Module 1 health promotions for advance practice nurses

o Emphasizing ideas of health equity that address social determinants of health and promote health across all stages of life o Replacing the traditional print publication with an interactive Web site as the main vehicle for dissemination o Maintaining a Web site that allows users to tailor information to their needs and explore evidence-based resources for implementation

Vision of healthy people 2020

· Chronic disease is among the most common, costly, and preventable of all health problems. · Chronic disease associated with unhealthy behaviors, such as unhealthy diets, caloric excess, inactivity, and obesity are the greatest public health problems in most countries of the world.

Why is health Promotion important?

Health belief model (HBM)

psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The constructs of this model are perceived susceptibility, perceived benefits, perceived barriers, cue to actions, and self-efficacy. Theory designed to exclusively predict health behaviors based on the constructs of perceived susceptibility, perceived severity, perceived benefits, perceived costs, cues to action, and self- efficacy

3. In 1910, which factors most significantly influenced the midwifery profession? Select all that apply. 1. Strict licensing requirements 2. Negative public perception 3. Dedicated funding for training 4. Poor maternal-child outcomes 5. Mandatory professional supervision

2, 4. This is correct. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. At that time, approximately 50% of all U.S. births were reportedly attended by midwives. However, especially with regard to perinatal health indicators, the national population's general health was poor. Unfavorable outcomes among both mothers and infants were attributed to midwives who, at that time, were largely unregulated and generally perceived as unprofessional. Poor maternal- child outcomes, negative perceptions of midwives, obstetricians' targeted efforts to take control of the birthing process, and a movement away from home births prompted major changes. Legislation was passed to tighten requirements related to licensing and supervision of midwives. One aim of the Sheppard-Towner Maternity and Infancy Act involved allotting funds to train public health nurses in midwifery; however, the bill lapsed in 1929.

1. Entry into which advanced practice nursing specialty will require a doctoral degree by 2022? 1. Clinical nurse specialist (CNS) 2. Certified registered nurse anesthetist (CRNA) 3. Nurse practitioner (NP) 4. Certified nurse-midwife (CNM)

2. This is correct. Beginning in 2022, the American Association of Nurse Anesthetists (AANA) will require a doctoral degree as a minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016).

3. Which type of grant proposal does the advanced practice nurse (APN) submit when completing a doctor of philosophy (PhD) residency? Select all that apply. 1. Practice 2. Business 3. Research 4. Leadership

3. This is correct. The advanced practice nurse (APN) will complete a research proposal when pursing a doctor of philosophy (PhD) degree.

7. Which of the following defines the current practice of the acute care nurse practitioner? 1. Unit-based versus practice-based assignment 2. Participation on a specialty care team 3. Geographical setting 4. Patient population

4. This is correct. Historically, the geographical setting defined the role of the acute care nurse practitioner (NP). However, the role of this nursing specialty is now defined by the patient population that is served. Acute care NPs may be practice based or unit based. The acute care NP may or may not participate as a member of a consultative team related to specialty care.

4. Which advanced practice nursing role is unique in that the practitioners view their role as comprising a combination of two distinct disciplines? 1. Nurse practitioner 2. Certified registered nurse anesthetist 3. Clinical nurse specialist 4. Certified nurse-midwife

4. This is correct. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery.

Levels of prevention: Tertiary

Implemented after a disease or condition is evident and are carried out to limiting further harm and disability. cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well.

The trans-theoretical model (TTM):

Individuals move through six stages of change; it is a process of change. These stages are: 1.Precontemplation: Not ready for change yet. 2.Contemplation: Getting ready for change 3. Preparation: Ready for change 4. Action: Changing 5. Maintenance: Action sustained for at least six months to prevent relapse. 6. Relapse Describes phases that people go through andmechanisms that people use when they adopt/modify/eliminate health behaviors

o Identify nationwide health improvement priorities o Increase public awareness and understanding of the determinants of health, disease, and disability, and the opportunities for progress o Provide measurable objectives and goals that are applicable at the national, state, and local levels o Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge o Identify critical research, evaluation, and data collection needs

Mission of healthy people 2020

Levels of prevention: Primordial

More along the lines of impacting the community Example: Truth.com with the aim at the community for no smoking.

