Caring for Diverse & Vulnerable Populations test 1

What is Public Health Nursing?

-It is population-focused. -It is community-oriented. It is the connection between the health status of the population and the environment in which the population lives (physical, biological, sociocultural). -There is a health and preventive focus. -Interventions are made at the community or population level. -Target populations are defined as those living in a particular geographic area or those who have particular characteristics in common

Tertiary Prevention

-Stopping deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care. ...........Example: The Public health nurse develops a diabetes clinic in which nursing care including educational programs for nutrition and self-care are provided for a defined population of adults in a low-income housing unit of the community

Secondary Prevention

-Stopping the progress of disease by early detection and treatment, thus reducing prevalence and chronicity. .......Example: The public health nurse develops a program of toxin screenings for migrant workers who may be exposed to pesticides and refers for treatment those who are found to be positive for high levels.

Primary Prevention

-Using general and specific measures in a population to promote health and prevent the development of disease (incidence) ..........Example: The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking on health.

Race

-is a biological variation within population groups based on physical markers derived from genetic ancestry such as skin color, physical features, and hair texture. -differences include areas of growth and development, skin color, enzymatic differences, susceptibility to disease, and laboratory test findings. -Individuals may be of the same race but of different cultures.

Culture

-is a set of beliefs, values, and assumptions about life -determines how health care information is processed, received, and distributed; -how rights and protections are exercised; -what is considered to be a health problem; -how symptoms and concerns of the problem are expressed; -who provides treatment for the problem; and -what type of treatment should be given

Assurance

-refers to the role of public health in ensuring that essential community-oriented health services are available, -which may include providing essential personal health services for those who would otherwise not receive them. -Assurance also refers to making sure that a competent public health and personal health care workforce is available

Principles of PHN

-the primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole -Primary prevention is the priority in selecting appropriate activities. -Selecting strategies that create healthy environmental, social, and economic conditions in which populations may thrive is the focus. -Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice. -Collaboration with a variety of other professions, organizations, and entities is the most effective way to promote and protect the health of the people.

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 core public health function of: a. assessment. b. assurance. c. policy development. d. research

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.

A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.

ANS: A Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups.

The state public health 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 eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

ANS: A 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 involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.

A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.

ANS: B Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences.

The role and goals of the community health nursing practice can best be described as: A. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. B. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. C. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. D. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: A. agency colleagues' push for nurses to focus on population initiatives. B. costs associated with staff training and revision of documents. C. lack of support from the agency's funding sources. D. opinions that nursing should focus on the provision of direct client care and services.

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation.

A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.

ANS: D Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices

A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: A. monitoring pregnant teenagers for symptoms of complications of pregnancy. B. offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. C. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. D. preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

C. The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy

Teamwork and Collaboration-

Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality care

Safety

Minimize risk for harm to clients and providers through both system effectiveness and individual performance

Client-Centered Care

Recognize the client or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for client preferences, values, and needs

Cultural Preservation

refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health.

Quality Improvement-

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems

Informatics

Use information and technology to communicate, manage knowledge, mitigate error, and support decision making

A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. Fidelity C. Respect for autonomy D. Veracity

a

A nurse is using the I PREP ARE mnemonic to assess a client's potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for "A" in the mnemonic? A. "What do you like to do for fun?" B. "What year was your residence built?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"

a

A nurse planning a smoking cessation education for adolescents in the local middle schools and high schools is providing: a. Primary Prevention c. secondary Prevention d. tertiary Prevention

a

A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following are influenced by an individual's culture? (Select all that apply.) A. Nutritional practices B. Family structure C. Health care interactions D. Biological variations E. Views about illness

a,b,c,e

nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.) A. A home health nurse performing wound care for a client who is immobile B. An occupational health nurse providing classes on body mechanics at a local industrial plant C. A school nurse teaching a student who has asthma about medications D. A parish nurse teaching a class on low-sodium cooking techniques E. A mental health nurse discussing stress management techniques with a support group

a,c

A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the client's perception of his current health status. B. Gather data about the client's cultural beliefs. C. Determine how the client's culture may impact the effectiveness of nursing actions. D. Gather information about previous client interactions with the health care system.

