-time at a local restaurant C.) The client has changed providers three times during her pregnancy D.) The client has recurring nightmares about her unborn baby

C.) The client has changed providers three times during her pregnancy Frequently changing health care providers is a warning sign for potential future child abuse because it can indicate that the client is in an abusive relationship and is attempting to hide it from her provider.

A faith community nurse is teaching the daughter of a client who has a terminal illness about her role as a member of the client's health care team. Which of the followign statements by the daughter indicates an understanding of the teaching? A.) "You will be able to access my mother's hospital medical records for us to review." B.) "You will be able to give my mother pain medication." C.) "You can submit invoices to Medicare to reimburse you for your services." D.) "You will coordinate with volunteers who will come to help my mother."

D.) "You will coordinate with volunteers who will come to help my mother." A faith community nurse can assist with receiving services from various volunteers within the client's spiritual community to provide additional support and comfort to the client during the dying process.

A nurse is planning a health promotion activities for the local community. Which of the following activities should the nurse include as an example of primary prevention? A.) Teaching foot care to adults who have diabetes mellitus B.) Testing school-age children for lead exposure C.) Providing tuberculosis screenings for day care providers D.) Teaching meal planning classes to older adults

D.) Teaching meal planning classes to older adults Only D is primary prevention. A is tertiary prevention, and B & C and secondary prevention.

A community health nurse is discussing the role of a faith community nurse with a chaplain. Which of the following information shoudl the nurse include in the discussion? A.) The faith community nurse can provide pharmacological pain management for clients who have a terminal illness B.) The faith community nurse can plan workplace safety training for employees in a local factory C.) The faith community nurse can provide wound care for clients in their homes D.) The faith community nurse can facilitate substance abuse support groups

D.) The faith community nurse can facilitate substance abuse support groups

Community leaders have requested a meeting with a community health nurse to discuss creating a mobile meals program. Which of the following should the community health nurse assess first? A.) The leadership support of the community B.) The accessibility of residences C.) The availability of volunteers D.) The need for the program

D.) The need for the program

Planning

Develop interventions to meet identified outcomes •Determine possible solutions to meet the health need •Compare the resources and interventions required for each solution, and select the best option •Establish goals and objectives for the selected solution - objectives are behaviorally stated, measurable, and include a target date •Select strategies/interventions to meet the objectives •Plan a logical sequence for interventions by establishing a timetable •Identify who will assume responsibility for each intervention •Determine available and needed resources to implement interventions •Assess the personnel needed and any special training required for screening or providing education •Determine funding opportunities for needed interventions and form a budget •Plan for program evaluation - what will this look like in the end?

Evaluation

Examine the success of the interventions -Evaluate strengths and weaknesses of the program -Determine achievement of desired outcomes -Examine the adequacy, efficiency, appropriateness, and cost of the program -Recommend and implement modifications to better meet community needs -Share findings and recommendations with community members -Ongoing evaluation is necessary in order to ensure program success (sustainability) and meet the changing needs of the community.

what are the steps in community health program planning, development and management

PREPLANNING (then ADPIE) Assessment Diagnosis Planning Implementing Evaluation

community nursing diagnoses often are written in what format

RISK OF (problem or risk) AMONG (the specific population affected by the problem or risk) RELATED TO (strengths and weaknesses in the community that influence the problem or risk) ex. RISK OF low birth rate AMONG adolescents who are pregnant in the downtown district RELATED TO low income, lack of availability of nutritious food, and tobacco use as evidenced by lack of secure housing, food bank use, increased rates of unemployment, and smoking among pregnant adolescents.

