CH Test 2: Ch 11
There are 12 students with confirmed cases of the H1N1 flu in grades 6 to 8 at the local middle school in the community. The community nurse advises the caregivers of the ill children to keep the children home for a minimum of 5 to 7 days. Which should be the nurse's next step? A) Recommend closing the school for 6 weeks B) Implement education in the school setting regarding respiratory and hand hygiene C) Require each child in the school to undergo a physical evaluation by the school nurse D) Initiate a system of discipline in the school setting for improper hand washing
B Association means that events of illness or disability have a strong tendency to occur together rather than just by chance. The school setting is a common site where illness occurs by association. Education can prevent or limit the transmission of this disease. Because the children with known cases of H1N1 are being kept at home now and will not be contagious on return, there is no need to close the school. A mandatory physical evaluation of each child in the school would be both impractical and unnecessary, as most children will not have the virus and those who do may not yet be symptomatic. Although children should be educated on methods of proper hand washing, simply punishing those who fail to perform proper hand hygiene would be neither appropriate nor effective.
The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community. To begin the assessment, the nurse should gather objective data from which source? A) Client interview aggregate data B) Internet aggregate data C) Internet Wikipedia D) Direct observation of the area
B By exploring data available on the Internet, community health nurses can not only describe trends but also identify resources that address the trends and determine where gaps may exist. The aggregate data from these resources include local demographics, such as death rates, causes of death, marital status, gender, age, ethnicity, and density of the population. Depending on the purpose of the community assessment, records in health facilities may be examined. Client interviews and direct observation of the area would render subjective data, not objective. Wikipedia is not an authoritative source.
Community assessment is a critical process for the future because it can: A) Identify the need for a community commission B) Identify a method to improve the health of at-risk clients C) Provide a means of grant funding for clinics D) Provide a client base for at-risk neighborhoods
B Community assessment has been called a critical process for the future that can be used as a means for understanding the interactions between people, health, and environment in a community, as well as finding a way to improve both the health status of at-risk populations and outreach activities.
The school nurse notifies the community nurse that there have been five confirmed cases of pertussis in the sixth-grade classes. In addition to responding to the cluster of cases, the community nurse should immediately: A) Recommend that the school be closed B) Research the vaccine compliance in the school C) Recommend that notes be sent home to the parents regarding a pertussis epidemic D) Consult with the infection control physician at the local hospital
B Existing (secondary) data can often be used to identify the community's strengths and weaknesses, to determine assets and liabilities, and to describe, along with available community resources, the amount of disease/disability or health in a population. The data that identify the ìwho, what, where, and whenî related to disease, disability, and exemplars of health must then be systematically organized and analyzed. In this case, the nurse should gather further data regarding the vaccination history of students in the school before initiating an intervention. If the pertussis is only affecting children who have not been vaccinated and 98% of the children in the school are vaccinated, then the nurse may focus efforts on getting those few children vaccinated who are not already. If, however, the disease is affecting children already vaccinated or if a significant number of children are not vaccinated, then the nurse might consider recommending that the school be closed, recommending that notes be sent home to the parents regarding an epidemic, or consulting with the infection control physician at the local hospital.
Following a hurricane, the disaster team chooses to use a collaborative model to assess the needs of the community. Each team member is given a community analysis and assigned the task to create a tentative plan of action. Why would the use of a collaborative model hamper the progress of the assessment and plan in a disaster? (Select all that apply.) A) Individual decision-making creates bias. B) Assessment is time-consuming. C) Approach to problem solving is linear. D) Approaches must be preestablished. E) Collaboration is limited.
B, D The collaborative model has distinct drawbacks. This form of assessment is time-consuming and logistical, and systematic approaches must be preestablished to maintain clarity in the approach for all those involved. The collaborative model is characterized by a group decision-making process, not an individual one. Problem solving would be multidisciplinary and simultaneous, not linear. Collaboration would be enhanced, not limited.
