NUR 428 Concepts Quiz

spectrum of prevention

offers a systemic framework for development of effective and sustainable primary prevention programs

oral rehydration therapy (ORT)

use of oral rehydration salts (ORS) are used to prevent or correct dehydration (not to treat the source of the diarrheal illness)

shelter in place

used as an alternative to evacuation people may be asked to remain indoors (homes, building, school) especially if there is a limited time to react to a threat people should plan on having 72hr worth of food, water, and medical supplies in order to remain indoors

active immunity

artificially acquired: immunity is achieved through vaccination or through naturally acquired: contracting the disease

A nurse is leading a therapeutic group for clients at an outpatient mental health clinic. Which of the following client statements indicates a problem with role transition? A. "If my husband had gone to the doctor like I told him to, he'd be alive today." B. "I am so angry with my husband's attitude. He thinks he knows everything!" C. "I want to have an intimate relationship, but I end up breaking off relationships as soon as they begin." D. "I just can't seem to find any energy to take care of my children since my husband divorced me."

"I just can't seem to find any energy to take care of my children since my husband divorced me."

A nurse is reinforcing teaching with a group of adolescent females who are pregnant about expected changes related to pregnancy. Which of the following client statements indicates understanding of the teaching? A. "It is normal to have a white vaginal discharge." B. "I should recognize fetal movement by 12 weeks." C. "I will take fluid pills if my ankles begin to swell." D. "My nipples and areolae will become pale as my breasts enlarge."

"It is normal to have a white vaginal discharge."

A charge nurse is discussing the phases of community response to disaster with nursing staff. Which of the following statements indicates an understanding of the heroic phase of disaster response? A. "Personnel are willing to work in dangerous conditions to provide assistance." B. "Survivors come together and share stories of survival." C. "Responders experience exhaustion due to extended relief efforts." D. "Normalcy begins to return to the community."

"Personnel are willing to work in dangerous conditions to provide assistance."

A public health nurse is teaching a group of nurses about smallpox. Which of the following statements by one of the nurses indicates understanding of the teaching? A. "There are rare, occasional occurrences of smallpox." B. "Vaccination against smallpox provides lifelong immunity." C. "Smallpox lesions appear in various stages of healing." D. "Unlike chickenpox, the vesicles of smallpox are more abundant on the face."

"Unlike chickenpox, the vesicles of smallpox are more abundant on the face."

Jakarta Declaration

1st health promotion conference held in a developing country (Jakarta, Indonesia)

A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the following clients should the nurse plan to care for first? A. A client experiencing a tension pneumothorax B. A client who has a closed upper extremity fracture C. A client who has full-thickness burns over 80% of his body D. A client who has agonal respirations

A client experiencing a tension pneumothorax

A nurse is helping to triage a group of clients at a mass casualty incident who were involved in an explosion at a local factory. Which of the following clients should the nurse tag to be the priority for care? A. A client who has severe head injuries, respiratory rate 6/min, and is unresponsive B. A client who has a simple fracture of the femur, multiple scratches on both legs, and is crying hysterically C. A client who has a piece of wood punctured into the chest wall and has an audible hissing sound coming from the wound site D. A female who is pregnant at 20 weeks of gestation, has multiple cuts and abrasions, and is walking around

A client who has a piece of wood punctured into the chest wall and has an audible hissing sound coming from the wound site

A nurse is assisting with triaging clients following an explosion. Which of the following clients should the nurse identify as the highest priority? A. An unconscious adult client who has a large head wound with gray matter exposed; absent respirations B. A conscious adult client who has second-degree burns on both lower legs; respiratory rate is > 30/min C. An unconscious 6-month-old infant with no respirations; no visible injuries D. A conscious adult client wearing a medic-alert diabetic bracelet; client reports feeling clammy and shaky

A conscious adult client who has second-degree burns on both lower legs; respiratory rate is > 30/min

Safety Net health care provider:

A provider that by mandate or mission organizes and delivers a significant level of health care and other health- related services to the uninsured, Medicaid, and other vulnerable populations

A nurse is providing staff education about smallpox as a bioterrorism threat. Which of the following statements indicates an understanding of this agent? (Select all that apply.) A. "Smallpox is transmitted person to person." B. "Infection is characterized by severe respiratory distress." C. "Smallpox vaccination ensures lifelong immunity." D. "Naturally occurring smallpox has been eradicated from the world." E. "Smallpox is often confused with varicella."