8. The advanced practice nurse (APN) is experiencing burnout and recognizes the need for self-care. Which action should the APN avoid? 1. Work through stressful situations and then take a break. 2. Plan self-care as seriously as client care. 3. Determine who owns each problem. 4. Examine the quality of peer support.

1. This is correct. The advanced practice nurse (APN) should schedule breaks during stressful situations.

· CRNA war: Readily accepted by physicians · Limited number of nursing training programs and education programs · Florence Nightingale changed health care w/ hand washing · Psychiatric specialization in nursing was the first clinical specialization · The first midwives were lay persons preprofessional women, when they delivered babies instead of physicians · Primary Care - rapid industrialization and nurses carrying for the poverty-stricken immigrants

1800

· Rapid growth and development for APN · Extending the scope of nursing practice (Richardson, 1971) · ANA Congress o Described the NP and CNS Roles and attempted to define the expanding scope: Conflict due to nurses struggling o Continues to redefine the roles and purpose · Some nursing associates rejected the role of APN · State legislatures increasing recognized APN · 1974 Nurse Practitioner Faculty held the first meeting in Chapel Hill, NC and founded the National Organization of Nurse Practitioner Faculties (NONPF). · This has been a continuous battle for DEA registration Numbers and prescriptive authority

1970s Building credibility and defining practice:

7. The advanced practice nurse (APN) is working in a busy emergency room. Which action can the APN take to reduce role strain? 1. Own the problem and work through it. 2. Find a quiet place to retreat. 3. Focus on helping others. 4. Become more involved in the work environment.

2. This is correct. The advanced practice nurse (APN) should manage role strain by finding a quiet place to retreat.

What are leading health indicators and examples? How are the leading health indicators organized and what is addressed by these indicators?

26 Leading Health Indicators (LHIs), organized under 12 topic areas, address determinants of health that promote quality of life, healthy behaviors, and healthy development across all life stages. The LHIs provide a way to assess the health of the Nation for key areas, facilitate collaboration across diverse sectors, and motivate action at the national, State, and local events · Organized using a health determinants and health outcomes by life stages conceptual framework. · The LHIs, Health Determinants, and Health Disparities Recognizing that factors related to social and physical environments, multi-sector policies, individual behaviors, health services, and biology and genetics influence the ability of individuals and communities to make progress on these indicators, the LHIs will be examined using a health determinants perspective. Addressing determinants is key to improving health disparities and overall population health · The LHIs Across the Life Stages the LHIs will also be examined using a life stages perspective. This approach recognizes that specific disease outcomes, risk factors, and health determinants need to be addressed at various stages across the lifespan and highlights the importance of tailoring strategies to fit a particular age group.

1. Biomedical: absence of disease or disorder and focuses on biological factors. Ex. No diagnosis or HTN. 2. Behavioral: Product of behaviors and habits. Ex. Not smoking, exercise, and no alcohol consumption. 3. Socio-environmental: product of social, economic and environmental determinants that provide incentives and barriers to health. Ex. Financial stability, employment, and support from family and or friends.

Models of health:

o The process of enabling people to increase control, and to improve their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.

WHO

The evolution of APN and development of professional organizations:

· Advance practice nurse includes nurse anesthetist, nurse-midwife, and clinical nurse specialist. · Certified nurse midwifes are licensed and independent w/ prescription authority in all 50 states. · 50,000 CRNA · CNS legally able to prescribe medications and medical equipment/supplies, as well as order, perform, and interpret diagnostic test. · 1st NP program was created by Loretta Ford and Dr. Henry Silver, graduate program for pediatric nurses with health nursing experience and a BSN education.

4. For nurse practitioners (NPs), which issue represents a current barrier to autonomy? 1. Restrictions on reimbursement for services 2. Absence of state-based prescriptive authority 3. Limited ability to serve in acute care settings 4. Lack of authority to manage medical problems

1. This is correct. One barrier to autonomy for nurse practitioners (NPs) stems from restrictions on reimbursement for services. Among advanced practice nurses (APRNs), NPs comprise the largest group. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). NPs serve in primary and acute care settings. Assessment and management of patients related to medical and nursing problems is within the NP's scope of practice.

