Population: Exam 1

Public Health Foundations and Population Health: Population-focused nursing practice is different from clinical nursing care delivered in the community. If one accepts that the specialist in public health nursing is population-focused and has a unique body of knowledge, it is useful to debate where and how public health nursing specialists practice. A. Which nurses in the following categories practice population-focused nursing and provide reasons for your choice. 1. School nurse 2. Staff nurse in home care 3. Director of nursing for a home care agency 4. Nurse practitioner in a health maintenance organization 5. Vice president of nursing in a hospital 6. Staff nurse in a public health clinic or community health center 7. Director of nursing in a health department

- 3 and 7 are population-focused, looking at the needs of their subpopulation and planning programs to meet their needs. - 1, 2, 4, and 5 are likely to be practicing community health nursing if their focus is health protection, health promotion, and disease prevention of the individuals/families in their subpopulations. - 2 and 4 are more likely to be practicing community-based nursing, caring for clients who are ill.

Application of Ethics in the Community: The retiring director of the division of primary care in a state department had recently hired Ann Green, a 34-year-old nurse with a master's degree in public health, to be director of the division. Ms. Green's work involved the monitoring of millions of dollars of state and federal money as well as the supervising of funded programs within her division. Ms. Green received many requests for funding from a particular state agency that served a poor, large district. The poor people of the district primarily consisted of young families with children and homebound older adults with chronic illnesses. Over the past 3 years the federal government had allocated considerable money to the state agency to subsidize pediatric primary care programs, but no formal evaluation of these programs had occurred. The director of the state agency was a physician who had been in this position for over 20 years. He was good at obtaining funding for primary care needs in his district, but the statistics related to the pediatric primary care program seemed implausible--that is, few physical examinations were performed on the children, which had resulted in extra money in the budget. This unspent federal money was being used to supplement home health care services for the indigent homebound older adults in his district. The thinking of the physician was that he was doing good by providing some needed services to both indigent groups in his district. Ms. Green felt moral discomfort because she did not have either the money or the personnel to provide both services. What should she do? C. How can Ms. Green resolve the issues?

1. Ann developed new policies for allocation of funds. For any agency within the state to receive funding from the Division of Primary Care, the agency had to follow the new policies. 2. Ann also initiated a task force to develop specific procedures for the policies she developed. The procedures and their implementation were reviewed by the task force monthly. Representatives from the federal government and all the state-funded primary care programs comprised the task force. The task force became a safety net for anyone misappropriating federal funds, thus ensuring accountability. 3. Periodic unannounced site visits to all agencies within the state were made by peer administrators from the 20 districts in the state health department. 4. Regarding the pediatric primary care program in his district, the director for the state agency would receive funds only if he submitted specified monthly reports to Ann about the pediatric program's performance. 5. The director for the state agency and his staff were given help regarding how to interpret the policies and follow the procedures. 6. As a result of Ann's initiatives, the director for the state agency followed the new guidelines, which ensured that the pediatric primary care program received all of the money the program was due. In addition, he sought new funding to assist the indigent homebound elderly persons with chronic illnesses in his district.

Application of Ethics in the Community: A community-oriented nurse using the principles for effective advocacy would do which of the following? a. Share data on a caseload medically indigent with philanthropic organizations. b. Follow the clients' wishes and directions tenaciously in all related activities. c. Monitor spending allocated by the state or local authorities for proper disbursement. d. Use the opinions and ideas of key community leaders first to drive policy creation and program development.

b. Follow the clients' wishes and directions tenaciously in all related activities. The six principles of effective advocacy include acting in the client's best interests; acting in accordance with the client's wishes and instructions; keeping the client properly informed; carrying out instructions with diligence and competence; acting impartially and offering frank, independent advice; and maintaining client confidentiality. Following a client's wishes tenaciously fits the description of these principles.