A. "Smallpox is transmitted person to person. D. "Naturally occurring smallpox has been eradicated from the world." E. "Smallpox is often confused with varicella." ."

A community health nurse is providing a community education program about disaster preparedness. Which of the following should the nurse recommend that clients include in their family's disaster readiness supply kit or "go bag"? (Select all that apply.) A. Pencil and paper B. Whistle C. Antibiotics D. Copies of insurance cards E. Household bleach

A. Pencil and paper B. Whistle D. Copies of insurance cards E. Household bleach

A nurse is working with an emergency response team in caring for a group of people who may have been exposed to anthrax while doing farm work, but are not exhibiting manifestation of illness. Which of the following is the appropriate action for the nurse to take? A. Place the clients in isolation. B. Initiate client decontamination. C. Administer antibiotic therapy. D. Treat clients with an antitoxin.

Administer antibiotic therapy.

A nurse is preparing to administer ciprofloxacin to a client. The nurse should identify that the medication is treatment for exposure to which of the following agents? A. Smallpox B. Sarin gas C. Ebola virus D. Anthrax

Anthrax

A community health nurse is conducting an educational program on various environmental pollutants. The nurse should emphasize that clients who have which of the following disorders are especially vulnerable to ozone effects? A. Osteoarthritis B. Basal cell carcinoma C. Asthma D. Hypothyroidism

Asthma

A nurse is educating community members about how to prepare for a disaster. Which of the following supplies should the nurse instruct the clients to include in a disaster preparedness kit? (Select all that apply.) A. Three quarts of water per person B. Clean clothing C. Personal ID D. Matches E. Prescription medications

B. Clean clothing C. Personal ID D. Matches E. Prescription medications

A nurse is planning a staff education session regarding biological weapons of mass destruction. Which of the following should he plan to include in the session? (Select all that apply.) A. Sarin B. Smallpox C. Anthrax D. Hydrogen cyanide E. Botulism

B. Smallpox C. Anthrax E. Botulism

A community health nurse is developing a pamphlet about breast self-examination (BSE) for a local health fair. Which of the following instructions should the nurse include? A. Expect some breast dimpling or discharge with age. B. For those who have a menstrual cycle, perform a BSE every month, 2 or 3 days before menstruation. C. Using the palm of the hand, feel for lumps using a circular motion. D. Breasts can be examined in the shower with soapy hands.

Breasts can be examined in the shower with soapy hands.

child abuse risk factors of child

Child factors: younger age, female, racial/ ethnic minorities, behavioral or disability problems present

A nurse is among the first responders to a mass-casualty incident and does not know what type of personal protective equipment (PPE) is needed. Which of the following actions should the nurse take? A. Wait until the type of equipment needed is known. B. Decontaminate victims before intervening. C. Choose the highest level of protection equipment available. D. Use a dosimeter to measure the level of radiation in the area before intervening.

Choose the highest level of protection equipment available.

A nurse is preparing a community health program for adults at risk for cardiovascular disease. Which of the following should the nurse include as a modifiable risk factor? A. Diagnosis of diabetes mellitus B. Family history of cardiac disease C. Increasing age D. Cigarette smoking

Cigarette smoking

Teamwork and collaboration:

Crucial to effective community nursing, work together as a team to turn around the face of health care more quickly, working jointly with others in a common endeavor (clients, nurses, physicians, teachers, health educators, social workers, PT, OT, nutritionist, psychologist, epidemiologists...)

