PH Chp. 21- The Nurse-led Health Center: A Model for Community Nursing Practice

A nurse executive would like to hire a neighborhood resident who is trained in community outreach to work at the nursing center. Which of the following would most likely be the title of this position? a. Community health worker b. Support staff member c. Clinical specialist d. Specialty care provider

ANS: A Community health workers are typically neighborhood residents who are trained in community outreach, family case management, or on-site services. A support staff member may include a business or operations manager and data operations personnel. A clinical specialist is an advanced practice nurse. A specialty care provider has had advanced education in a specialty area.

Which characteristic is common among all nursing centers? a. Provision of community-based culturally competent care b. Services provided by physicians and health care providers c. Focus on the biological factors contributing to the development of disease d. Fee-for-service reimbursement model

ANS: A One characteristic that is common among all nursing centers is the provision of community-based culturally competent care that is accessible, acceptable, and responsive to the populations being served. Services are provided by nurses in a nurse center. A variety of reimbursement models are used in nursing centers. Nursing centers use a holistic approach to care.

A nurse needs to make the final decision about establishing a nursing center in the local community. Which of the following factors would be the most important for the nurse to consider? a. Legal and regulatory considerations b. Community involvement c. Nursing interest d. Potential grant funding

ANS: A Several essential areas must be explored before a final decision is made about establishing a nursing center, including legal and regulatory considerations. Community interests would be important to consider, not necessarily community involvement. All funding sources, not just grant funding, should be considered. The nursing interest is not a main component that needs to be considered when establishing a nursing center.

What is the focus of a special care nursing center? a. A particular demographical group or those with special care needs b. An affiliation with a school of nursing c. Providing services while maintaining a not-for-profit status d. Providing fee-for-service care with designated Health Maintenance Organization (HMO) providers

ANS: A Special care centers focus on a particular demographical group or those with special needs. Examples are those that focus on persons with HIV/AIDS, adolescent mothers, and the frail elderly. An academic nurse-led center has an affiliation with a school of nursing. A 501(c)(3) center is considered a nonprofit business. An HMO provider provides fee-for-service care with contracted rates by an HMO.

A nursing center is going to be placed in a rural community. Which of the following would have the most power and influence on model development and team composition? a. The rural community b. The mayor c. The nursing executive d. The center's staff

ANS: A The fundamental premise of any nursing center is that the community has the most power and influence. The mayor, nursing executive, and staff do not have as much power as that of the community.

A nurse has recently completed a research study in a nursing center. Based on the historical pattern of research in nursing centers, what would likely have been the focus of this research? a. The development and characteristics of nursing centers b. The effects of nursing models of care in nursing centers c. Client outcomes d. Managed competition in nursing centers

ANS: A Typically, descriptive data has been collected about clients, types of services, financial support systems, and community relationships over the past three decades. Additional research in the future needs to be done to look at the effects of nursing models of care and client outcomes. There is no need at the present time to look at managed competition in nursing centers

A nurse is looking for financial support when developing a nursing center. Which of the following would be an appropriate source for funding? (Select all that apply.) a. Grant funding b. Charitable organizations c. Private pledges d. Foundations e. State and federal agencies

ANS: A, B, C, D Support for nursing centers can come from grants, charitable organizations, private pledges, and foundations. State and federal agencies typically do not provide funding for nursing centers.

A nurse is performing the role of researcher in a nurse center. Which of the following types of data would most likely be collected by a nurse in this setting? (Select all that apply.) a. Client use of services b. Trends in community characteristics c. Staff compliance with HIPAA d. Client satisfaction e. Morbidity rates

ANS: A, B, D Trends in health care services, client responses, and changes in community characteristics must be documented and summarized periodically. Outcome measurements such as client use of on-site services, childhood and adult immunization patterns, pregnancy outcomes, emergency department and hospital use, and other health indexes including client satisfaction and quality-of-life measures should also be collected. Staff compliance with HIPAA is a legal responsibility of staff and data should not need to be collected about this topic.

A nurse develops a plan to describe the development and direction of the nursing center and identifies how the center will meet its goals. Which of the following best describes this plan? a. Feasibility study b. Business plan c. Strategic plan d. Organizational framework

ANS: B A business plan describes the development and direction of the nursing center and how goals will be met. A feasibility study identifies the strengths, limitations, and capacity of an organization and the community to support the establishment and continuation of a nursing center. A strategic plan looks into the future and guides the work of the center in that direction. The organizational framework shows how the organization is organized.

A nurse is examining the strengths, limitations, and capacity of an organization and the community to support the establishment and viability of a nursing center. Which of the following best describes what the nurse has completed? a. Data collection b. Feasibility study c. Focus groups d. Community forums

ANS: B A feasibility study reveals the strengths, limitations, and capacity of an organization and community to support the establishment and viability of a nursing center. Focus groups, community forums, and data collection are all used in order to complete a feasibility study.

