Populations Exam 1 Review Questions

1. In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income persons

a, b, c The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs.

1. Which of the following are the best argument(s) for supporting community-as-client nursing? (Select all that apply.) a. Change for the benefit of the community-client must often occur at several levels. b. Changes in the health of individuals will affect the health of their communities. c. The idea of providing health-related care within the community is not new. d. The impact of the environment on health has long been established. e. Direct hands-on nursing care delivered to individuals or families in community settings is important.

a, b, c, d The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, PBHs, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall.

1. Factors related to the determinants of health identified in Healthy People 2020 include which of the following? (Select all that apply.) a. Education and literacy b. Genetic endowment c. Gender d. Culture e. Social status

a, b, c, d, e The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.

3. The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical care

a, b, d The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.

2. The poor environmental conditions experienced by immigrants in tenement houses and sweatshops were familiar features of urban life across the northeastern United States and the upper Midwest. Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of the times? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the town and country nursing services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseases

a, b, e In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities.

1. A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences

a, e Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen his or her pain, and other pain-reducing medications should be explored.

9. At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level? a. Aggregate client system level b. Environmental level c. Family client system level d. Individual client system level

a. Aggregate client system level Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention.

10. After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change? a. Preparation b. Contemplation c. Action d. Precontemplation

a. Preparation Preparation is the stage where the person intends to do something. Precontemplation is when the person does not plan to change; this may be because the person does not know there is a problem or does not want to do anything about it. In the contemplation stage, the person begins thinking about making a change in the future and examines the pros and cons of doing so. Action occurs when the person actually buys a radon testing kit and uses it in his home.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

a. advocacy The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

8. In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members: a. are best at determining the health needs and plan interventions for their community. b. create a passive partnership. c. provide oversight for the health promotion activities. d. relieve local service providers of mundane tasks.

a. are best at determining the health needs and plan interventions for their community. The CBPR approach to community assessment allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process. In CBPR, partnerships are active and community members are involved in assessing, planning, implementing, and evaluating change. Both professionals and community residents determine health needs and plan interventions. As residents increase their awareness, they are better able to determine what they want for themselves, their families, and their community and they are more likely to take leadership roles in program development, using health professionals as consultants.

5. A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

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

2. Public health nursing practice is guided by the community's priorities as identified by community: a. assessment. b. diagnosis. c. interventions. d. planning.

a. assessment. Assessing the health status of the populations that make up a community requires ongoing collection and analysis of relevant qualitative and quantitative data. Community assessment includes a comprehensive evaluation of the determinants of health. Data analysis identifies deviations from expected or acceptable rates of disease, injury, death, or disability, as well as risk and protective factors. Community assessment generally results in a lengthy list of community problems and issues. However, communities rarely possess sufficient resources to address the entire list, and priorities must be set after assessing the community's beliefs, attitudes, and opinions, as well as the community's readiness for change.

6. The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

a. assurance The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.

9. If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: a. boundaries, parts, and dynamic processes of the client community. b. community health status and structure. c. community problems and problem correlates. d. role of the nurse and lay advisors in the community partnership.

a. boundaries, parts, and dynamic processes of the client community. In most definitions, the community includes three factors:people, place, and function. The people are the community members or residents. Place refers to both the geographic and time dimensions, and function refers to the aims and activities of the community. The parts of a community are interdependent, and their function is to meet a wide variety of collective needs. Therefore, the definition of community should also recognize the interaction among systems within the community.

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

a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups.

8. A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.

a. clinical community health practice Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.

7. The local public health nurse (PHN) participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be: a. coalition building. b. evaluation of outcomes. c. health-risk assessment. d. wellness appraisal.

a. coalition building The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time.

6. When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses (PHNs) conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.

a. community-level practice The goal of community-level practice is to improve the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized. These strategies lead to an increase in the percentage of people who obtain recommended immunizations for themselves and their children.

7. A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.

a. community-oriented care Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.

9. The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.

a. cultural accommodation Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively.