Health Equity and Care of Vulnerable Populations: A community-oriented nurse wants to begin a program to reduce health inequality. What action by the nurse would be most successful? a. Conduct research on the prominent causes of inequity within the community. b. Gather a group of acute and community health care providers to brainstorm solutions. c. Invite a cross section of health professionals and lay people to join the action team. d. Use a successful model and divide the tasks among volunteers in the community.

b. Gather a group of acute and community health care providers to brainstorm solutions. A cross-sectoral approach would be the best way to work on this problem. This means that nurses and other health professionals must partner with stakeholders outside of traditional public health and health care delivery systems to design multi-level solutions for improving health. Effective cross-sectoral work is collaborative. When diverse people and organizations collaborate, they work together in inter-connected ways to achieve a common goal.

Health Equity and Care of Vulnerable Populations: 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. No difference in access or outcomes d. Worse health outcomes despite access

b. Greater likelihood of exposure to risk factors d. Worse health outcomes despite access 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.

Application of Ethics in the Community: The community-oriented nurse who uses the principle of justice would demonstrate that ethical principle best when doing which of the following? a. Learns disaster triage and volunteers for service during local catastrophes. b. Has a permanent "navigation booth" to help people learn how to contact elected officials. c. Takes continuing education on emerging trends in health care such as pharmacogenomics. d. Takes the lead on a committee reviewing and revising nursing home standards.

b. Has a permanent "navigation booth" to help people learn how to contact elected officials. Distributive or social justice refers to the allocation of benefits and burdens to members of society. Benefit refers to basic needs, including material and social goods, liberties, rights, and entitlements. By helping citizens learn to advocate for themselves, they can help force more equal distribution of benefit, including health care, to society. This option also allows the nurse to have an impact on a larger number of community members than the other options do.

Health Equity and Care of Vulnerable Populations: The population group that is likely to be the most vulnerable is which of the following? a. Children with a family history of sickle cell disease b. Homeless pregnant teens in a substance abuse program c. Native Americans at risk for diabetes d. Overweight children

b. Homeless pregnant teens in a substance abuse program Populations most vulnerable to risk include poor or homeless persons, pregnant adolescents, migrant workers, severely mentally ill individuals, substance abusers, abused individuals, people with communicable diseases, and people with sexually transmitted diseases.

Program Management: When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. What action would be the nurse's initial and most critical step for funding purposes? a. Finding the lay leaders in the community b. Identifying the target population's health problems and needs c. Outlining the major causes of mortality in the community d. Prioritizing the community's problems

b. Identifying the target population's health problems and needs Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

History of Public Health and Public and Community Health Nursing: What was one of Mary Breckenridge's innovative contributions to health care in the United States? a. Establishing the Federal Emergency Relief Administration b. Introducing the first nurse-midwifery training c. Introducing the nursing process d. Establishing occupational health nursing

b. Introducing the first nurse-midwifery training Mary Breckenridge established the Frontier Nursing Service (FNS) in 1925 to provide health programs to rural Appalachia and she introduced the first nurse-midwife training to the United States.

Achieving Cultural Competence in Community Health Nursing: A new group of migrant farmworkers has arrived in a community. What action by the public health nurse is most important prior to scheduling clinic services? a. Consult the public health staff regarding their schedule for large open time blocks. b. Learn about the farmworkers' concept of time and their work schedule. 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. 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. Services should also be available when work allows; it is of no benefit to schedule services when the workers cannot leave their jobs.

Public Health, Primary Care, and Primary Health Care Systems: The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is which of the following? a. Department of Homeland Security b. U.S. Department of Health and Human Services c. Local Health Department d. State Department of Health

b. U.S. Department of Health and Human Services The U.S. Department of Health and Human Services (USDHHS) is the agency most heavily involved with the health and welfare concerns of U.S. citizens. The USDHHS is charged with regulating health care and overseeing the health status of Americans.