What was the overarching concept upon which Healthy People 2020 was built? a. Establish nursing centers for the purpose of health promotion b. Create partnerships among individuals, communities, and systems c. Eliminate disease in lesser-developed countries d. Further the agenda of the World Health Organization (WHO)

ANS: B Healthy People 2020 builds upon shared responsibility to improve the nation's health. Powerful, productive partnerships among diverse people and groups and long-term commitments to community collaboration are needed to achieve these goals. Healthy People 2020 did not promote the establishment of nursing centers. Healthy People 2020 focuses on the needs of the United States, not that of lesser developed countries or the agenda of the WHO.

A nursing faculty member is discussing the importance of joining a professional organization as a registered nurse with a group of undergraduate students. Which of the following statements would be most appropriate for the faculty member to include in this discussion? a. "All nurses should be members of the American Nurses Association." b. "Membership in a professional organization helps nurses organize around critical health issues." c. "Dues for professional organizations are expensive, so it is important to set aside money to pay these dues." d. "Membership in a professional organization will foster change in legislation."

ANS: B Membership in a professional organization helps nurses to organize around one or more critical health threats and strategize about what interventions work locally, regionally, and nationally. Membership in organizations should be based on interest, clinical and academic preparation, and employment. Dues for professional organizations vary, but most are not extremely expensive. One of the benefits of membership in a professional organization is that legislation can be influenced, however this in only one of the benefits of belonging to a professional organization.

A nurse working at a nursing center has been asked to develop materials about a health promotion topic that can be used at the center. Which of the following topics would the nurse most likely select? a. Advanced care of the chronically ill elderly at home b. Smoking cessation and weight management techniques c. How to access specialty services d. Providing financial support for nursing students

ANS: B Nurse centers are positioned to improve the health and well-being of vulnerable populations. One way to achieve this is by providing access to comprehensive primary health care and health promotion and disease prevention services. Smoking cessation and weight management techniques focus on health promotion, which address the main focus of the nurse center. Advanced care of the chronically ill and accessing specialty services does not address health promotion and disease prevention services. Providing financial support for nursing students does not address a health promotion and disease prevention topic and does not meet the needs of the broad population that may be served by the center.

A nurse is employed by a nursing center. Which of the following types of services will be provided here? a. Illness-oriented care b. Direct access to nursing services c. Free services d. Physician diagnosis of health problems

ANS: B Nursing centers provide unique opportunities to improve the health status of individuals, families, and communities through direct access to nursing and nursing models of care. A nursing center deemphasizes illness-oriented care, is reimbursed for services, and uses nurses to diagnose and treat.

A client would like to enroll in a smoking cessation program. Which of the following types of nursing centers would be most likely to provide this type of programming? a. Academic Nursing b. Wellness c. Comprehensive Primary Care d. Special Care

ANS: B Wellness centers focus on health promotion, disease prevention, and management programs. An academic nurse-led center has an affiliation with a school of nursing. A comprehensive primary care center provides health-oriented primary care and public health programs. Special care centers focus on a particular demographical group or those with special needs.

A nurse is using the Health Insurance Portability and Accountability Act (HIPAA). Which of the following situations is the nurse most likely in? a. Counseling an employee that his insurance will remain the same after changing jobs b. Supervising staff to ensure that all work has been completed c. Adhering to client confidentiality when providing care d. An employee takes additional time off of work to care for a sick family member

ANS: C HIPAA states that staff must monitor and keep client records secure, and have mechanisms to transfer client information securely and appropriately. Counseling about insurance, supervising staff to make sure work has been completed, and taking additional time off of work is not part of HIPAA.

A nurse executive reports that the nursing center receives reimbursement through contracted rates. Which of the following types of reimbursement mechanism is being used? a. Fee-for-service b. Federally Qualified Health Center (FQHC) c. HMO provider d. Third-party reimbursement

ANS: C HMO providers pay at contracted rates. Fee-for-service means payment is provided at time of service. FQHC has federal designation that allows cost-based reimbursement per encounter. Third-party reimbursement involves client billing to a public program or commercial/private insurance.

A nurse would like to improve the ability of the nursing center to be responsive to the needs of the community. Which of the following best describes how this can be accomplished? a. Having staff examine the needs of the community b. Determining the services to be provided by the center c. Involving the community in assessing its own needs d. Addressing the problems in the community

ANS: C Nurses work in close partnership with the communities. As the community and center work together, a multilevel approach is needed. For comprehensive community health improvement, strategies are needed at organizational, community, and sociopolitical levels. Thus, it is important to involve the community in the planning of a nursing center. Having the staff examine the community needs does not involve the community. If the nurse determines the services to be provided, this does not demonstrate collaboration and communication with the community. The nurse needs to work with the community in order to determine which problems in the community should be addressed.