The community health nurse explores pedestrian access to all healthcare facilities in the community. Which tool would be most helpful in performing this task? A) Geographic information systems B) Functional health pattern C) Epidemiologic model D) Developmental model
A A geographic information system (GIS) is a system of hardware and software used for storage, retrieval, mapping, and analysis of geographic data. Spatial features are stored in a coordinate system that refers to a particular place on the earth. The GIS tool assists in determining locations of disease incidence, characteristics of surrounding environments, locations of healthcare facilities, the geographic boundaries of the communities, and other essential community infrastructures. A functional health pattern is a systematic and deliberate approach to community assessment that involves evaluating the behavior patterns of community dwellers that occur sequentially over time. An epidemiologic model is a process used to assess a community using data collected from descriptions and statistical relationships to evaluate the level of health and well-being within a community and to address identified healthcare needs. A development model is a retrospective, historical analysis of system parameters such as the physical environment, education, safety and transportation, politics and government, health and social services, communication, economics, and recreation in a community.
The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. This assessment is based on: A) Subjective data B) Objective data C) Cognitive analysis D) Valid data
A Community health nurses often use informal assessments, such as windshield surveys, to learn about the neighborhoods in which their clients live. These surveys involve subjectively observing the physical community on foot or through the windshield of a car. In this way, the nurse can assess the level of economic development of the community on the basis of its physical environment, educational systems, safety and transportation, health and social services, communication, and recreation. This type of assessment is not based on objective or ìvalidî data, as the means of the assessment are purely subjective. It also does not involve cognitive analysis.
The community is concerned about public safety and the care of their elders living at home. When the nurse assesses the community, the nurse finds there is potential to solve their problems within the community setting without outside resources. The plans to meet the community needs are accepted by the members of the community. Which action has been most successfully demonstrated in your assessment of this community? A) Make the assessment process empowering to the community B) Assess the community through interview and share findings in a timely manner C) Involve the community when there is difficulty with the assessment D) Create an environment of change within the community
A When attention is directed to community strengths and resources, better relationships can be developed between all those working on the assessment, especially when the community is part of the process. Working relationships are enhanced when community members realize that the assessment process has the potential to be an empowering experience; the strengths and positive aspects of the community are measured in conjunction with what is needed or not actualized. There is no evidence of interviewing or creating change within the community in the scenario. There is also no evidence that there was any difficulty with the assessment
The nurse conducts a community assessment in a town once supported by multiple paper factories. The factories closed 2 years ago and most of the population is now out of work. The school nurse notes that 68% of the students are behind schedule in their physicals and immunizations. On the basis of this community assessment, the nurse should recommend: A) Initiation of neighborhood clinics at low or no cost to the community B) Creation of a task force to assess the impact of low income on immunization compliance C) A formal petition to the local government to mandate immunizations by imposing monetary fines on parents whose children are not immunized D) A tax relief program for new companies wishing to settle in the community
A Whenever nurses conduct an assessment of a community, they examine biological, psychological, and sociocultural influences of the environment of a group of people who share specific characteristics. Knowledge gained from this endeavor provides valuable insight into the ways that people's health behaviors directly and indirectly influence the overall health and well-being in their community. The neighborhood clinics meet the immediate need for childhood immunizations. The assessment has already determined that immunization compliance is low, so there is no need to create a task force to assess this.
The nurse assesses a community undergoing change. Five years ago, a series of setbacks caused the local foundry to close. Through interviews, the nurse discovers that generations of families worked at the foundry. Research indicates that no other businesses have been able to provide work for those who no longer work at the foundry. Developmental data gathered through this research into the community's history will help the nurse: (Select all that apply.) A) Determine what resources were available before the foundry closed B) Determine what variables may have enhanced or detracted from community development C) Develop an understanding of the community's strengths and resources today D) Understand cultural changes within the community over time E) Identify where in the community health clinics are most needed
A, B, D Both historical informants and mined data (i.e., data that are examined through extensive and rigorous searches) can help describe the cultural changes within a community or aggregate over time to inform the future. In this way, developmental data are obtained and then compared to determine what variables may have enhanced or detracted from development and what resources were available at the time. Historical research would not help you develop an understanding of the community's strengths and resources today; an assets-based approach would help you do that. Historical research would also not help you identify where in the community health clinics are most needed; a windshield survey or use of geographic information systems would help you do that.