10. Which action should the advanced practice nurse (APN) avoid when attempting to resolve role strain? 1. Using alcohol to escape stress 2. Taking meditation breaks during a shift 3. Talking with coworkers 4. Voicing opinions at a staff meeting

1. This is correct. The advanced practice nurse (APN) should avoid the use of drugs and alcohol when trying to resolve role strain.

The beginning of modern nursing is traditionally considered to have begun with which event? 1. Establishment of the first school of nursing 2. Incorporation of midwifery by the lay healer 3. Establishment of the Frontier Nursing Service (FNS) 4. Creation of the American Association of Nurse-Midwives (AANM)

1. This is correct. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. The Frontier Nursing Service (FNS), which provided nurse-midwifery services, was established in 1925. In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of Nurse-Midwives (AANM).

4. Which activity does the advanced practice nurse (APN) complete when participating in a doctor of nursing practice (DNP) residency? 1. Participate in quality improvement 2. Present at research conferences 3. Pilot research projects for dissertation 4. Submit research grant proposals

1. This is correct. When completing a doctor of nursing practice (DNP) residency, the advanced practice nurse (APN) anticipates participation in quality improvement.

1. Which activity does the advanced practice nurse (APN) anticipate when completing a doctor of philosophy (PhD) research residency? 1. Literature review in nursing science 2. Participation in quality improvement 3. Presentation at practice conferences 4. Development of capstone with mentors

1. This is correct. When completing a doctor of philosophy (PhD) research residency, the advanced practice nurse (APN) anticipates completing a literature review in nursing science.

· High infant and mother mortality rates along with increase public concern o Nurse Midwives and Frontier Nursing Service (FNS) led to a significant decrease in morality rates o 1930's train public health nurses to deliver babies · War in Europe and Influenza outbreak - led to expansion of the role of the nurse o Rapid and immediate treatment on the battlefield o Critical shortages · 1910's physician began questioning the ability of nurses to administer anesthesia o Unsuccessful lawsuit to stop nurses from administering anesthesia o Did lead to nurse anesthetist can legally administer anesthesia but were to be subordinate to the medical profession o War was again expanded the need and role of the nurse anesthetists · 1930's AANA (American Association of Nurse Anesthetists · 1920's professional education of nurses: few universities and mostly diploma programs · 1930's depression changed the workforce: hospitals had to close their nursing schools and hire graduate nurse · 1930's Primary Care Nurse Practitioners FNS autonomy in care for patients in the Appalachian area following standing orders and treatments · 1930's Psychiatric Specialty continued to grow

1900-1930s

5. Which changes have contributed to the evolution of the present-day nurse practitioner (NP)'s role? Select all that apply. 1. Focus on delivering care to low-income patients 2. Development of retail patient care clinics 3. Increased access to Medicaid recipients 4. Inclusion of patients from suburban areas 5. Emphasis on serving uninsured immigrants

2, 4. This is correct. With expansion of services to include patients who seek care in urban and suburban outpatient settings, the nurse practitioner (NP)'s practice has expanded. An increase in the number of walk-in, retail, and urgent care clinics has also increased opportunities for patients to access NPs who serve as primary care providers.

6. Which consideration led to designation of the nurse practitioner (NP) rather than the clinical nurse specialist (CNS) as the advanced practice nurse (APN) who would deliver care related to psychiatric or mental health services? 1. Level of educational preparation 2. Eligibility for prescriptive authority 3. Ability to serve in community settings 4. Practice based on core competencies

2. This is correct. A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs has underscored the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to clinical nurse specialists (CNSs) and nurse practitioners (NPs) (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. Both the CNS and the NP may be prepared at either the master's or doctoral level. Likewise, both the CNS and the NP may practice in a community setting. Core competencies guide the practice of both the CNS and the NP.