9. A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements. a. evaluate the effectiveness of b. assess the expansion needs of c. identify problems with d. implement the expansion of

a. evaluate the effectiveness of The evaluation phase of a community-level intervention attempts to determine the effectiveness of the intervention in meeting the desired outcome (decreased social isolation for the elder community population) and in establishing new healthier practices (increased social networking and increased involvement in other community activities) while identifying any emerging barriers (problems) that may interfere with the desired outcome. Very often this can be achieved through a repeat assessment such as a survey of the population receiving the intervention to measure change in attitudes, beliefs, and behaviors.

5. Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.

a. culture shock Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin.

6. During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by: a. decrease in focus on the community as the unit of service. b. increase in the scope of fundamental services. c. increase in field experience. d. decrease in the need for training and supervision.

a. decrease in focus on the community as the unit of service. Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health; but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision.

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

a. educate about self-care and the women's rights as employees. Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

7. A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention. a. individual/family, secondary b. community, primary c. community, secondary d. individual/family, primary

a. individual/family, secondary Based on this nursing diagnosis, one could assume that the level of practice is at the individual/family level (young child who is being parented by a primary parent who is experiencing mental health problems) and at the secondary level of prevention (because the family has an existing identified risk, i.e., a mental health problem).

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

a. frail older adults One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

5. The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who introduces her to the neighborhood residents she needs to partner with. The role of the pastor in this example is: a. gatekeeper. b. community health worker (CHW). c. professional service provider. d. stakeholder.

a. gatekeeper Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Gatekeepers can confer credibility to the nurse. CHWs are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. Stakeholders refer to anyone with a personal or occupational interest or concern in a community's life. Professional service providers who are community members such as school teachers, public safety officers, and agricultural extension agents play a large part in the overall health of the community.

6. A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.

a. general cultural assessment The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship.

7. A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: a. influential with their insider status to engage community members. b. medical professionals within the migrant community. c. natural healers within their community. d. translators to help overcome language barriers.

a. influential with their insider status to engage community members. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. They can also serve as gatekeepers, using their own insider status to engage community members in the assessment process

4. A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.

a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence.

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

b, c, e Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.

1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

b, d Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

5. A clinic-based public health nurse (PHN) has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level? a. Analysis of the immunization clinic appointment rate over the next few months b. Analysis of the trend in childhood immunization rates for the health district c. Assessment of the immunization status of each child who visits the clinic d. Determination of the budgetary impact of the media campaign on the clinic's operations

b. Analysis of the trend in childhood immunization rates for the health district The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs.

8. The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation? a. Evaluation should start in the planning phase of the nursing process. b. Evaluation can have unintended consequences. c. Effectiveness is the only true measure of worthiness. d. The power to design, judge, or institute change is important.

b. Evaluation can have unintended consequences. Evaluation of community health interventions can provide valuable information about an intervention's effectiveness and efficiency in obtaining the desired measurable outcome or its progress to date in reaching that desired outcome. Factors related to costs in money and time should also be addressed to determine if the intervention was worth carrying out. This is especially true given the fact that health care operates in a political environment in which competition for limited resources is a reality. The nurse must also recognize when selecting measurable outcomes in the planning phase that unintended outcomes may result from the intervention that may become evident upon evaluation. The success or failure of the intervention may carry unintended consequences. It may uncover new trends in the community. Finally, the evaluation process should identify whether the intervention was adequate and acceptable to the community. In this case, the change in the outcome measure was not sufficient to be acceptable, and the community's expectations were greater than the results delivered. The community decided to invest its limited resources elsewhere. The issue was not the power to design, judge, or institute change. The results of the intervention were not good enough in the community's eyes. Some of these challenges could have been addressed in the planning stages by exploring alternative approaches that would have ensured a better return on the dollar. This would have built community confidence in health interventions and fed success into the initiative. It may be harder to propose new initiatives when past initiatives produced such unintended consequences.

1. Which of the following community health improvement projects uses subjective health perspective? a. Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use

b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program The subjective life process approach involves taking a holistic view of the person's total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model.