Promoting Healthy Communication: Because nurses work in partnership with the community in Healthy Communities, the examples of outcomes of EC initiatives reflect that partnership rather than a specific nursing interventions. An example of an outcome of a HC initiative that used the Community Health Promotion process is Fort Wayne, Indiana, Healthy City. Committee members of the Fort Wayne, Indiana, Healthy City project collaborated in a community-wide program to address the fact that only 65% of Fort Wayne preschool children were immunized. Access to immunization services was expanded to five sites throughout the city at three different times in a program called Super-Shot Saturday. A nurse, along with other members of the Fort Wayne, Indiana, HC committee, would be using which of the following principles of health promotion to provide access to immunizations for preschool programs? A. Promoting healthy public policy B. Creating supportive environments C. Strengthening community action D. Reorienting health services E. Improving personal skills

B. Creating supportive environments C. Strengthening community action D. Reorienting health services These examples pertain to local communities and rely on participation, cooperation, equity, and the use of technology.

Community As Client- Assessment and Analysis: Lily, a nurse in a small city, became aware of the increased incidence of respiratory diseases through contact with families in the community and the local chapter of the American Lung Associations. During family visits, Lily noticed that many of the parents were smokers. Because most of the families Lily visited had small children, she became concerned about the effects of secondhand smoke on the health of the infants and children in her family caseload. Further assessment of this community indicated that the community recognized several problems, including school safety and the risk of water pollution, in addition to the smoking problem that Lily had identified during her family visits. Talks with different community members revealed that they wanted each of these identified problems "fixed," although these same community members were uncertain about how to start. In deciding which of the three identified problems to address first, which criterion would be most important for Lily to consider? A. The amount of money available B. The level of community motivation to "fix" one of the three identified problems C. The number of people in the community who expressed a concern about each of the three identified problems D. How much control she would have in the process

B. The level of community motivation to "fix" one of the three identified problems high level of community motivation is critical for any community-focused intervention and will help ensure active community involvement in the planning process and commitment to the intervention itself.

Health Equity and Care of Vulnerable Populations: 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 health status can be related to: a. barriers to access. b. chronic stress. c. cumulative risk. d. socially based inequity.

b. chronic stress. 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.

Achieving Cultural Competence in Community Health Nursing: A nurse is conducting a diabetes self-management group-education session for recent immigrants. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. What action by the nurse is best? a. Clarify that no one has to remove his or her shoes and continue the education. b. Explain that everyone must learn to do foot inspection to manage their diabetes. c. 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 and continue the education. The nurse should become familiar with cultural norms prior to providing education, but in this case he or she didn't. The nurse should allow people to keep their shoes on and continue the presentation without drawing attention to and potentially embarrassing the two men. After the presentation is over, the nurse should research the men's culture.

Public Health Foundations and Population Health: 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. This can best be described as an example of which type of care? 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.

Achieving Cultural Competence in Community Health Nursing: The nurse is educating an immigrant 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 which of the following? a. Cultural accommodation b. Cultural brokering c. Cultural preservation d. Cultural repatterning

a. Cultural accommodation Cultural accommodation means that the nurse assists, supports, facilitates, or enables clients in their use of cultural practices to achieve satisfying health care outcomes when such practices are not harmful to clients.

History of Public Health and Public and Community Health Nursing: During the Depression, which of the following created a negative effect on public health nursing? 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 requirements for public health. 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.

Application of Ethics in the Community: The community-oriented nurse best exemplifies the application of feminist ethics when the nurse does which of the following? a. Design health care programs that incorporate social justice, respect and equity, and address social and political power. b. Design health care programs for women that respect their dignity and autonomy. c. Ensure that male providers do not use sexist terms with clients, families, and coworkers d. Participate in political action that focuses on women's rights and status in the community.

a. Design health care programs that incorporate social justice, respect and equity, and address social and political power. Feminine ethics not only focuses on equity between genders, but also recognizes the social and political powers that help maintain a socially unjust system. The best way to apply feminist ethics for this nurse is to design programs that focus on equity, respect, and social justice and attempt to address the social and political forces.

Health Equity and Care of Vulnerable Populations: A nurse in a nurse-managed health center providing a tertiary prevention intervention to a population of women who are HIV positive will most likely do which of the following? 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.