A nurse working for a home health agency is assessing an older adult male client. Which of the following findings is the priority for the nurse to address? A. Swollen gums B. Pruritus C. Urinary hesitancy D. Dysphagia

Dysphagia

herd immunity

Enough people in a population that have immunity to a certain disease, it protects those in the community that cannot have the vaccine such as organ transplants, elderly, immunocompromised, autoimmune diseases, Indirect protection for those who cannot be vaccinated, including those who have allergies to vaccines

A nurse is caring for a client who suspects recent exposure to inhalation anthrax. Which of the following findings indicate possible exposure? A. Flu-like symptoms B. Sloughing of skin C. Vesicles on the skin D. Respiratory failure

Flu-like symptoms

community base nursing

Focusing on prevention and improved health behaviors for aging populations

US Public Health Service Commission Core:

Group of more than 6500 specially trained public health members who serve the US with goal of protecting and promoting the health of the US. Nurses in this program focus on providing care, conducting research, or reviewing new medications; can be deployed to protect nations (like Haiti in the earthquake) est 1798 as part of an act to treat sick seaman in marine hospitals

what are some new and reemerging diseases

H1N1, ebola, zika, west nile

A school nurse receives a call that some children and teachers report being exposed to an undetermined noxious gas odor presenting in the classrooms and are experiencing dizziness. Which of the following actions should the nurse take? A. Have students evacuated from the school and establish a triage area in the school parking lot. B. Move individuals who are reporting symptoms to one of the affected classrooms and create a triage area inside the room. C. Arrange for client transportation to the nearest emergency department and tell the group triage will occur there. D. Transport all children and school personnel to the nearest medical facility using school buses.

Have students evacuated from the school and establish a triage area in the school parking lot.

An occupational health nurse in the clinic of an industrial plant is developing a guidebook for clinic workers. Which of the following actions should the nurse include as a secondary prevention strategy? A. Teach plant workers about proper lifting techniques. B. Set up an influenza immunization campaign. C. Help plant workers identify signs of carpal tunnel syndrome. D. Collaborate with physical therapists to develop programs for injured employees to return to work.

Help plant workers identify signs of carpal tunnel syndrome.

indirect transmission

If through animals or insects, infectious agent is transported in contaminated material, food and water, fomites: toys/ tissues

A nurse is reviewing the guidelines for reporting nationally notifiable infectious diseases. Which of the following diseases should the nurse plan to report to the Centers for Disease Control and Prevention (CDC)? A. Lyme disease B. Cytomegalovirus C. Streptococcus pharyngitis D. Toxoplasmosis

Lyme disease

An older adult client who lives alone tells a clinic nurse that he is unable to drive himself to the store and is afraid to cook on the stove. Which of the following community resources should the nurse recommend for this client? A. Hospice care B. Meals on Wheels C. A rehabilitation facility D. Temporary Assistance for Needy Families (TANF)

Meals on Wheels

A community health nurse in a pediatric clinic is reviewing the history of a 12-year-old client. Which of the following immunizations should the nurse expect to administer? A. Meningococcal conjugate B. Herpes zoster C. Rotavirus F. Pneumococcal polysaccharide

Meningococcal conjugate

A school nurse is teaching a group of nurses newly hired to work in the school system about pediculosis capitis (head lice). Which of the following information is appropriate to include in the teaching? A. Family pets can contribute to the transmission of lice. B. Children from lower socioeconomic areas are more likely to have lice. C. Nits that are shed into the environment are capable of hatching for up to 10 days. D. Infestation often appears as grayish brown, threadlike burrows along the skin behind the ears.

Nits that are shed into the environment are capable of hatching for up to 10 days.

A nurse is working with an interdisciplinary disaster committee to develop a community-wide emergency response plan in the event of a nonbiological or chemical incident. The nurse should include which of the following agencies to be notified immediately after calling 911? A. Office of Emergency Management (OEM) B. Federal Emergency Management Agency (FEMA) C. American Red Cross (ARC) D. U.S. Department of Homeland Security (DHS)

Office of Emergency Management (OEM)

collaborator

Passing information between professionals on behalf of the patient, working with many difference professionals, coordination of services

A nurse is triaging victims of a multiple motor-vehicle crash. The nurse assesses a client trapped under a car who is apneic and has a weak pulse at 120/min. After repositioning his upper airway, the client remains apneic. Which of the following actions should the nurse take? A. Start CPR. B. Place a red tag on the client's upper body and obtain immediate help from other personnel. C. Place a black tag on the client's upper body and attempt to help the next client in need. D. Reposition the client's upper airway a second time before assessing his respirations.

Place a black tag on the client's upper body and attempt to help the next client in need.