3. An advanced practice nurse (APN) consistently identifies each client by the five rights upon every encounter. This behavior is an example of which of the following? 1. First-order change 2. Second-order change 3. Role-making 4. Subrole internalization

2. This is correct. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version.

10. Implementation of the anesthesia care team (ACT) model yielded which direct effect on anesthesia services? 1. Regulation of conditions related to reimbursable services 2. Mandatory direction of certified registered nurse anesthetists (CRNAs) by an anesthesiologist 3. Reduction in charges related to fraudulent anesthesia care 4. Increased accountability for physicians who employ CRNAs

2. This is correct. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Also in 1982, Medicare's introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists' accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs) (Shumway & Del Risco, 2000). Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care.

9. The doctor of nursing practice (DNP) degree was developed to support the achievement of which goal related to advanced practice nursing education? 1. Eliminating master's degree programs 2. Promoting excellence in clinical practice 3. Replacing doctor of philosophy programs 4. Emphasizing the generation of nursing research

2. This is correct. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). Whereas the PhD emphasizes research, the DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. Current legislative efforts related to nursing education do not include elimination of master's degree programs for advanced practice registered nurses (APRNs). Rather, current legislation exists to preserve existing master's degree programs designed to prepare APRNs.

4. Which action by the advanced practice nurse (APN) demonstrates role-making? 1. Practicing autonomy when working in a busy practice 2. Suggesting a change in treatment to the supervising physician 3. Changing a client's medication to a lower dosage 4. Teaching a client how to self-administer insulin

2. This is correct. This demonstrates role-making, which is bidirectional and interactive.

7. Differentiation between the role of the clinical nurse specialist (CNS) and the nurse practitioner (NP) is primarily based on which premise? 1. Designation as an advanced practice nurse 2. Diagnosis of patient health conditions 3. Nature of practice setting environments 4. Authority to prescribe medications

3. This is correct. A primary differentiation between the roles of clinical nurse specialist (CNS) and nurse practitioner (NP) centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. Both the CNS and the NP are designated as advanced practice nurses (APNs), educationally prepared to diagnose patient health alterations, and eligible to apply for prescriptive authority.

3. The relationship to which aspect of the function of the clinical nurse specialist (CNS) shows the greatest need for research? 1. Patient satisfaction 2. Care outcomes 3. Income generation 4. Role adaptability

3. This is correct. Additional research is needed to examine the relationship between utilization of the clinical nurse specialist (CNS) and income generation. Role adaptability is a central feature of the CNS. Research has identified a correlation between CNS-patient interaction and favorable patient care outcomes, as well as patient satisfaction.

2. Which action should the advanced practice nurse (APN) take to be successful in socialization? 1. Be better at multitasking. 2. Develop a rapport with colleagues. 3. Develop skills in empathic communication. 4. Practice sympathetic listening.

3. This is correct. Developing skill in empathic communication does lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other's situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other's response.

6. Which factor contributed to expansion of the role of the clinical nurse specialist (CNS) during the 1960s? 1. Increased numbers of practicing physicians 2. Tightening of female role definitions 3. Return of nurses from military conflict 4. Lack of medical specialization

3. This is correct. Expansion of the CNS role during the 1960s occurred in part because of the return of nurse veterans from the Vietnam War who sought to increase their knowledge and skills, and to work in advanced roles and nontraditional fields, such as anesthesia and trauma.

1. Nurses working in a Magnet facility have low staff turnover rates and report high job satisfaction, making others aspire to have the longevity in employment experienced by those at the Magnet facility. Which of the following reference groups is this an example of? 1. Evaluative 2. Normative 3. Comparison 4. Audience

3. This is correct. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group.

5. Which is the predominant route to certification for the advanced practice nurse (APN)? 1. Doctor of philosophy (PhD) 2. Doctor of nursing practice (DNP) 3. Master of science in nursing (MSN) 4. Bachelor of science in nursing (BSN)

3. This is correct. The master of science in nursing (MSN) degree continues to be the predominant route of certification for the advanced practice nurse (APN).

5. The advanced practice nurse (APN) is mentoring an APN student. The APN recognizes that the student is having a hard time adjusting to the new role. Which action should the mentor take? 1. Allow the student to work through the process. 2. Listen sympathetically to the student. 3. Refer the student to a colleague with similar experiences. 4. Treat each failure as a learning opportunity.