Application of Ethics in the Community: One step in the ethical decision-making framework is to place an ethical issue within a meaningful context. What is the rationale for this step? a. Multiple factors affect the formulation and justification of ethical issues and dilemmas. b. The nature of ethical issues and dilemmas determine the specific ethical approach used. c. People cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. Professionals cannot avoid choice and action in applied ethics.

a. Multiple factors affect the formulation and justification of ethical issues and dilemmas. Ethical decision-making frameworks use problem-solving processes and provide guides for making sound ethical decisions that can be morally justified. To make these decisions, a person must be able to articulate the ethical issue or dilemma.

Public Health, Primary Care, and Primary Health Care Systems: Primary health care (PHC) differs from primary care in which of the following ways? a. PHC encourages community participation. b. PHC focuses on prevention and cure. c. PHC is defined more narrowly. d. PHC is the primary method of health care delivery in the United States.

a. PHC encourages community participation. The definition of PHC is broad, incorporating a comprehensive range of services including public health, prevention, and diagnostic, therapeutic, and rehabilitative services. PHC is the mainstay of the public health system in the United States, with a main focus on prevention instead of cure. Although endorsed by the United States as a strategy for achieving the goal of health for all in the twenty-first century, it is not the chief means of delivery of health care in the United States.

Public Health, Primary Care, and Primary Health Care Systems: The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand include which of the following? (Select all that apply.) a. Transforms the health care system from a sick care system to health care system. b. Uses piecemeal approach to strengthen the safety net. c. Replaces the rational equitable health care system. d. Provides insurance reform. e. Increases access to affordable health care insurance.

a. Transforms the health care system from a sick care system to health care system. d. Provides insurance reform. e. Increases access to affordable health care insurance. The Affordable Health Care for America Act of 2010 requires most Americans to have health insurance coverage, expands Medicaid, subsidizes private coverage for low- and middle-income people, transforms the current system from a sick care system to a true health care system, lowers mortality related to preventable causes, institutes health insurance reform, increases access to affordable health care coverage, and increases support for nursing workforce development programs.

Health Equity and Care of Vulnerable Populations: 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.

Achieving Cultural Competence in Community Health Nursing: 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. Often these beliefs and values are also not approved in the nurse's culture.

Public Health, Primary Care, and Primary Health Care Systems: A factor that strongly influences the success of a PHC system is: a. participation of the community members in the design, implementation, and evaluation of the initiative. b. assurance of access to care for every woman and child from pregnancy through childhood. c. each entity's sense of urgency regarding the evaluation of indicators. d. cure orientation of the private sector of health care delivery in the United States.

a. participation of the community members in the design, implementation, and evaluation of the initiative. PHC, the focus of the public health system in the United States, is defined as the broad range of services including but not limited to, basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education. It consists of programs designed to be affordable for the recipients of the care and the governments that provide them. The emphasis is on prevention, and the means of providing the care are based on practical, scientifically sound, culturally appropriate, and socially acceptable methods provided at the community level, accessible and acceptable to the community and inviting of community participation.

Promoting Healthy Communication: The HCC model process relies on a problem-solving approach to achieve goals. The best example of this approach is which of the following? a. Community activists lobbying their state legislature to mandate increased primary care access b. Community-oriented nurses using the nine-step Community Health Promotion Model (CHPM) to encourage and empower community members to take responsibility for change c. Health care professionals working independently to determine priorities for their community and then educating their community about these health-promotion needs d. Teachers using health-promotion curricula to reduce teenage smoking in their community

b. Community-oriented nurses using the nine-step Community Health Promotion Model (CHPM) to encourage and empower community members to take responsibility for change The goal of the CHPM is to encourage community members to take responsibility for the changes they wish to see happen. The model focuses on community involvement in every step of the process. Health care providers can best act as facilitators, educators, and promoters of the model, not "experts" who dictate solutions to the community.

Application of Ethics in the Community: A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Autonomy of the professional b. Confidentiality, when possible c. Funding d. Advocacy for disenfranchised persons e. Respect of only community rights

b. Confidentiality, when possible d. Advocacy for disenfranchised persons The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; maintaining trustworthiness; and advocating for disenfranchised persons within the community.