A is nurse assisting with field triage following a motor-vehicle crash involving a bus with multiple victims. The nurse assesses a child who has an open fracture of the femur. Which of the following actions should the nurse take? A. Locate the child's parents to obtain consent for treatment. B. Place a yellow triage tag on the child. C. Notify the emergency department of the child's imminent arrival. D. Perform a complete head-to-toe assessment

Place a yellow triage tag on the child.

School Based Health Centers:

Provide ready access to health care for large numbers of children and adolescents during school hours, reducing absences from school due to health care appointments; school nurses influence children's health, but often still need to refer them to a primary care provider

community health worker

Provider refers to the heath care team, which may include a community health nurse, a physician, a midwife, an "injector"

A community health nurse is reviewing the levels of disease prevention. Which of the following activities is an example of tertiary prevention? A. Providing treatment for clients who have chronic obstructive pulmonary disease B. Performing screening for sexually transmitted infections C. Administering influenza immunizations at a local health fair D. Testing new nurses for exposure to tuberculosis.

Providing treatment for clients who have chronic obstructive pulmonary disease

palliative intervention

Relieves suffering without curing underlying disease

A public health nurse is assessing an older adult client who lives with a family member. The nurse identifies several bruises in various stages of healing. The client and family member explain that the bruises are a result of clumsiness. However, based on the distribution of the bruises, the nurse suspects abuse. Which of the following actions should the nurse take first? A. Document the bruises in the client's chart. B. Report the findings to a supervisor. C. Provide the client with a crisis hotline number. D. Discuss respite care with the client's family.

Report the findings to a supervisor.

passive immunity

Short term resistance, passed from mother to newborn or through immunoglobulin (give someone resistance if they had infection exposure)

A nurse is reviewing treatment protocols for clients exposed to bioterrorism agents. For which of the following agents should the nurse plan to administer a vaccine following exposure? A. Anthrax B. Botulism C. Plague D. Smallpox

Smallpox

community health nurse

Specialty field of nursing, adds public health knowledge and skills that address the needs and problems of communities and aggregates and focuses care on communities and vulnerable populations, combines nursing science with public health science to formulate a community-based and population-focused practice (protect and promote health through nursing, social, and public health knowledge)

nightingale model

Standard for proper education and supervision of nurses in practice, written in the Notes for Nurses publication, specifically the environment for patients, need for keen observations, whole patient rather than the disease, assisting nature to bring about a cure (from her Hippocrates studies)

antibiotic resistant strains

TB, MRSA, HIV

A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include? A. The client will list foods that are high in calcium, which should be avoided. B. The client will walk for 30 min 5 days a week. C. The client will increase calorie intake by 200 cal per day. D. The client will replace cigarettes with smokeless tobacco products.

The client will walk for 30 min 5 days a week.

Potentially inappropriate medications:

Those that senior citizens should avoid due to either their ineffectiveness or because the potential adverse effects overshadow the proposed benefits; they also should be avoided if other safe drugs are available

direct transmission

Transmission from the reservoir to the infected person, sneezing to inhalation from an infected person to a healthy person

A nurse is preparing a response protocol for botulism as a bioterrorism agent. The nurse should prepare the protocol based on which of the following information? (Select all that apply.) A. Botulism can produce paralysis within 12 to 72 hr following exposure. B. Notify the Centers for Disease Control and Prevention (CDC) when more than three cases are confirmed. C. Botulism is acquired through direct contact with an infected person. D. Vomiting and diarrhea are expected findings following exposure. E. Botulism is a toxin found in castor beans.

Vomiting and diarrhea are expected findings following exposure.

What are the types of eating disorders?

anorexia nervosa, bulimia nervosa, binge eating disorder

what is used in bioterrorism

anthrax

cognitive domain vs. affective domain

cognitive = recall and recognition affective = feelings and emotions

advocacy

defined as pleading the case of another or championing a cause

vector borne pathogen

dengue fever

obesity

having a BMI of 30 or greater and is recognized as a national health threat and a major public health challenge more men than women and common in native americans and african americans increased risk for CVD, cancer,T2DM, OSA, premature death educate about healthy lifestyle, physical activity, decrease calorie intake, bariatric surgery

primary level of prevention

health promotion and educaiton, health protection. used for those with risk factors for disease

