Chapter 18: Health Promotion and Risk Reduction in the Community

d. Work with interested employees to create a no tobacco products environment. Although all of the actions could be performed and probably would be helpful, the most effective way to change behavior is to restructure the environment so that the behavior is not possible. Information alone is insufficient to effect large-scale, community-wide behavioral change, as the widespread dissemination of information on the health risks of obesity clearly demonstrates. Environmental restructuring makes it more difficult to engage in the high-risk behavior and improves and optimizes the healthful conditions (air) existing in the environment.

A local employer was concerned about rapidly increasing health care costs. The nurse did an assessment and found that most of the employees smoked heavily. Which of the following suggestions should the nurse make to the employer as the most effective approach to decrease smoking among the employees? a. Lobby area legislators to increase the tax on cigarette sales. b. Offer a smoking cessation program at the workplace. c. Talk to the employees in small groups and ask them to quit smoking. d. Work with interested employees to create a no tobacco products environment.

b. Assessing the extent of the problem in the local community Assessment is always the first step in the nursing process; it is needed to determine the focus of the community program.

A nurse is planning a community-wide program about reducing the risk of developing cardiovascular disease. Which of the following actions should the nurse take first? a. Developing a public education campaign by using public service announcements b. Assessing the extent of the problem in the local community c. Forming partnerships and establishing support with community agencies d. Gathering resource materials and identifying funding sources

b. Collaborate with the client in choosing what changes to make. A plan must involve both the nurse and the client to identify outcomes signifying success from the clients perspective. Only the client can decide what behaviors to attempt to change. The nurse collaborates as a partner to share information. Changing behavior is always the clients decision.

A nurse used a lifestyle assessment to measure health-promoting lifestyle behaviors of participants at a meeting. Which of the following actions should the nurse take when reviewing the results with each individual? a. Arrange for the client to meet with a lifestyle coach. b. Collaborate with the client in choosing what changes to make. c. Explain ways that the client can engage in new behaviors. d. Tell the client what to do to improve his or her health.

a. Elementary school program for children to which parents are invited A healthy lifestyle is easier to maintain when healthful patterns of behavior are learned early in life. Therefore, learning healthy lifestyle behaviors at a young age yields more benefit in years of life.

A public health agency had enough funds to provide one more health-promotion program during the calendar year. In relation to nutrition and exercise, which of the following would be the best choice? a. Elementary school program for children to which parents are invited b. High school program for those who are involved in athletics c. Young adult programs provided at the YMCA d. Senior citizen programs offered during a free meal

c. Having employees complete a health-risk appraisal form The most easy and effective way to determine current needs of the particular aggregate is by having each employee complete a paper-and-pencil form. Because the employer is a community college, literacy should not be a major problem. However, this is a subgroup, the wider communitys data might be misleading.

A public health nurse was asked by a towns community college to offer health education programs for its employees. How would the nurse most effectively determine which programs to offer? a. Asking the administrators which programs they would like b. Performing a complete physical examination on each employee during work time c. Having employees complete a health-risk appraisal form d. Planning a program on the basis of the broader communitys demographic data

d. Identify and reinforce client strengths. The process begins with summarizing information and then proceeds to identification and reinforcement of strengths. Then goals, outcome measures, a plan, reward system, and time frame are created. Good nursing practice always builds on client strengths rather than focusing just on weaknesses.

After obtaining data from a health-risk appraisal tool, a nurse met with a client for follow-up. Which of the following actions should the nurse take first after summarizing the information? a. Create a reward system to reinforce healthful behaviors. b. Design a behavior change plan acceptable to the client. c. Establish an implementation time frame. d. Identify and reinforce client strengths.

a. Decreased absenteeism c. Decreased use of insurance benefits d. Decreased accidents e. Decreased turnover There are numerous positive outcomes for employer and employee participation in health-promotion activities. Incentives for employers include reduced rates of employee absenteeism because of improved health status, improved employee productivity, decreased use of medical insurance benefits and workers compensation for illness and accidents, decreased employee turnover, fewer accidents, and decreased rates of premature morbidity and mortality. Workplace health-promotion programs may not decrease the incidence of obesity or decrease the commitment to self-improvement.