Assessment

collect data about the community -complete a needs assessment and identify community strengths and weaknesses -assess avability of community reasources - list any sources of funding like grants, fund raising, or charitable giving -evaluate secondary health data

to best identify the health needs of the local community it is essential to

combine several methods of data collection. relying on only one or two key pieces can result in an incomplete assessment

what is the foundation for community specific program planning

community assessment and diagnosis

problems identified by community assessments are often stated as

community health diagnoses

focus group are similar to

a community forum

is the analysis of community assessment a long or short process

a very long process

nonofficial agencies

american cancer society or american associates of retired persons, mothers against drunk drivers, american hospital or medical association us camber of commerce

secondary data

anything that has already been collected by people that know the community well - however they do not always totally reflect the communities self perception and therefore need to be used in conjunction with other data collection methods use of existing data to assess problems ex. death, birth stats, census data, mortality, morbidity data, health records, minutes from meetings, prior health surveys

the community health nurse plays an active role in

assessment, data interpretation, and problem identification

Preplanning

brainstorming ideas -gain entry into community and establish trust -obtain community awareness, support, and involvement -COORDINATE COLLABORATIONS that have similar interests in addressing identified problems

participant observation limitations

bring your own or see bias in the community time consuming inability to ask questions of participants

Implementation

carry out the plan -Initiate interventions to achieve goals/objectives according to program plan -Monitor the intervention process and the response of the community in terms of values, needs, and perceptions

primary methods of data collection

informant interviews community forum focus groups

community health program plannings improve the health of the community by setting priorities based on

community perception of the problem percent of population of affected supporting data degree of risk likelihood to make an impact with interventions

participant observation strengths

community priorities environmental profile identifies who has power in the community

unstructured

conducted by asking questions that seem appropriate for the person being interviewed

what is a critical community health nursing function

data collection

survey strengths

data is collected on client population and problems random sampling available as written or online format contact with participants not required

windshield survey

descriptive approach that assesses several community components by driving through a community makes the nurse familiar with the community - can be down by walking or driving

what is the goal of surveys

determine the variable that affect disease and health in the community ex. healthcare patterns or needs or health beliefs and practices in a community

official sources

develop documents based on data complied by the government - ex. united states department of health and human services which includes national center for health statistics, CDC, and healthy people 2020, national institutes of health

cons of community forum

difficultly finding a convenient time and place potential to drift from the issue challenging to get adequate participation possibility that a less vocal person can be reluctant to speak

informant interviews are

direct discussion with community members for the purpose of obtaining ideas and opinions from key informants

focus groups are

directed talk within a representative sample

problem analysis is completed for

each identified problem most often work groups are formed to examine individual problems and develop solutions

what evaluates determinants of health for a population and for targeting interventions to multiple factors

ecological model

informant interviews can be

face to face interviews or telephone ones

structured

formal with specific identical questions being asked for each participant

steps in the analysis of community assessment data include

gathering collected data into a composite database assessing completeness of data identifying and generating missing data synthesizing data and identifying themes identifying community needs and problems identifying community strengthens and resources

focus groups are designed to obtain what

grassroots opinion

Focus Groups Disadvantages

hard to find participants find suppporters may go off top - irrelevant issues needs a strong facilitator to control and keep the discussion going hard to ensure that the sample is truly representative of the overall community time consuming to transcribe discussion

want to learn about adolescents who do we interview?

health clinic or rec center as well as parents, school nurses and even adolescents themselves to learn about the how they view the community and its reasources

housing

how old are the homes? good quality? single or multifamily? housing in good repair or disrepair? is their vacant housing?

Diagonsis

identify and prioritize health needs of the community -analyze data to determine health needs -work with community members, local health professionals and administrators to develop priorities and establish outcomes -In setting priorities among identified community problems o Community awareness of the problem o Community readiness to acknowledge and address the problem o Available expertise/fiscal resources o Severity of the problem o Amount of time needed for problem resolution

where do community forum take place?