4. This is correct. The advanced practice nurse (APN) should treat each failure as a learning opportunity.

Which change represents the primary impetus for the end of the era of the female lay healer? 1. Perception of health promotion as an obligation 2. Development of a clinical nurse specialist position statement 3. Foundation of the American Association of Nurse-Midwives 4. Emergence of a medical establishment

4. This is correct. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. Whereas lay healers viewed their role as being a function of their community obligations, the emerging medical establishment viewed healing as a commodity. The era of the female lay healer began and ended in the 19th century. The American Association of Nurse-Midwives (AANM) was founded in 1928. The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA's position statement on the role of the CNS was issued in 1976.

What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? A. Associations with area hospitals B. Costs of ambulatory care C. Ease of access to care D. The ratio of providers to patients

ANS: C As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care, walk-in settings and the ability to be seen within 30 minutes, and care that is close to home. Associations with hospitals, costs of care, and the ratio of providers to patients were not part of these results.

What is the purpose of clinical research trials in the spectrum of translational research? a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior

ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the preclinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage.

What is a goal of the Healthy People initiative? a. To increase a patient's quality of life b. To create physical environments that promote proper health c. To achieve health equality by eliminating disparities d. To provide free health care to those unable to pay for care e. To promote healthy behaviors across all life stages

ANS: C Overarching goals of the Healthy People initiative are to increase quality and length of life, free of preventable disease, disability, injury, and premature death; to achieve health equality by eliminating disparities; to create social and physical environments that promote proper health; and to promote increased quality of life, healthy development, and healthy behaviors across all life stages, all goals consistent with the definition of wellness. Free health care is not a stated goal of the initiative.

· Serve a multi-dimensional role in health promotion. Now includes community engagement, patient counseling, clinical rehabilitation, and corporate and community wellness programs. This as well as technological advances increase chronic disease rate and budget pressures. · Helping pt to better manage their own health, and ultimately become less reliant on health care institutions. · Community offers resources social support and tool that enhance an individual's ability to live a healthy life. Reinforce structural inequalities w/in society, leaving marginalized individuals and groups in disadvantage positions.

Health care settings:

Theory

Supposition or system of ideas intended to explain something, especially on general principals independent of the thing to be explained. No right or wrong theory for health promotion. Theory should match the individual or community

o Health promotion: The process of enabling people to increase control over, and to improve their health. To reach out, a state complete physical, mental and social well-being, an individual or group must be able to id and to realize aspirations, to satisfy needs, and to change or cope with the environment. o Health is seen as a resource for everyday life, not the objective of living. o Health promotion is not just the responsibility of the health sector but goes beyond healthy lifestyle to well-being.

· Ottawa Charter of Health Promotion emerged in 1986 as predominant framework.

8. Certified nurse-midwives (CNMs) are most likely to practice in which setting? 1. Hospital organizations 2. Physician-owned practices 3. Nonprofit health agencies 4. Federal facilities

1. This is correct. Most certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013).

6. The advanced practice nurse (APN) is working with a colleague in a busy surgical center and becomes concerned with the colleague's change in behavior. Which sign indicates that the colleague might be experiencing burnout? 1. Empathic behavior 2. Short attention span 3. Sensitivity 4. Intolerance

4. This is correct. Intolerance is a sign of burnout, and should be treated appropriately.

6. Which doctoral degree may be inappropriate for the nurse educator who seeks a tenure track position in the university setting? 1. Doctor of medicine (MD) 2. Doctor of philosophy (PhD) 3. Educational doctorate (EdD) 4. Doctor of nursing practice (DNP)

4. This is correct. Most universities do not accept the doctor of nursing practice (DNP) for tenure track positions.

10. Among national nursing leaders, which argument serves as a basis for opposition to the requirement that advanced practice nurses (APNs) earn a doctor of nursing practice (DNP) degree? 1. Greater professionalization is needed among advanced practice nurses. 2. The number of graduate nursing programs should be limited. 3. Advanced practice nursing certification should not require a doctoral degree. 4. The need for care providers should be prioritized.

4. This is correct. National nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. National nursing leaders have neither sought to limit graduate nursing education programs for APRNs nor recommended that advanced practice nurses (APNs) be required to complete a doctor of philosophy (PhD) degree.