A public health nurse was trying to persuade the largest employer in town to offer workplace health-promotion programs. Which arguments could the nurse offer as benefits of these programs? (Select all that apply.) a. Decreased absenteeism b. Decreased incidence of obesity c. Decreased use of insurance benefits d. Decreased accidents e. Decreased turnover f. Decreased commitment to self-improvement

a. Feeling susceptible to a severe disease According to the health-belief model, people are motivated by the sense of personal susceptibility to a disease, as well as the perceived severity of a disease.

According to the health-belief model, which factors influence whether a person will engage in a particular health-promoting behavior? a. Feeling susceptible to a severe disease b. Being told to do so by a significant other on a frequent basis c. Believing that high-income persons engage in such behavior d. Viewing posters emphasizing the behavior in an area that the person frequents

c. Increase programs for teaching and encouraging health-promoting lifestyle choices. The data highlight the importance of health-promotion programs and the need for individual and community commitment to health-promoting lifestyle changes, particularly in regard to nutrition and physical activity.

Because, in relation to physical activity, none of the Healthy People 2010 objectives was met, what does the United States need to do? a. Ensure more tax funding for education of physical education teachers. b. Encourage funding for an increased number of exercise centers. c. Increase programs for teaching and encouraging health-promoting lifestyle choices. d. Require health care providers to serve as role models of appropriate physical activity choices.

c. Absence of disease Historically, health and illness were viewed as extremes on a continuum; the absence of clinically recognizable disease was equated with the presence of health.

How was the concept of health defined originally? a. Balance and harmony b. Maximum self-actualization c. Absence of disease d. Total well-being

c. Faith community nurses Faith community nurses (formerly called parish nurses) intentionally focus on care of the spirit as part of the process of promoting holistic health and preventing illness in a faith community.

Care of the spirit, as well as promoting health of the body, is performed very effectively by which professional nursing specialty? a. Church-based nurses b. Community/public health nurses c. Faith community nurses d. Public health nurses

c. Both my mother and father died of heart problems. The statement Both my mother and father died of cardiac problems suggests both susceptibility (my parents) and severity (died).

Considering the health-belief model, which statement suggests that the person is going to begin a new healthy habit? a. If I could be asleep while they did the colonoscopy, it might be alright. b. I did have a cousin who was treated for breast cancer. c. Both my mother and father died of heart problems. d. Because my employer was paying for the health screening, I thought I might go.

d. Socioeconomic class, education, and occupation All of the options influence health and illness, as well as the individuals lifestyle. However, higher education and socioeconomic class are associated with greater participation in health-promotion activities and, therefore, better lifestyle choices overall.

In the United States, which of the following is the most crucial influence in the sociocultural environment? a. The community in which a person grows and develops b. Familys values and beliefs c. Health care provider from whom care is sought as needed d. Socioeconomic class, education, and occupation

d. The media had publicized a famous womans diagnosis of breast cancer. Even though the local nursing school hosted a health fair, some other factor (probably a new, one-time-only, external cue) had emphasized the importance of the behavior and made women aware of their susceptibility to and the severity of breast cancer. Only a very famous persons problems would be a current media event that would create enough attention to cause a sudden great increase. External cues to action influence decisions related to health care behavior. A publicity campaign by the American Heart Association may increase the publics cue to action in relation to heart disease, but it would not likely be a factor relevant to the risk for breast cancer.

The community/public health nurse charted the number of persons who came in to be taught breast self-examination. The nurse noted that during the past 3 days, there was a sudden increase in the number of women coming in. Which of the following is the most likely reason for the increase? a. The increased number is probably just a coincidence. b. The local nursing school hosted a womens health fair. c. The American Heart Association had just started its annual publicity campaign. d. The media had publicized a famous womans diagnosis of breast cancer.

c. To motivate participants to consider changing high-risk behaviors The health risk appraisal tool helps the nurse obtain data, which is statistically analyzed to determine health risks. However, it may stimulate the individual to engage in the necessary behavioral changes that reduce known health risks. Data about a subgroup should not be considered representative of a wider population.