in the neighborhood or community involved - school gym, auditorium, churches - somewhere the community can gather

important to

include business and government representatives as well as volunteers - important to have people of different ethnics represented as well

ecological model includes

individual traits (age, gender, biological, mental and behavioral factors) social, family, and community relationships occupational, school and home environments overall conditions created by local, state, national and worldwide forces and trends

focus group advantages

inexpensive reading/writing of participants is not required participants being supporters provides into community support

pros of community forum

inexpensive allows for community input

participant observation can happen at an

informal or formal setting ex. just sitting in a park or going to an organized event

focus groups

involve smaller groups of people normally 5-15 - members chosen are homogeneous (are the same and have similar experiences and backgrounds)

social systems

is their public transportation? parks? grocery stores? any other stores? police? fire? animal control? religious centers? community centers? schools? rec centers? dentists? common hangouts? does it feel safe?

semi structured

less structured and are a list of questions that guide the interview and allow for more relaxed conversion

nurses should consider what when developing interventions

literacy needs an persons ability to understand basic health information and make decisions or health literacy can affect the ability or desire to take action

strengths of informant interviews

low cost no reading or writing of participants are required personal interactions can elicit more detailed responses offers insight into beliefs and attitudes of community members participants serve as future supporters

survey weaknesses

low response rate expensive time consuming possible collection of superficial data requires reading/writing of participants

with secondary data it is important to

make sure the data is reliable - websites with .gov, .edu, .org are good

windshield survey weaknesses

needs a driver so the nurse can document and visualize time consuming results are only based on visualization not from any input from the community

want to learn about elderly who do we interview?

nursing homes, hospice, health clinics, long term care sites, senior citizen centers, and the seniors themselves as well as organizations that represent them

Healthy people 2020 communicates high-priority health issues and actions such as

o Access to health care o Clinical Preventive Services o Environmental Quality o Injury and Violence o Maternal, Infant, and Child Health o Mental Health o Nutrition, Physical Activity, and Obesity o Oral Health o Reproductive and Sexual Health o Social Determinants o Substance Abuse o Tobacco

barriers

o Inadequate assessment o Inadequate or misconstrued data o No involvement with community partners o Impaired communication o Inadequate resources o Lack of planning o Poor leadership

Helpful Strategies

o Thorough assessment o Accurate interpretation of data o Collaboration with community partners o Effective outreach and communication patterns o Sufficient resources o Logical planning o Skilled leadership

participant observation is

observation of community activities

community forums are designed to

obtain community opinions

community health nurses can assess existing data of two sources

official and nonofficial

community forums who participates?

participate by invitation to spread the word of the community for those involved ex. want to build a swimming pool so residents that want to use the pool will come to the meeting; such as people that do not have pools, health and safety personal, elderly etc - they will give their views on the pool like where it will be built, who will use it and how cost and maintenance will be taken care of and any cons that they can think of

windshield survey components

people, place, housing, and social systems

key informants are

person who is representative of the community

secondary data limitations

possibility that data might not represent current situation can be time consuming

during a focus group, the person guides the discussion using

predetermined questions

windshield survey strengths

provides a descriptive overview of a community

surveys can be

questionnaires, telephone or face to face

surveys include

self report or response to predetermined questions

surveys are

specific questions asked in a written format uses a broad source of data and is used with other assessments

tools to conduct an informant interview can be

structured semi structured unstructured

community nursing diagnoses incorporate information from

the community assessment, general nursing knowledge, epidemiological concepts - especially the concept of risk in a population

cons of informant interviews

time consuming built in bias meeting time and place

community forums are also known as

town hall meetings or open public meetings

home health includes care where

traditional homes, assisted living facilities and nursing homes

place

where is the community located? what are its boundaries? natural and man made boundaries? any major health care facilities? any geographic features that can harm the community? any harmful plants and animals to the community ? what industaries are there? easy access to health care? roads marked well? employment rates? grocery stores or food desert? where is the garbage disposed? is there trash everywhere?

people

who is on the street? are they well nourished? what do they look like? age, dress, obese, unkempt? what origin and race are they? any pets? any evidence of substance use, violence, disease, or mental illness