2. The most important contribution made by Florence Nightingale to community-oriented nursing was: a. development of the settlement house concept as a strategy to improve urban health standards. b. expansion of the role of nursing to include health-promotion practices. c. founding of the first district nursing association in England. d. introduction of professional schools of nursing in the United States.

b. expansion of the role of nursing to include health-promotion practices. Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

b. cascade effects Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

9. Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.

b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

b. health literacy A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

b. homeless pregnant teens in a substance abuse program. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

1. In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was: a. establishment of the Federal Emergency Relief Administration. b. introduction of the first nurse-midwifery training. c. introduction of the nursing process. d. introduction of occupational health nursing.

b. introduction of the first nurse-midwifery training. The unique pioneering spirit of the FNS influenced the development of public health programs to improve the health care of rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckenridge, the founder of the FNS, introduced the first nurse-midwives into the United States.

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

b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences.

7. The Association of Community Health Nurse Educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in such areas as: a. immigrant and migrant health. b. natural and human-made disasters. c. automobile safety for children. d. student health.

b. natural and human-made disasters. The Association of Community Health Nurse Educators calls for increased graduate programs to educate PHN leaders, educators, and researchers. Natural disasters (such as floods, hurricanes, and tornados) and human-made disasters (including explosions, building collapses, and airplane crashes) require innovative and time-consuming responses. Preparation for future disasters and potential bioterrorism demands the presence of well-prepared nurses.

3. The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was: a. establishment of an FNS. b. provision of funding to support employment and education. c. provision of funding for research and investigation of disease. d. institution of a district nursing model.

b. provision of funding to support employment and education. Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses (PHNs). More than 1,000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of PHNs with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease.

1. Which action by the community-oriented nurse best illustrates a partnership for health? a. Assisting a school nurse in conducting vision screening of elementary school children b. Developing a volunteer program for teaching parenting skills c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions d. Informing a neighborhood council that smoking is its major community health problem

c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions Healthy People 2020 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term.

3. Collaboration is an intervention that would be located where in the Intervention Wheel? a. Red wedge at the individual/family level of practice b. Blue wedge at the community level of practice c. Orange wedge at the community level of practice d. Green wedge at the systems level of practice

c. Orange wedge at the community level of practice The public health interventions are grouped with related interventions, and these wedges are color coordinated. The red wedge includes five interventions: surveillance, disease and health investigation, screening, outreach activities, and case finding. They typically occur in pairs or in sequence, although all can occur independently. The green wedge consists of three interventions: referral and follow-up, case management, and delegated functions; these are often implemented together. Similarly, the blue wedge includes three interventions—health teaching, counseling, and consultation—that are often implemented together. The orange wedge combines three interventions—collaboration, coalition building, and community organizing—which are all types of collective action that are usually carried out at the systems or community level of practice. Similarly, the three yellow wedge interventions—advocacy, social marketing, and policy development and enforcement—are often interrelated when implemented. Interventions in the orange and yellow wedges are typically used at the systems and community levels of practice, whereas those in the red, blue, and green wedges are usually carried out at the individual/family level of practice and to a lesser degree at the community and system levels of practice. Collaboration is a collective action and therefore, must be in an orange wedge.

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

c. Resource limitations Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

2. A rural PBH is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency? a. County public health department b. National Centers for Disease Control and Prevention c. State vital statistics bureau d. U.S. Census Bureau

c. State vital statistics bureau Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community, but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus.

6. A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices? a. The family is responsible for the health behaviors of children. b. The individual is responsible for health behaviors. c. There is multilevel responsibility for health behaviors. d. The community has a sense of responsibility for health behaviors.

c. There is multilevel responsibility for health behaviors. In the ecological perspective, individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

c. Trying to minimize the "hassle factor" Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

5. In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client: a. access to care. b. adjustment of lifestyle. c. compliance with a prescribed regimen. d. response to treatment.

c. compliance with a prescribed regimen In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional.