The nurse gave each participant a health-risk appraisal tool to determine the health needs of the group as a whole. What other purpose may the tool serve? a. To assess the needs of the broader community b. To demonstrate the necessity of having health education programs c. To motivate participants to consider changing high-risk behaviors d. To provide data for future planning by the nurses employer

d. Ability to maximize human potential Although all are accepted definitions, the most contemporary definition of health has emphasized the relationship between health and wellness. Wellness is the process of moving toward maximizing human potential.

Which of the following definitions of health is most typically used in nursing today? a. Ability to interact and adapt to the environment b. Ability to perform required social roles c. Ability to stay free from disease d. Ability to maximize human potential

d. Use multiple strategies to publicize the clinic in the community. Although planning, being present, and having necessary supplies are important, the crucial task is to inform community residents who might be interested. Establishing such a clinic means decreasing barriers to care (lack of access), and using every means to let people know about it is a cue to action.

The public health clinic was planning its once-a-month dental clinic in the community with a visiting volunteer dentist. Which of the following would be the most important task in preparation for this clinic? a. Plan to be there that day to assist with client flow. b. Sterilize all the dental equipment. c. Tell everyone to make an appointment to decrease waiting time. d. Use multiple strategies to publicize the clinic in the community.

a. Educate students that political options must conceptualize prevention as preferable to treatment in health care. b. Encourage partnerships with consumers and other professionals. c. Increase knowledge and skill in providing preventive services. f. Support requiring health insurance to pay for preventive health care. Box 18-1 lists various efforts that the ANA encourages. These include increasing nurses knowledge and skill in providing preventive services, encouraging partnerships with consumers and other disciplines in promoting health, supporting health care legislation that holds health insurance plans accountable for preventive care, educating the public to promote the health of the population, and influencing local and national economic and political options toward reconceptualizing health care in preventive ways. The ANA does not support requiring specific actions by health care providers in their private life. Beer and liquor taxes are not discussed in the document.

What efforts does the American Nurses Association (ANA) suggest all professional nurses should make? (Select all that apply.) a. Educate students that political options must conceptualize prevention as preferable to treatment in health care. b. Encourage partnerships with consumers and other professionals. c. Increase knowledge and skill in providing preventive services. d. Lobby for legislation to vastly increase sales tax on beer and liquor. e. Require health care providers to serve as role models of healthy lifestyles. f. Support requiring health insurance to pay for preventive health care.

b. Enabling people to exercise control over their own well-being Health promotion is the process of helping people enhance their well-being and maximize their human potential by changing patterns to promote health rather than simply to avoid illness. The goal of health promotion is to enable people to exercise control over their well-being and ultimately improve their health.

What is the primary goal of health promotion? a. Discovering people who are at risk and helping them obtain appropriate health care b. Enabling people to exercise control over their own well-being c. Preventing further physiologic damage by early intervention and education d. Reducing specific risks by early diagnosis and treatment

b. Provide feedback and follow-up information to attendees. Although all of the actions should be taken, it is ethically required to provide feedback, education, and appropriate follow-up for identified risks.

When a nurse plans educational programs appropriate for a population being served, which of the following actions should the nurse take? a. Bill the employer for the actual cost of the health program. b. Provide feedback and follow-up information to attendees. c. Make handouts available to the audience. d. Incorporate the latest technology into the presentation.

b. Community participation c. Economics, politics, and environment The primary health care model is not focused on primary care or personal health services, which address health care for individuals; instead, it emphasizes community involvement and environmental change.

Which of the following are factors in the primary health care model? (Select all that apply.) a. Commitment to a plan of action b. Community participation c. Economics, politics, and environment d. Personal health care services e. Primary health care and personal health services f. Universal access to primary health care clinics

b. It would effect more widespread change in the local social norms. c. Cost-effectiveness would be increased. d. The meeting would serve as an environmental cue. Benefits of community-wide programs include cost efficiency, ability of the program to serve as an environmental cue, development of an environment of social support, increased ability to evaluate success, and opportunity to reach more people and effect widespread change in social norms.

