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7. A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? a. To allow participant observation by the nurse b. To ensure that the nurse would care about her intervention outcomes c. To maximize convenience and minimize commuting time for the nurse d. To save gasoline in these difficult economic times
ANS: A Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse "observations" of the community's life. The nurse should care about the interventions that are performed regardless of where the nurse lives. The priority is that the nurse is knowledgeable of and can observe the community, the assignment does not have to do with the convenience of the nurse.
5. A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? a. A change in the distribution or redistribution of power and influence b. An increase in awareness of the importance of health c. Continued ongoing interest in community health activities d. Improved family functioning and involvement in health activities
ANS: A Collaborative practice models involving the community and nurses in joint decision making and specific nursing roles are required. Nurses must remember that collaboration means shared roles and a cooperative effort in which participants want to work together. These participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. This means sharing not only the power but also the responsibility for the outcomes of the intervention. By having the community members involved in creating the health change it is likely they will have an increased awareness of the importance of health, an ongoing interest in the health of the community. These things should occur because the community is more educated about its health because of its involvement. Being involved will not necessarily result in improved family functioning so this consequence will most likely not occur.
A nurse is working toward an objective to "increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care." During which of the following phases of the nursing process would determination of the objective occur? a. Assessment phase b. Planning phase c. Implementation phase d. Evaluation phase
ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. Assessment involves getting to know and understand the community as the client. Implementation involves the work and activities aimed at achieving the goals and objectives. Evaluation is the appraisal of the goals and objectives that have been created.
Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a. All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition. b. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. c. 95% of children will be immunized by 1 year of age. d. There will be a 25% reduction in health disparities by 2015.
ANS: B Objectives must be precise, behaviorally stated, and measurable. The response that describes mothers receiving nutrition counseling represents a specific, measureable behavior as an objective. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1 year old.) A 25% reduction by 2015 is a goal, not an objective.
A nurse is assessing a community's openness to change. Which of the following variables indicate that the community is ready? a. Commitment to current processes and policies b. High socioeconomic status in the community as a whole c. Long history of dependence on the community health agency and its staff d. Minimal level of social participation by community members
ANS: B The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents. Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. A community that is open to change is likely to be open to changing current processes rather than focusing on traditon. Communities that are open to change typically have a high level of social participation by its residents.
A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a. A problem that affects the most disadvantaged residents in the community b. A problem that is very easy and inexpensive to address c. A problem that is of high concern to the community d. A problem in an area in which the nurse has a great deal of expertise
ANS: C Choice of priority must depend on the community's awareness of the problem—and their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities. Rather than examining the issues from the perspective of the most disadvantaged residents, the nurse should look at the problem which affects the most individuals in the community who may or may not be disadvantaged. The cost of the problem will need to be addressed, but if the problem is not a priority to the community the agency may be wasting money addressing a problem that the community does not care to solve. If the nurse is unfamiliar with interventions to solve the probem, the nurse should collaborate with others to solve the problem. The priority should be the needs of the community, not the needs of the nurse.
2. A nurse is practicing in the community but also has the community as the target of practice. NURSINGTB.COM Which of the following best describes the activities of this nurse? a. Providing care to an active caseload of 50 families in the neighborhood b. Inviting all the parents of asthmatic children in the school to meet together for mutual support c. Sharing assessment findings and health goals with every community group that will listen d. Writing articles for the local newspaper highlighting the various programs and services of the local health department
ANS: C Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals. Although it is not possible to know the nurse's goals from the nurse's behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn't necessarily help eligible clients access care.
8. A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurse's reason for driving through the community twice in the same day? a. On the second trip, the nurse can carefully confirm the results of the first assessment. b. Repeating the experience ensures that the nurse absorbed all the relevant details. c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.
ANS: C When doing a windshield survey as part of community assessment, the nurse should observe two times: one during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. It is likely that different things are occurring in the community when the nurse drives through the community at different times. Therefore, it is likely that the nurse will learn more about the community by doing this and not necessarily confirm previous findings. If the nurse was interested in writing down the results of the findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings, this would not necessarily occur by the nurse driving through the community in the evening.
4. A nurse is focusing on the process dimension of a community's health. Which of the following interventions will the nurse most likely implement? a. Assessing the health care services available in a community b. Establishing screening programs to diagnosis diseases as early as possible so treatment can begin c. Implementing health promotion activities such as education programs d. Planning for new programs to be developed based on identified needs
ANS: C When the emphasis is on the process dimension—usually the level of intervention of the nurse in community health—the best strategy is usually health promotion, such as various primary prevention strategies. The other responses represent the structure dimension of the community. Structure is defined as the services and resources within the community. This includes service use patterns, treatment data from various health agencies, and provider-to-client ratios.
A nurse is assessing the structure of a community's health. Which of the following data will the nurse examine? a. The community's commitment to health b. Health risk profiles of selected aggregates c. Statistics of morbidity and mortality in comparison with similar communities d. Treatment and service use patterns from local health agencies and care providers
ANS: D Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios. The community's commitment to health is part of the process dimension of the community. Health risk profiles and vital statistics are part of the status dimension of the community.
1. Which of the following is the best brief definition of community? a. A geographic area or political division under common leadership b. A group sharing a common bond such as a profession or occupation c. A group working together to confront a common problem d. A social group with common goals within a geographic area
ANS: D According to WHO, a community is "A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future." The correct answer includes aspects of people, place, and function or aims. In addition to sharing geographic boundaries and leadership, a community also has common values and interests. In addition to sharing a common bond, members within a community have to interact with one another. A group working together to confront a common problem only addresses the aspect of function; it does not address people or place.
3. Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don't simply focus on helping persons who engage in poor health behaviors to behave appropriately? a. Addicts don't have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d. Society must offer healthy choices, offer support, and practice helpful policies.
ANS: D Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies. Change in society is helpful for addicts to change their behavior. Many times certain aspects of society limit an individuals ability to make change on their own. Laws and policies within society must support individuals to make healthy lifestyle choices.
During which of the following activities is the nurse in community health acting as a partner in change? a. Administering vaccinations to preschoolers b. Analyzing community problems to determine the best interventions c. Establishing an elder-care center for older adults living with family members who work d. Teaching anger management skills to a group of teens in a halfway house
ANS: D Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change partner roles include those of enabler-catalyst, teacher of problem-solving skills, and activist agent. Teaching anger management skills to a group of teens in a halfway house demonstrates the use of a change partner role of teacher of problem-solving skills. Change agent roles stress gathering and analyzing facts and implementing programs. The nurse establishing an elder-care center is acting as a change agent. The nurses administering vaccinations and analyzing community problems are carrying out other nursing roles.
6. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurse's plans for interventions b. To confirm the nurse's initial findings and conclusions c. To encourage community partners to feel they "own" the data d. To generate nonstatistical data such as values, beliefs, and perceived needs
ANS: D Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community's knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation. Interviews with key informants provide data; the purpose is not to ensure agreement with the nurse's plan or confirm findings. The key informants are formal or informal leaders within the community and although they may have information to share about the community, it may not be important that they feel that they "own" the data.
A nurse is assessing the status of a community's health. Which of the following will the nurse examine? a. Community awareness b. Health facilities c. Health care manpower d. Vital statistics
ANS: D The status of community health involving biological indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g., hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process.