b

A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. I don't drive, and my son is only available to take me places in the morning. B. I can't take off during the day, and the local after-hours clinic is no longer in operation. C. Only one doctor in my town is designated provider by my health maintenance organization. D. I would like to schedule an appointment with the local doctor in my town who speaks SPanish and English

b

Assessment

refers to systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community

A nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health departments to provide? A. Managing the WIC program B. Providing education to achieve community health goals. C. Coordinating directives from state personnel. D. Reporting communicable diseases to the CDC. E. Licensing of RN.

b,c

Public health nursing specialists are interested in which of the following topic(s)? Select all that apply. A) Educational materials for individuals with HIV/AIDS. B) Evaluation of an outreach program for at-risk pregnant teenagers. C) Community subpopulations with high rates of type 2 diabetes. D) New technologies to monitor diabetes. E) Prevalence of hypertension among various age, race, and gender groups

b,c,e

A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? A. Performing a home safety check at a client's home B. Teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. Implementing a program to notify individuals exposed to a communicable disease

c

A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.) A. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity

c,d

A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners? A. Showing informational videos B. Providing equipment to practice hands-on skills C. Supplying outlines for note-taking D. Facilitating small group discussions

d

ethnicity

in contrast to race, is the shared feeling of peoplehood among a group of individuals and relates to cultural factors such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions

Evidence-Based Practice-

integrate best current evidence with clinical expertise and client/family preferences and values for delivery of optimal health care

Racism

is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are 157judged to be inferior on the basis of intelligence, morals, beauty, inheritance, and self-worth. Individuals are denied certain opportunities (e.g., jobs, housing, education, and health care) typically enjoyed by the larger group because of some characteristic over which they have no control.

Cultural Conflict

is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual's cultural practice because of unfamiliarity with the practice (Andrews and Boyle, 2012). Although cultural conflicts are unavoidable, the nursing goal is to manage conflicts so that they do not affect the delivery of culturally competent nursing care. Knowing how conflict is managed in the particular culture can minimize the conflict. It is important, when resolving the conflict, that all persons involved in the conflict have a way to "save face."

Cultural Imposition

is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. Nurses impose their values on clients when they forcefully promote biomedical traditions while ignoring the clients' valuing of non-Western treatments such as acupuncture, herbal therapy, or spiritualistic rituals.

Prejudice

is the emotional manifestation of deeply held beliefs (stereotypes) about a group. These beliefs are directed toward a person who is a member of that group, and who is presumed to have the qualities ascribed to the group. Prejudice is not based on reason or experience but rather on negative or favorable preconceived feelings.

Policy development

refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.

Cultural Shock

is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individual's culture. When nurses experience culture shock, it may be a normal reaction to a client's beliefs and practices that are not allowed or approved in the nurse's own culture (Andrews and Boyle, 2012). Culture shock is brought on by anxiety that results from losing familiar signs and symbols of social interaction. As nurses change their practice environments and leave the safety of the hospital for community settings, they may experience heightened discomfort and feelings of powerlessness to confront differences between themselves and clients. This is especially true when nurses have little knowledge or exposure to the culture from which the client comes. For example, nurses who are unfamiliar with "cupping" may experience culture shock when Cambodians use this practice to relieve headaches, to reduce stress and sinus tension, or to delay the onset of colds. Being aware of the clients' own cultural beliefs and having knowledge of other cultures may help nurses to be more accepting of cultural differences.

Mortality rate

is the rate of death in a population

Morbidity rate

looks at the incidence of a disease across the population and/or geographic location

Cultural Accommodation

refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies, or negotiate with nurses to achieve satisfying health care outcomes.

Cultural Repatterning

refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial

Public health

what we, as a society, do collectively to assure the conditions in which people can be healthy"