Public Health Foundations and Population Health: Nurses 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. Which is an example of such opportunity? a. Operator of a nurse practitioner-run urgent care center in a major retail location b. Director of clinical services providing a wide range of services to 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 providing a wide range of services to 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.

History of Public Health and Public and Community Health Nursing: 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 of Title VI of the Social Security Act (1935) related to public health nursing was funding which of the following? a. The Frontier Nursing Service b. Employment and education of nurses c. Research and investigation of disease d. The district nursing model

b. Employment and education of nurses 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, but this did not have the far reaching results as the increase in public health nurses.

Public Health Foundations and Population Health: 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. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes e. Prevalence of hypertension among various age, race, and gender groups 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.

History of Public Health and Public and Community Health Nursing: The most important contribution made by Florence Nightingale to community-oriented nursing was which of the following? a. Developing the settlement house concept to improve urban health standards b. Expanding the role of nursing to include health-promotion practices c. Founding the first district nursing association in England d. Introducing professional schools of nursing in the United States

b. Expanding 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.

Program Management: A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? a. Community forum b. Focus group c. Indicators approach d. Survey

b. Focus group There are several types of needs assessment tools, including community forums, focus groups, key informants, indicators approach, survey of existing agencies, and general surveys. Both community forums and focus groups are low-cost tools. The focus group provides clients with the opportunity to participate in identification of needs and can help increase community support for a program.

Program Management: The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: a. cost-benefit analysis. b. cost-effectiveness analysis. c. cost-efficiency analysis. d. Multi-Attribute Utility Technique.

b. cost-effectiveness analysis. An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).

Promoting Healthy Communication: The nurse knows the Ottawa Charter identified the most effective health-promotion action as: a. creating supportive environments. b. developing health-promoting public policy. c. reorienting health services. d. strengthening community action.

b. developing health-promoting public policy. The Ottawa Charter for Health Promotion (World Health Organization, 1986) lays the foundation for the HCC movement definition of health promotion. In order of priority, the Ottawa Charter identifies developing health-promoting public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services as the key strategic health-promotion action for achieving health for all. Health-promoting public policy supports health in a broad ecological sense that includes environmental, physical, social, and mental well-being. Although efforts to change individual behavior are important, the contributions of policies that affect the broader environment are thought to be more effective in achieving social change. Good examples of such impacts are statewide seat belt laws, helmet laws, and local nonsmoking ordinances.

History of Public Health and Public and Community Health Nursing: The Association of Community Health Nurse Educators has called for increased graduate programs to educate Public Health Nursing 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.

Achieving Cultural Competence in Community Health Nursing: A community-based hospice nurse has an Asian client with terminal-stage cancer. The client complains of continuous pain and receives no relief from the prescribed opioid medication. The nurse contacts the client's provider to discuss replacing this medication with another pain-reducing drug. What is this action 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.

Public Health, Primary Care, and Primary Health Care Systems: A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include which of the following? a. Administration of Medicare reimbursement rates and eligibility determination b. Programs involving the local community, including sanitation and communicable disease contact tracing c. Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes d. Monitoring drugs and over-the-counter products available for sale and use by consumers.

c. Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes The public health system at the state level is responsible for standing ready to prevent or respond to disasters, both human caused and natural; overseeing health care financing and the administration of programs such as Medicaid and the State Children's Health Insurance Program; providing mental health and professional education; establishing health codes; licensing facilities and personnel; regulating the insurance industry; and providing direct assistance to local health departments, such as ongoing health needs assessment.

Application of Ethics in the Community: A nurse takes a new position as a community health nurse. Her first assignment is to perform an assessment of the community's migrant farmworker population. What is the most appropriate step for the nurse to take first? a. Begin the community assessment using a survey tool proven effective in previous assessments. b. Perform a literature review to study assessment data for similar populations. c. Enroll in a college course to learn community research, measurement, and analysis techniques. d. Form a relationship with the farmworkers' community leaders and other key informants.

c. Enroll in a college course to learn community research, measurement, and analysis techniques. Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population.