Which rationales are appropriate for performing community assessments in the school setting? (Select all that apply.) A) To learn about an outbreak of lice B) To assess effectiveness of children with type I diabetes managing insulin shots at school C) To stage a student's brain tumor D) To assess students for food allergies E) To provide education on preventing the spread of influenza
A, B, E Appropriate rationales for performing community assessments in the school setting include the following: to learn about the outbreak of specific communicable infectious disease (lice); to learn about healthcare practices associated with a specific chronic disease (asthma); and to learn how best to protect children and adolescents, as well as their families, from the spread of infectious disease in a school setting. The staging of a brain tumor would not be appropriate for a community assessment and should be performed by a specialist in a provider's office or in a hospital. Assessing students for food allergies would also not be an appropriate community assessment as it does not pose an immediate threat to the health of the public, is not infectious, and is not communicable.
At an international nurses' conference, nurses from all around the world make contact. The various communities represented at this conference most likely: (Select all that apply.) A) Vary significantly in composition B) Have no shared interests and goals related to health and safety C) Are challenged in their attempts to identify its members D) Thought of as members of a global community E) Do not need to assess their communities' needs because they are obvious
A, C, D The international community or global community encompasses all nations. Although the overall composition of the communities that make up this global community may differ, some have strikingly similar characteristics, with shared interests and goals, including members' health and safety. To continue to advance the goals of health and safety, there must be a thorough way of understanding each of the communities described, especially if nurses are to accurately target ways to address goals for change. The first step in any plan to help a community is to assess the community's needs. The amorphous nature of the community can create some challenges to the identification of its members and to the assessment of their immediate needs.
The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. To most accurately assess the community, the nurse should: A) Use a questionnaire written on a fifth-grade reading level B) Use multiple methods or perspectives C) Interview a subpopulation of each group represented D) Analyze census data
B Triangulation is the use of multiple methods or perspectives to collect and interpret data about some phenomenon for the purpose of constructing an accurate representation of reality. When trying to answer a question about a community, the nurse should consider the question from different perspectives.
Many in the community have developed cancer. The EPA has discovered a leak of biohazardous waste from a local factory that has leached into the water table. The area is decontaminated and cleaned. The community identifies the need for a local hospice for those with cancer who are dying. Area communities participate in the fund drive. This type of community effort may best be described as: A) Geopolitical community B) Epidemiologic model C) Community of solution D) Developmental model
C A community of solution is formed by an aggregate specifically to address health concerns within a particular area. Communities of solution are composed of persons not only from the area of need but also members of neighboring communities who have a vested interest in a challenge the community faces. These communities can form in response to a health threat, such as contaminated water or industrial air pollution. A geopolitical community is a group of people who live within identified boundaries and governing systems. An epidemiologic model is a process used to assess a community using data collected from descriptions and statistical relationships to evaluate the level of health and well-being within a community to address identified healthcare needs. A developmental model is a retrospective, historical analysis of system parameters such as the physical environment, education, safety and transportation, politics and government, health and social services, communication, economics, and recreation in a community.
The community health nurse learns that there are statistically high levels of obesity and elevated cholesterol in the community. In addition, the community has a disproportionately high number of fast food restaurants, compared with surrounding communities. Which would be the most appropriate next step, based on these data? A) Gather support in the community to ban fast foods B) Gather further information regarding trans fats C) Target education and support programs D) Create local exercise programs
C Information such as that gathered in the scenario above is best used to help target education and support programs that can help members of populations obtain the information they need to make health promotion decisions. In addition, it helps ensure access to reasonably inexpensive screening and follow-up. The other answers do not thoroughly address the root causes of high cholesterol and obesity.
The new community health nurse introduces herself to the local minister and attends various neighborhood meetings. The nurse learns about the ethics, values, and culture of the neighborhood. The community is vocal about the need for public safety and the care of the homeless, especially in the winter. Which is the best rationale for considering all of the influences in the neighborhood affecting their health and well-being? A) The information can be used to obtain funds to create shelters for the homeless B) A neighborhood watch may be created with police support C) The information will help to effectively assess the community D) It will help the nurse create a controlled clinical environment
C It is necessary to consider the history, demographics, ethnicity, and values and beliefs of the entire community because these factors can be used as part of a systems approach by teams to effectively assess a community. Although interventions such as a homeless shelter and a neighborhood watch may result from this study of the community, the primary purpose of the study is to inform the assessment of the community, which will in turn lead to appropriate interventions. The purpose of considering these influences is not to create a controlled clinical environment.