A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? a. Bonuses based on achievement of benchmarks b. Care coordination for chronic diseases c. Standards for minimum cash reserves d. Strict requirements for financial reporting

ANS: A A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality measures and expenditures. Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial reporting.

· There is a strong positive intention to perform the behavior. · Absence of environmental barriers to prevent the behavior. · Consistency b/w the behavior and the person's self-image. · Person has more positive than negative reaction to performing the behavior. · The advantages of performing the behavior outweigh the disadvantages of performing or not performing the behavior. · Perceived self-efficacy to perform the behavior.

Common conditions necessary for health behavior change:

o Attain high quality, longer lives free of preventable disease, disability, injury, and premature death o Achieve health equity, eliminate disparities, and improve the health of all groups o Create social and physical environments that promote good health for all o Promote quality of life, healthy development, and healthy behaviors across all life stages

Goals of healthy people 2020

· Settings in which people live, love, work, learn and play helps us to understand health behavior and implement appropriate health promotion interventions. As NP, we develop skills and broaden our knowledge to help us understand further health behavior, the level of care needed by individuals, and which health promotion interventions are adequate based on a settings approach. · Family: Role in determining health beliefs, practices, and how we cope with stress and illness. · School: Have potential for enormous impact. Most formative and impressionable years are spent in school setting. Both formal and informal learning takes place in the school setting, regarding nutrition, physical activity, sexual health behavior, and substance use. · Workplace: Technological innovations, globalization, mechanization of manual labor and increased controls on environmental workplace hazards, have changed the nature of workplace health promotion. Focus is increasingly moving to social aspects of health and mental health. Id the root causes affecting physical and mental health in the workplace and provide an equitable, safe and supportive working environments.

Health Promotion Setting:

· Holistic approach: Not just physical health, or the absence of disease, but also mental and social wellbeing. · Participation and interaction: Doing things with people rather than for them. Active participation and collaboration. Support people to take greater control over the condition. · Strengths and assets: Strong community leaders, existing programs and services, strong social support networks, or community institutions and events that bring people together. · Complementary strategies: Healthy public policy, creates supportive environments, strengthens community actions, develops personal skills and reorients health services. Health promotion programs using multiple strategies are more effective than those with a single strategy approach.

Key elements of health promotion:

· Approach to health that aims to improve the health of an entire human population. · Health status of a subset of the population, or to the level to which the population aspires. · Influence by physical, biological, behavioral, social, economic, and cultural · Effectiveness of these approaches is monitored through large-scale population health status survey.

Population health:

Levels of prevention: Primary

Prevents the disease or condition from occurring. measures that come before the onset of illness or injury and before the disease process begins. Examples include immunization and taking regular exercise to prevent health problems developing in the future.

Levels of prevention: Secondary

Screening asymptomatic individuals for disease to detect it early, and with early intervention achieve a better outcome than with later detection and treatment. For example, a Papanicolaou (Pap) smear is a form of secondary prevention aimed to diagnose cervical cancer in its subclinical state before progression.

· Pathogens, biological agents, dysregulation of mood, thoughts and or/ behavior, risk factors, and social determinants. · Pathogens: Bacteria, viral and microorganisms. · Biological agents: Bacteria, viruses, fungi, parasites and their toxins. Ex. Anthrax, botulism, and smallpox. · Dysregulation: Mood, thoughts, and or behavior are depression, anxiety, and bipolar disorder. · Risk factors: According to WHO any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Ex. Smoking, unsafe sex practice and unsafe water. · Social determinants: according to WHO conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping conditions of daily living.

What causes Illness:

Social cognitive theory (SCT)

explores how a person's goals, expectations and self-efficacy are shaped by the social context in which they live. Main conditions that affect health behavioral change are personal goals, positive outcomes, and self-efficacy or collective efficacy. How to encourage changes are to facilitate change by providing resources or tools and observational learning by role modeling the change, incentive motivation, and self-regulation. attempts to explains what underlies human behaviour, and how human behaviour change can be brought about.