Achieving Cultural Competence in Community Health Nursing: 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 is integrating client care with knowledge of which cultural organizing factor? a. Biological variations b. Communication c. Environmental control d. Space

c. Environmental control Environmental control refers to a person's relationships with nature and efforts to plan and direct factors in the environment that affect them. Persons who value harmony with the environment (e.g., African Americans, Asians, and American Indian/Alaskan Natives) may not adhere to protocols, believing illness is in disharmony with nature, and would look to the mind, body, and spirit connection, for healing comes from within.

Program Management: In addition to ensuring that available resources are used to meet the needs of the population, what is another advantage of community health program planning? a. Ability to applying for grants b. Identifying clients and soliciting board members' support c. Identifying resources, activities, and needs d. Decreasing the visibility of the program

c. Identifying resources, activities, and needs Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results.

Promoting Healthy Communication: Which is an example of tertiary prevention related to HCC? a. Assessing the need for programs to treat alcohol addiction b. Assessing the strengths of local schools' adolescent pregnancy prevention programs c. Initiating an evaluation of a program to address endemic hepatitis A in a community d. Organizing a community forum to explore health-promotion priorities

c. Initiating an evaluation of a program to address endemic hepatitis A in a community Tertiary prevention includes initiation of community action when problems have occurred, and evaluation of progress and effectiveness of programs and policies.

History of Public Health and Public and Community Health Nursing: Categorical Congressional funding has had which effect on health care? a. Positive by adoption of 2-year associate degree nursing programs b. Negative leading to exclusion of home-based care from health insurance coverage c. Negative as the national preference service model neglects emerging problems d. Positive due to the sharp rise in hospital-based care and technological resources

c. Negative as the national preference service model 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.

Health Equity and Care of Vulnerable Populations: Ms. Green, a 46-year-old farm worker pregnant with her fifth child, has come to the clinic requesting treatment for swollen ankles. During your assessment, you learned that she had seen the nurse practitioner at the local health department two months ago The nurse practitioner gave her some sample vitamins, but Ms. Green lost them. She has not received regular prenatal care and has no plans to do so. Her previous pregnancies were essentially normal, although she said she was "toxic" with her las child. She said that her middle child was "not quite right." He is in the 7th grade at age 15. Ms. Green is 5'2", weighs 180 lbs, and has a BP of 160/90. She has pitting edema of the ankles and a mild HA. Ms. Green says that she usually takes chlorpromazine hydrochloride (Thorazine) but has run out of it and can't afford to have her prescription refilled. She says that she has been in several mental hospitals in the past and that she has been more agitated lately, and now has problems managing her daily activities. As her agitation grows, she says that she usually hears voices and this makes her aggressive. None of her children lives with her, and she has no plans for taking care of the infant. She thinks she will ask the child's father, a race track worker, to help her, because she usually travels around the country with him. A. What additional information do you need to help you adequately assess Ms. Green's health status and current needs?

After obtaining as much health history as possible by talking to Ms. Green and reviewing any past medical records, the nurse should learn as much as she can about Ms. Green's cultural practices and values. Learn about her priorities—such as legal or financial problems. She may need help with these issues before she can focus on her medical needs. The nurse should try to obtain information about Ms. Green's living environment and she should assess for any signs of physical or substance abuse.

Application of Ethics in the Community: The retiring director of the division of primary care in a state department had recently hired Ann Green, a 34-year-old nurse with a master's degree in public health, to be director of the division. Ms. Green's work involved the monitoring of millions of dollars of state and federal money as well as the supervising of funded programs within her division. Ms. Green received many requests for funding from a particular state agency that served a poor, large district. The poor people of the district primarily consisted of young families with children and homebound older adults with chronic illnesses. Over the past 3 years the federal government had allocated considerable money to the state agency to subsidize pediatric primary care programs, but no formal evaluation of these programs had occurred. The director of the state agency was a physician who had been in this position for over 20 years. He was good at obtaining funding for primary care needs in his district, but the statistics related to the pediatric primary care program seemed implausible--that is, few physical examinations were performed on the children, which had resulted in extra money in the budget. This unspent federal money was being used to supplement home health care services for the indigent homebound older adults in his district. The thinking of the physician was that he was doing good by providing some needed services to both indigent groups in his district. Ms. Green felt moral discomfort because she did not have either the money or the personnel to provide both services. What should she do? A. What facts are the most relevant in this scenario?