disability adjusted life-year (DALY)

combo of years of life lost because of premature mortality and years of life lived with disability adjusted for the severity of disability

tularemia

cough is not bloody rare infectious disease that attacks the skin, eyes, lymph nodes, and lungs (aka rabbit fever)

secondary level of prevention

early diagnosis, prompt treatment

A nurse is the triage officer in the emergency department when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first? A. A conscious adult client who reports shortness of breath, has a respiratory rate of 24/min, and capillary refill of < 2 seconds B. An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of < 2 seconds C. A conscious adult client who has a dislocated right shoulder, respiratory rate of 18/min, and capillary refill of < 2 seconds D. An unconscious adult client who has no respirations, capillary refill is > 2 seconds, and paramedics have already tried to reposition airway without results

An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of < 2 seconds

child abuse

at minimum = any recent act or failure to act on the part of a parent or care taker which results in death, serious physical or emotional harm, sexual abuse or exploitation; an act or failure to act which presents immanent risk of serious harm;

sign of radiation

bloody diarrhea

who are community health nurses governed by?

governed by ANA

health promotion

has been defined as health behaviors that improve well-being and lead to a desire to meet one's human potential

plague symptom

hemoptysis (coughing up blood or blood stained mucus from lungs) the airway is bleeding

environment that could lead to abuse

loneliness, isolation, lack of social support

child abuse risk factors of environment

loneliness, isolation, lack of support

aggregate

mass or group of people who are considered as a whole and who are loosely associated with one another

federally qualified health centers

provide care to underserved populations through Medicare, Medicaid, or a sliding fee scale

A charge nurse is making a room assignment for a client who has scabies. In which of the following rooms should the nurse place the client? A. A negative-pressure isolation room B. A semi-private room with a client who has pediculosis capitis C. A positive-pressure isolation room D. A private room

A private room

palliative care

Consists of comfort and symptom management and does not provide a cure

A charge nurse is discussing staff nurses' responsibilities in preplanning for response to a disaster. Which of the following responsibilities should the nurse include in the discussion? A. Identify community resources that are available. B. Evaluate the impact of a disaster on the community. C. Assess survivors of a disaster for levels of psychological stress. D. Link victims with support agencies to help with food, clothing, shelter, and counseling needs.

Identify community resources that are available.

Triple Aim:

Improving population health, reducing health costs, and providing improved patient outcomes

A nurse is preparing to care for a client who has suspected exposure to plague as a result of bioterrorism. Which of the following actions should the nurse plan to take first? A. Prepare for drainage of lesions. B. Initiate contact precautions. C. Notify the Centers for Disease Control and Prevention (CDC). D. Decontaminate the client.

Initiate contact precautions

Florence Nightingale

Laid the foundation for modern community health nursing practice, she is referred to as the reformer, reactionary, and researcher

Outcome criteria

measurable standards that community members use to measure success as they work toward improving the health of their community

typical biologic warfare agents include:

anthrax, botulism, bubonic plague, ebola, and small pox

bulimia

characterized by recurrent episodes of binge eating with repeated compensatory mechanisms to prevent weight gain, such as vomiting (purging type) and fasting or exercise (non-purging type)

Windshield Survey (Familiarization)

descriptive approach that assesses several community components by driving through a community an activity often used by nursing students in public health courses and by new staff members in community health agencies

child abuse risk factors of family

disorganized, violence and marital conflict, financial problems, social isolation

family characteristics that could lead to abuse

disorganized, violence, marital conflict, financial problems, social isolation

A nurse is participating in a biological disaster simulation where citizens are exposed to pneumonic plague. Which of the following isolation precautions should the nurse plan to use while caring for these clients? A. Airborne B. Contact C. Droplet D. Protective

droplet

anorexia nervosa

emotional etiology that is characterized by body image disturbance, intense fear of gaining weight or becoming fat, and refusal to maintain adequate body weight (BMI of 18 or greater)

child abuse risk factors of child of parents

external locus of control (something else controls what is happening to them, its never their fault), poor impulse control and self-esteem, antisocial,

parental behaviors that could lead to child mistreatment

external locus of control, poor self esteem, poor impulse control, antisocial

Triple Aim

improving population health, reducing healthcare costs, and providing improved patient outcomes