Which of the following factors would most likely be motivating factors for setting up large community-wide group meetings instead of face-to-face counseling? (Select all that apply.) a. A more comfortable party atmosphere would result. b. It would effect more widespread change in the local social norms. c. Cost-effectiveness would be increased. d. The meeting would serve as an environmental cue. e. Most people would rather learn in a group setting. f. People would carpool to the meeting.

a. Centers for Disease Control and Prevention (CDC) c. National Health and Nutrition Examination Survey (NHANES) e. National Health Care Survey (NHCS) Numerous federal resources support the objectives and interventions related to Healthy People 2020 and are incorporated into each topic area. These data sources include the CDC, NHANES, and NHCS. The ODPHP coordinates the efforts of public and private sectors to reduce the risks of disease and promotes the nations health. Links to various data sources can be found within the ODPHP website, but the role of the ODPHP is coordination of efforts to promote health, not data collection. The Dietary Guidelines for Americans and Healthfinder.gov provide information about interventions that can be used to address the Healthy People 2020 objectives.

Which of the following federal resources supply data that support the objectives and interventions described in Healthy People 2020? (Select all that apply.) a. Centers for Disease Control and Prevention (CDC) b. Dietary Guidelines for Americans c. National Health and Nutrition Examination Survey (NHANES) d. Healthfinder.gov e. National Health Care Survey (NHCS) f. U.S. Public Health Service Office of Disease Prevention and Health Promotion (ODPHP)

a. An increase in community-based chronic diseaseprevention programs c. Improvements to include health and preventive practices in daily life The purpose of Steps to a Healthier US Initiative (2007) was to improve the lives of Americans through community-based chronic diseaseprevention programs. Further progress has been made to weave health and preventive practices in all aspects of peoples lives, including how they live, where they work, their ability to access clean water and safe food, and how they spend leisure time.

Which of the following has resulted from the Steps to a Healthier US program? (Select all that apply.) a. An increase in community-based chronic diseaseprevention programs b. An increase in funding for health-promotion programs c. Improvements to include health and preventive practices in daily life d. Improvements in continuing education programs for health professionals e. An increase in availability of online interactive health risk appraisals f. An increase in tax deduction for participating in health-promotion programs

b. Achieving health equity, eliminating disparities, and improving the health of all groups The goals of Healthy People 2020 are to achieve high-quality, longer lives free of preventable disease, disability, injury, and premature death; to achieve health equity, eliminate disparities, and improve the health of all groups; to create social and physical environments that promote good health for all people; and to promote quality of life, health development, and health behaviors across all life stages.

Which of the following is one of the goals of Healthy People 2020? a. Decreasing institutionalization and increasing community-based care services b. Achieving health equity, eliminating disparities, and improving the health of all groups c. Creating environments to improve the eating and exercise habits of all people d. Expanding the technology, resources, and medications used to treat chronic illness

b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss nutrition and exercise options for families. Teaching good nutrition and encouraging exercise are excellent health-promotion activities. The other choices are all risk reduction or health protection programs.

Which of the following is the best example of a health-promotion program? a. The nurse collaborated with the local police department to prepare a public safety announcement about the benefits of using ones seat belt. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss nutrition and exercise options for families. c. The nurse worked with the local school parent-teacher organization to give free bicycle helmets to the students with bicycles. d. The nurse collaborated with the local motorcycle club to make sure all the cyclists who wanted one could obtain a free helmet.

c. The nurse worked with the local health maintenance organization (HMO) to make infant car seats available without charge to all first-time pregnant mothers. Providing infant seats helps lower the risks of death or injury from car accidents. The other choices are all health-promotion behaviors.

Which of the following is the best example of a risk reduction program? a. At the senior citizens center, the nurse set up an exercise program for persons in wheelchairs. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss good parenting skills. c. The nurse worked with the local health maintenance organization (HMO) to make infant car seats available without charge to all first-time pregnant mothers. d. The nurse wrote a weekly local newspaper column on healthy lifestyle behaviors, such as the importance of exercise.

c. Food, water, and exposure to toxic substances An estimated 25% of the preventable illnesses worldwide can be attributed to poor environmental quality (e.g., poor water, sewage disposal, air quality). The government, the health care system, and the value/belief system are sociocultural aspects of the environment whose effects are harder to measure.