5. In the 19th century, which factors led to the administration of anesthesia by nurses? Select all that apply. 1. Surgeon entitlement to collecting anesthesia fees 2. Collaborative practice between physician-anesthetists and nurses 3. Lack of recognition of anesthesiology as a medical specialty 4. Opposition to anesthesia administration by physicians 5. Formation of a national organization by nurse anesthetists

1, 3 This is correct. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon's entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific modality for treating health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931.

8. The National Council of State Boards of Nursing's Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation prompted gains related to which aspects of the role and function of the nurse practitioner (NP)? Select all that apply. 1. Legal authority 2. Reimbursement 3. Consumer recognition 4. Prescriptive privilege 5. Autonomy

1,2,4 This is correct. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care.

2. Which activity is completed for both a doctor of nursing practice (DNP) and doctor of philosophy (PhD) program? 1. Interprofessional education (IPE) collaborative experiences 2. Participation in full scope research 3. Presentation at practice conferences 4. Submission of research grant proposals

1. This is correct. Both the doctor of nursing practice (DNP) and doctor of philosophy (PhD) candidate will participate in interprofessional education (IPE) collaborative experiences.

9. The advanced practice nurse (APN) is working with a new nurse. Which action by the nurse does the APN interpret as the social integration phase of resocialization? 1. Working well with others in the profession 2. Mastering skills 3. Integrating values into work setting 4. Displaying competency in routine

1. This is correct. Working well in the profession is an example of the social integration phase of resocialization.

1. Which assessments of care providers are performed as part of the value-based purchasing (VBP) initiative? (Select all that apply.) A. Appraising costs per case of care for Medicare patients B. Assessing patients' satisfaction with hospital care C. Evaluating available evidence to guide clinical care guidelines D. Monitoring mortality rates of all patients with pneumonia E. Requiring advanced IT standards and minimum cash reserves

ANS: A, B, D Value-based purchasing looks at five domain areas of processes of care, including efficiency of care (cost per case), experience of care (patient satisfaction measures), and outcomes of care (mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of evidence-based practice. The requirements for IT standards and financial status are part of Accountable Care Organization standards.

Which assessment question would a health care provider ask when engaging in the previsit stage of the new model for primary care? (Select all that apply.) a. "Are you ready to discuss some of the community resources that are available?" b. "Are you experiencing any side effects from your newly prescribed medications?" c. "Do you anticipate any problems with adhering to your treatment plan?" d. "Are you ready to discuss the results of your laboratory tests?" e. "Do you have any questions about the lab tests that have been ordered for you?"

ANS: B, C, E The nursing responsibilities in the previsit stage include assessing the patient's tolerance of prescribed medications, understanding of existing treatment plan, and education about required lab testing. The primary care provider is responsible for screening lab data and discussing community resources during the actual visit.

1. Which statement made by a health care provider demonstrates the most appropriate understanding for the goal of a performance report? a. "This process allows me to critique the performance of the rest of the staff." b. "Most organizations require staff to undergo a performance evaluation yearly." c. "It is hard to be personally criticized but that's how we learn to change." d. "The comments should help me improve my management skills."

ANS: D The goal of the performance report is to provide guidance to staff in the areas of professional development, mentoring, and leadership development. A peer review is written by others who perform similar skills (peers). The remaining options may be true but do not provide evidence of understanding of the goal of this professional requirement.

· Empowerment: Wallerstein 3 conditions contribute to empowerment: 1. Social networks 2. Community participation 3. Community competence o Positive impact include increase levels of social support; enhanced coping capacities; increased life satisfaction; and, decreased susceptibility to illness. · Equitable access: Income determines living conditions such as safe housing, affordability of nutritious food, and greater control over stressful life circumstances, lower income individuals are more likely to die younger and suffer more illness than individuals with higher income regardless of age, sex, race, or place of residence. · Inclusion: People who are excluded do not have the opportunity to reach the health, social and economic benefits of full participation in communities and society. We strive to work with members of marginalized groups who face systemic barriers to good health to ensure that everyone has a voice in decisions that affect their health. · Respect: Respecting a diverse range of viewpoints, cultures and perspectives is an important prerequisite for building sustainable relationships, the basis for action to achieve shared healthcare goals.