8. A community-based hospice nurse has an Asian male client with terminal-stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.

c. cultural brokering Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client.

7. A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.

c. environmental control The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition.

6. The most important aspect of the nursing community assessment phase can best be described as: a. analyzing and synthesizing data. b. collecting and gathering data. c. formulating a community nursing diagnosis. d. identifying problem correlates.

c. formulating a community nursing diagnosis. Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____."

8. After consulting with the health department director, a PHN collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice. a. evaluation, systems b. assessment, community c. implementation, systems d. diagnosis, community

c. implementation, systems Collaboration and advocacy are often collective actions applied at a community or systems level of practice. In this case, the identification of the community problem probably emerged out of practice, rather than from a formal community assessment. The nurse's goals were to enforce the tenant's legal rights and improve their living conditions. The nurse sought advice from a housing advocate service and connected the clients with legal counsel. The nurse also sought political support by consulting with health department officials before implementing the nursing plan.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

c. insure children without health insurance. Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

4. A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of: a. aggregate primary prevention. b. individual-level primary, secondary, and tertiary prevention. c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. d. promotion of optimal health for the individual, family, aggregate, and total community.

c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community—individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach.

5. From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as: a. adoption of 2-year associate degree nursing programs. b. exclusion of home-based care from health insurance coverage. c. national preference service model that neglects emerging problems. d. rise in hospital-based care.

c. national preference service model that neglects emerging problems. The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only.

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

c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.

1. The three components of the Intervention Wheel are: a. communities, systems, and individuals/families. b. interventions, color wedges, and levels of practice. c. population base, levels of practice, and public health interventions. d. populations at risk, populations of interest, and levels of practice.

c. population base, levels of practice, and public health interventions. The components of the Intervention Wheel include population base, three levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges.

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

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

4. A community-oriented nurse leader is working with community leaders and interested citizens to improve access to services for the underserved by planning an expansion of the local community health clinic. This is an example of which type of community partnership model? a. Coalition b. Democratic c. Passive d. Community member professional

d. Community member professional Community members who are recognized as community leaders, (whether professionals, pastors, government officials or interested citizens) possess credibility and skills that health professionals often lack. The community member-professional partnership approach specifically emphasizes active participation. Coalitions are formal partnerships in which individuals and organizations serve in defined capacities such as steering committees, advisory committees, and work groups. Coalitions are active partnerships, in which all participants share leadership and decision making to some degree.

4. In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: a. enforcing the department of health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for students.

c. providing and obtaining medical treatment for absent students. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide follow-up care to children absent from school.

3. The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies? a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease

d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models, and strategies to reduce CHD risk. The Alameda County study followed a large sample for 4 years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs.

3. Which community attribute is an indicator of a community's health status? a. Mean educational level b. Location of health facilities within the community c. Ratio of police to citizens d. Suicide rate

d. Suicide rate Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes include morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios.

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

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

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

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

2. An effective community-oriented diabetes program should include: a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques. b. care that incorporates the American Diabetes Association treatment guidelines. c. access to a primary care provider, medication and supplies, and nutritionist consult. d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.

d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies. From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies).

4. The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as: a. advocacy. b. coalition building. c. consultation. d. social marketing.

d. social marketing Social marketing utilizes commercial marketing principles and technologies in programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Recent examples of the use of these techniques are antismoking campaigns, campaigns for refunding of the State Children's Health Insurance Program, and campaigns to address the needs of uninsured/underinsured populations.

5. Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.

d. systems-level practice The goal of systems-level practice is to change the laws, policies, and practices that influence immunization rates, such as promoting the creation of population-based immunization registries and improving clinic and provider practices.

1. In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: a. what public-private partnerships do to treat vulnerable populations. b. what the government does to ensure that vital programs are in place. c. what the U.S. Public Health Service does to prevent disease, promote health, and deliver services. d. what society does collectively to ensure the conditions in which people can be healthy.

d. what society does collectively to ensure the conditions in which people can be healthy. In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.