Which of the following is the most crucial environmental influence on health? a. Government in the local community b. Health care system in the local community c. Food, water, and exposure to toxic substances d. Religious and cultural beliefs and values

c. A dont smoke campaign for elementary school students Only a dont smoke campaign for young children would represent action taken before they begin smoking, which is primary prevention. Primary prevention aims to prevent health problems and promote health.

Which of the following services implemented by nurses would represent primary prevention? a. A nurse-managed hospital respiratory unit for patients with chronic obstructive pulmonary disease (COPD) and emphysema b. A quit-smoking-now clinic for adults who want to give up the habit c. A dont smoke campaign for elementary school students d. A stay beautiful campaign for high school female smokers that stresses that smokers have wrinkles about a decade earlier than their chronologic peers

a. A free diabetes screening held at the local shopping mall Screening, which is aimed at diagnosis and treatment of illness at an early stage, is secondary prevention. Secondary prevention establishes the earliest possible diagnosis and early treatment, even before symptoms are present, to prevent disease progression.

Which of the following services implemented by nurses would represent secondary prevention? a. A free diabetes screening held at the local shopping mall b. A postheart attack exercise program at the local community college c. A stay beautiful program stressing safe exercises for pregnant moms d. An elementary school dont smoke campaign for students

c. A posthospitalization social support program for persons with chronic severe mental illness and their families Only a social support program for ill persons and their families aims to prevent further disability in both the clients and their families. Tertiary prevention is rehabilitation and prevention of further disability and disease.

Which of the following services implemented by nurses would represent tertiary prevention? a. A free high-cholesterol screening at the neighborhood grocery store b. A healthy lifestyle exercise and information program for all the employees of the citys largest employer, held at the worksite c. A posthospitalization social support program for persons with chronic severe mental illness and their families d. An exercise and parenting class for new first-time mothers

a. I bought walking shoes and have scheduled a walk before breakfast each day. The best indicator of whether a client is going to implement a health improvement plan is when the client has moved beyond contemplation and preparation or considering reasons they should engage in the behavior and actually takes action to initiate behavior change, such as buying exercise clothing and scheduling a time to engage in the action.

Which of the following statements best demonstrates a clients intention to start exercising on a regular basis? a. I bought walking shoes and have scheduled a walk before breakfast each day. b. I exercise when I can find someone to walk with. c. I need to buy a treadmill or exercise bike so that I dont get fat. d. I think exercising would reduce my stress and help my appearance.

c. Perceived self-efficacy Self-efficacy is a central concept in Penders health-promotion model with regard to behavior-specific cognition and affect. Other such behavior-specific cognitions and affect variables are perceived benefits, perceived barriers, interpersonal influences, and situational influences.

Which of the following would be a behavior-specific cognition and affect variable according to Penders model? a. Commitment to a plan of action b. Competing demands (family or work) c. Perceived self-efficacy d. Personal realities such as demographics

d. Influencing improved health policies and legislation for healthier communities The American Nurses Association (ANA) suggests that nursings role in prevention includes supporting health care legislation and influencing local and national economic and political options (i.e., affecting health policies and legislation).

Which of the following would be the most effective mechanism to use when collaborating with others to have an extensive and lasting impact on health outcomes? a. Broadly disseminating health-related information to inform citizens b. Encouraging the creation of more health programs on client lifestyle modification c. Increasing funding to health agencies for more health education programs d. Influencing improved health policies and legislation for healthier communities

c. It was the first time that national goals for improving the health of Americans were established. Healthy People was instrumental in identifying major health problems and setting national goals for reducing death and disability. However, there were no funds or plans for implementing the goals.

Why was the publication of Healthy People a landmark document? a. It was the first time that a national plan had been created with funding to implement it. b. It was the first time that evaluation measures based on outcomes to judge effectiveness were created. c. It was the first time that national goals for improving the health of Americans were established. d. It was the first time that universal agreement on federal government priorities was reached.

c. The dietitians and nutritionists It is very important to develop partnerships with people who are most likely to be affected by the program and promote a sense of cooperation, collaboration, and teamwork in order to be successful.

With which of the following populations would collaboration be most important when a school nurse proposes that additional healthy options be added to the school lunch program? a. The staff and teachers b. The children and their parents c. The dietitians and nutritionists d. The school board and administration