A community health center conducts blood lead screenings on a regular basis for children under 6 years old. Which of the following best describes the level of prevention that is being used? a. Tertiary prevention b. Primary prevention c. Secondary prevention d. Health education

ANS: C Secondary prevention often involves screening. Primary prevention involves education. Tertiary prevention involves rehabilitation. Health education is provided to improve knowledge about a health topic

Individuals, families, groups, organizations, policy makers, and staff who are involved in community collaboration are known as: a. nursing center workers. b. policy makers. c. stakeholders. d. diversity.

ANS: C Stakeholders offer diversity in perspective in community collaborative efforts. Policy makers are those involved in creating the policies. Nursing center workers are those who work as staff within the nursing center. Diversity is demonstrated through working with a variety of populations.

Which term addresses the multiple levels of intervention required for bringing about and sustaining change? a. Community collaboration b. Community assessment c. Strategic planning d. Partnership

ANS: C Strategic planning addresses the multiple levels of intervention required for bringing about and sustaining change. Community collaboration involves the capacity of those involved to enhance the capacity of another person, group, or organization to achieve the common purpose. Community assessment involves examining the community to determine its needs, strengths, and weaknesses. Partnership involves working together to solve community problems.

A nursing student would like to become involved by working at a nursing center. Which of the following would be an appropriate role for a nursing student? a. Leader b. Follower c. Advocate d. Researcher

ANS: C Students most often play the role of advocate in a nursing center. Students have the opportunity to promote social justice while engaging in community service learning activities with underserved, vulnerable populations. A student needs to be a leader, but with supervision. A student can collect data, but is not yet a researcher.

Which type of nursing center operates under a service model? a. Free-standing center b. Affiliated center c. Comprehensive primary care center d. Proprietary

ANS: C The service model includes comprehensive primary care centers, wellness centers, and special care centers. Organizational structure is the typology used to describe a free-standing and affiliated center. Internal Revenue Service Designation is the typology used to describe a proprietary center.

A nurse executive publishes information about the effectiveness of a prenatal program. Which of the following describes this essential step of evaluation of this program? a. Focusing on design b. Engaging stakeholders c. Ensuring use and sharing lessons learned d. Gathering credible evidence

ANS: D A nurse executive providing materials on the effectiveness of a prenatal program is an example of gathering credible evidence. Focus on design, engaging stakeholders, and ensuring use and sharing lessons learned are parts of evaluation. However, these steps are not necessary before publishing information about program effectiveness. Credible evidence must be gathered before publication.

Which type of nursing center actively integrates service, education, and research in its model? a. Special care b. Free-standing c. Fee-for-service d. Academic

ANS: D Academic nursing centers actively integrate service, education, and research in their model. Special care centers provide services and specialized health knowledge and skills to a particular group, and they are an adjunct to comprehensive primary health care models. A free-standing center is an independent center with its own governing board. A fee-for-service center means that payment is provided at time of service and it may include a sliding-scale fee.

A nurse is working with a group and would like to facilitate successful collaboration. Which of the following would be the most important factor for the nurse to consider? a. Focus of the group b. Planned change that will occur c. Decisions made by executive director d. Open and frequent communication

ANS: D Although the focus of the group and its planned change are important, they are not the most important factor for the nurse to consider. To accomplish anything with the group, open and frequent communication is necessary. Decisions should be made through consensus of the group, not the decisions of one person.

A nurse is presenting information to community members about the potential development of a retail care clinic in the neighborhood. Which of the following information would the nurse include in this presentation? a. These clinics are typically staffed by physicians. b. These clinics are usually located in community centers. c. These clinics focus on providing information related to health promotion. d. These clinics are often owned by for-profit organizations.

ANS: D Retail care clinics are typically staffed by nurse practitioners, located in a high volume retail business, and provide a limited scope of care including immunizations, routine school physicals, and care for common acute problems. The majority of retail clinics are owned by for-profit organizations and its management does not consider the clinics as nurse-managed health centers.

A nurse executive is managing a nursing center. Which of the following would be an expected responsibility of a nurse in this role? a. Managing the business operations b. Managing the data systems c. Providing patient care and referral d. Overseeing contracts and grants

ANS: D The nurse executive has many leadership roles and responsibilities including responsibility for overseeing contracts and grants, annual reports, development of the advisory board, and hiring and retention of highly qualified staff. Other staff members will manage the business operations, data systems, and provide patient care and referral.