Psychomotor domain

includes visible, demonstrable performance skills that require some kind of neuromuscular coordination

examples of psychomotor domain

infant bathing, temperature taking, breast/testes self exam, prenatal breathing exercise, ROM, catheter irrigation, walking with crutches, dressing changes

binge eating

involved recurrent episodes of binge-eating without fasting, self-induced vomiting, or other compensatory measures, lifetime prevalence of this disorder is 1.6%

Chemical Warfare

involves the use of chemicals such as explosives, nerve agents, blister agents, choking agents, and incapacitating or riot-control agents to cause confusion, debilitation, death, and destruction

nuclear warfare

involves the use of nuclear devices as weapons and can take several forms, but no known terrorist attacks have yet involved the use of nuclear power plants as weapons. A terrorist attack using nuclear weapons or destruction of a nuclear plant would cause multiple and prolonged deaths with extensive damage and negative effects for decades.

biologic warfare

involves using biologic agents to cause multiple illnesses and deaths; can be graded as category A,B, or C by the CDC; can be used to contaminate food, water, or air

planned change

is a purposeful, designed effort to effect improvement in a system with the assistance of a change agent per Spradley's classic definition (1980), also known as managed change, is crucial to the development of successful community health nursing programs

elder abuse

mistreatment (abuse/neglect) is defined as intentional actions that cause harm or create serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or another person who stands in trust relationship to the elder

continuum of care

model where programs are developed to assist persons to transition from emergency to transitional to permanent housing. Emergency shelters provide temporary overnight shelter, whereas transitional housing provides up to 24 months of housing and supportive services.

global burden of disease (GBD)

numerically verified numerous long-held assumptions about disparities in the burden of disease worldwide, especially regarding children

role of a public health nurse

nurse who works to promote and protect the health of an entire population

Quality indicators:

of patient outcomes are the quantitative measures of a patient's response to care. they are worthwhile processes that enable the nursing staff to evaluate the results of the care they provide

mandated reporters

people who have a responsibility for the welfare of children are required by law to report suspected cases of severe emotional neglect or abuse or deprivation in addition to suspected legal neglect and physical or sexual abuse include: public and private school employees; administrators and employees of youth centers and recreation programs; child welfare employees; foster parents; group home and residential facility personnel; social workers; probation workers; health care workers including nurses, doctors, and chiropractors; animal control workers; and personnel working in film development laboratories

Advocate

pleasing the case for a patient or acting on their behalf to explain services promote need for services make referrals

fetal alcohol spectrum disorder and ss

pre and post-natal growth deficits, small size, facial abnormalities- facial dysmorphology (thin upper lip, short palpebral fissures, smooth philtrum), poor coordination, flat vomer bone, wideset eyes, thin upper lip, hyperactive, Poor reasoning and judgment, sleep and sucking disturbances, problems in school especially math, vision and hearing problems, poor judgment, sleep disturbances

health disparities

preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations unequal distribution of these factors among certain groups is thought to contribute to health disparities that are persistent and pervasive

enabling factor

promote or facilitate the behavior based upon availability

Reinforcing factors:

provide a continued motivation to repeat or persist in the behavior

Predisposing factors

provide the rationale or motivation for subsequent behavior

tertiary level of prevention

rehab and primary prevention (health promotion, education, health protection)

health literacy

several tasks that relate to ability to understand basic medical info (how to take med, follow order from HCP, use health ed. from print/online)

types of child abuse (child maltreatment)

shaken baby syndrome, failure to thrive (not up to right height or weight, child is under stress)

Americans with Disabilities Act

signed into law in 1990 to protect the civil liberties of the many American living with disabilities

nightingale

standard for proper education and supervision of nurses in practice

empathy

the ability to understand and share the feelings of another critical component of communication process/essential to nurse process

Vulnerability

the social determinants of health can define a persons vulnerability including where they were born, age, ethnicity, and social class barriers can make a person vulnerable (employment, housing, food instability, education, discrimination, incarceration, health literacy, environment, and access to healthcare)

benchmarking

uses continuous, collaborative, and systemic processes for measuring and examining external programs' strength and weaknesses; benching marking including studying another's processes in order to improve one's own