The community health nurse is responsible for the general health of the community on multiple levels. The nurse discovers an increase in the number of sick days used by children aged 7 to 11 years at the local elementary school in recent weeks. Research indicates that the families of asthmatic children tend to be less educated and less likely to comply with current treatment plans. Using the epidemiologic approach, the next step in the care plan should be to: A) Conduct a broad-based survey of all families with asthmatic children within several communities B) Determine trends that interfere with family problem-solving techniques C) Develop school-based education programs for both the children and their caregivers D) Submit a proposal to the town for neighborhood asthma clinics
C Principles of epidemiology are used throughout the development, planning, implementation, and evaluation phases of the community assessment process. Epidemiologic methods can help identify patterns of health and social inequity and determine trends in three ways: (1) by describing the disease or disability, (2) by determining relationships that can predict health or health disparities, and (3) by developing and testing interventions. By noting that families of asthmatic children tend to be less educated and less likely to comply with current treatment plans, you have already determined relationships that can predict the health disparity. Therefore, the next step would be to develop and test an intervention on the basis of these findings. The school-based education program is the only intervention listed that directly addresses the cause of the health disparity and that may be tested.
While completing a community assessment, the nurse notes that the computer companies in the community hire a disproportionate number of their employees from local suburban communities rather than the community in which the company is housed. To create an accurate assessment, the nurse should collect data on: A) All of the company's employees but count those living outside the community separately, as outliers B) Only the employees that live in the community, disregarding the others as statistically irrelevant C) All of the company's employees and include those living outside the community as part of the aggregate D) Only the employees that live in the community in your initial assessment; then collect data on the others as part of a separate assessment for the community in which they live.
C The group of people, or an aggregate as it is often called in the literature, consists of those who live within the boundary of the geopolitical community. However, these borders are really ambiguous. The aggregate could also include people who work within the community who do not necessarily live there, as well as those living close to community boundaries who visit the communities to purchase goods or use facilities for nonwork activities. Thus, the nurse should collect data on all of the company's employees and include those living outside the community as part of the aggregate.
The community health nurse works in a community recently devastated by a tornado. Many of the survivors are cared for in their homes. Care is needed for those who are ill, recovering, or in hospice. To provide the most holistic and effective care to the community, the nurse should: A) Refer the clients to an outreach center B) Consult with the hospice nurse and the social worker C) Provide care according to the physician's orders D) Collaborate with other health care workers and the clients
D Beyond interdisciplinary expert collaboration, another approach used in community assessment is the collaboration between experts and those with health concerns.
When the community collaborates in a plan to create services and education to enhance their health and well-being, the plan is most likely to: A) Create an environment that fosters change B) Have an increased rate of success C) Empower the community but diminish the rate of success D) Shift the focus from dependency to empowerment
D Collaborating with community members shifts the focus from dependency on experts to empowerment of all together working toward a goal. Using an assets model requires taking a different philosophic approach to the assessment process. Interaction with the community is the primary approach. Although this approach may also help create an environment that fosters change and leads to an increased rate of success, the most likely result is the focus shifting from dependency to empowerment. It is not likely that the approach would empower the community but diminish the rate of success.
Which type of assessment considers a configuration of behaviors that occur sequentially over time? A) Asset-based assessment B) Epidemiologic model C) Collaborative model D) Functional health pattern
D Functional health pattern (FHP) assessment may be used for individual, family, or community assessment. It involves a systematic and deliberate format and considers a configuration of behaviors that occur sequentially over time. Understanding community patterns provides insight into how groups respond to problems and take action. A key factor of the asset-based assessment model is building coalitions and active partnerships with the community during the assessment phase. Collaboration with community members shifts the focus from dependency on experts to empowerment of all, working together toward a goal. An epidemiologic model is a process used to assess a community using data collected from descriptions and statistical relationships to evaluate the level of health and well-being within a community and to address identified healthcare needs. A collaborative model of assessment involves nurses, social workers, and other public health experts working with each other and with community residents to assess the community in an interdisciplinary manner.