Health Promotion Values:

· Help people who are healthy but engaging in health risk behaviors. o Health risk behaviors: Unhealthy behaviors you can change. (Lack of exercise, poor nutrition, tobacco use, and drinking to much alcohol). o Not simply an information campaign or providing education or opportunities. o We cannot expect people to adopt a healthier lifestyle just because they have been exposed to a health care program. o Cannot force people to partake in physical activity just because we feel it is good for them.

Health promotion programs

· Set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States. · Released by US department of health and Human Services each decade · Setting objectives and providing science-based benchmarks to track and monitor progress can motivate and focus action · Measure progress for health issues in specific populations, and serves as 1. Foundation for prevention and wellness activities across various sectors and within the federal government 2. Model for measurement at the state and local levels.

Healthy people 2020

Social ecological model (SEM):

It is derived from social ecology. It believes that people cannot act in isolation and that we are influenced by our beliefs and society (internal and external factors). It is multi factorial and has five levels. 1. Intrapersonal level 2. Interpersonal level 3. Organization 4. Community 5. Policy

· The Position Statement on the Practice Doctorate in Nursing was endorsed by the members of the AACN in October of 2004which recommends the advancement of graduate level nurses to the doctoral level versus the current master's level by 2015. · Nurse practitioners continue to fight for prescriptive authority in many states · The role and scope of the nurse practitioner is ever‐ changing and continues to evolve

The Future of the NP role:

· The consensus model, published in 2008, is a regulatory model used in an attempt to standardize curriculum for nurse practitioner programs nationwide · Four roles of advanced practice registered nurses (APRNs) were defined in the model, including: CNMs, CRNAs, CNSs, and certified nurse practitioners (CNPs) · An APRN is defined in the consensus model as "an RN who has completed a graduate degree or postgraduate program that has prepared him or her to practice in one of these four roles" · LACE is an acronym within the consensus model that stands for "licensure, accreditation, certification, and education" · According to the NCSBN APRN advisory committee, 15 states were in full compliance with the LACE model and all others were in some stage of change by December of 2016.

The consensus Model:

· Educational, Organizational, procedural, environmental, social and financial support that help individual groups and negative behaviors promote positive change. Develop a way to target the root causes of health and wellness

What is health Promotion:

· American Nurses Association (ANA) defines Nursing Practice: Virginia Henderson o The practice of professional nursing means the performance for compensation of any act in the observation, care and counsel of the ill ... or in the maintenance of health or prevention of illness ... or the administration of medications and treatments as prescribed by a licensed physician .... The foregoing shall not be deemed to include acts of diagnosis or prescription of therapeutic or corrective measures (ANA, 1955, p. 1474) · CNS - 1960's redefining and higher education · NPs - 1960's modeled from 1930 FNS to 1960's first formal description and implementation in outpatient clinics; plus, the public demanded accessible, and sensitive health care, while health care delivery costs were increasing at annual rate from 10% ‐ 40%.

continued evolution

· War - nurses activated and deployed to the Persian Gulf · ANA wrote Agenda for Health Care Reform (1992) · Individual State regulations · Increasing numbers of APN · APN could never agree · New roles and specialties

1990s

9. Which function of the certified registered nurse anesthetist (CRNA) is prohibited in certain states? 1. Induction of general anesthesia 2. Pain management procedures 3. Administration of spinal anesthesia 4. Provision of post-anesthesia care

2. This is correct. Pain management procedures, such as epidural steroid injections, are regulated at the state level; therefore, not all certified registered nurse anesthetists (CRNAs) are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). All 50 states and the District of Columbia authorize CRNAs to provide induction of general anesthesia, administration of spinal anesthetics, and delivery of post-anesthesia care (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995).

2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology

4. This is correct. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Per the Consensus Model, the population focus of adult nurse practitioners (NPs) has shifted to adult gerontology. As opposed to emphasizing state-based regulation of advanced practice nursing, broad goals of the Consensus Model include developing more consistent standards for advanced practice nurses (APNs) that promote eligibility for interstate licensure reciprocity. Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. The Consensus Model describes the practice of clinical nurse specialists (CNSs) as including both acute and primary care settings.