1. Ann's job entailed the monitoring of federal money and the supervising of funded programs within her division. 2. The federal government had allocated considerable money to the state agency to subsidize pediatric primary care programs. 3. The pediatric primary care programs had never received a formal evaluation. 4. The director of the state agency was using considerable federal money targeted for the pediatric primary care program in his district to supplement home health care services for indigent homebound elderly persons.

Achieving Cultural Competence in Community Health Nursing: Mr. Nguyen, a 64-year-old man from rural Vietnam, entered the US with his family three years ago through the refugee program. Mr. Nguyen was a farmer in his homeland, and since his arrival he has been unable to obtain a stable job that would allow him to adequately care for his family. His financial resources are limited, and he has no insurance. He speaks enough English to interact directly with people outside his family and community. His oldest daughter, Aeyoung, is enrolled in a 2-year program to become a registered nurse. The Nguyen family attends the neighborhood church with other Vietnamese families. Mr. Nguyen has been attending the clinic at the hospital but refuses to discuss with his family, even with Aeyoung, the reason for these visits. Aeyoung became increasingly concerned as she observed her father to have insomnia, retarded motor activity, an inability to concentrate, and weight loss. However, Mr Nguyen denied that he was not well. Aeyoung decided to discuss her concerns with a nurse, with whom she had developed an attachment, at the church. She invited the nurse to her home for lunch on a Saturday so she could meet her father and validate her impressions. After several visits with the family, the nurse was able to establish a close enough relationship with Mr. Nguyen so that she could engage him in a discussion in his health. Because of her extensive work with other Vietnamese immigrants, the nurse was familiar with themes of loss and decided to focus her conversation with Mr. Nguyen on his adjustment to his new community living, gains and losses as a result of immigration, and coping strategies. After several discussions, Mr. Nguyen confided in the nurse that he feared that he was dying because he had been diagnosed with cancer of the small intestine. He further revealed because he did not want them to know of his "bad news." Mr. Nguyen had refused treatment because he know that people never get better when they have cancer; they always die. A. Which of the following actions best characterize the nurse's willingness to provide culturally competent care to Mr. Nguyen and his family? 1. Discuss with the client his understanding of his diagnosis. 2. Discuss with the client the prognosis for a person diagnosed with cancer of the small intestine in the US 3. Discuss with the client the prognosis for a person diagnosed with cancer of the small intestine in Vietnam. 4. Discuss the medical treatment and surgical intervention for cancer of the small intestine.

1. Discuss with the client his understanding of his diagnosis.

Application of Ethics in the Community: The retiring director of the division of primary care in a state department had recently hired Ann Green, a 34-year-old nurse with a master's degree in public health, to be director of the division. Ms. Green's work involved the monitoring of millions of dollars of state and federal money as well as the supervising of funded programs within her division. Ms. Green received many requests for funding from a particular state agency that served a poor, large district. The poor people of the district primarily consisted of young families with children and homebound older adults with chronic illnesses. Over the past 3 years the federal government had allocated considerable money to the state agency to subsidize pediatric primary care programs, but no formal evaluation of these programs had occurred. The director of the state agency was a physician who had been in this position for over 20 years. He was good at obtaining funding for primary care needs in his district, but the statistics related to the pediatric primary care program seemed implausible--that is, few physical examinations were performed on the children, which had resulted in extra money in the budget. This unspent federal money was being used to supplement home health care services for the indigent homebound older adults in his district. The thinking of the physician was that he was doing good by providing some needed services to both indigent groups in his district. Ms. Green felt moral discomfort because she did not have either the money or the personnel to provide both services. What should she do? B. What are the ethical issues?

1. The first ethical issue involved the inappropriate allocation of federal funds. 2. The second ethical issue involved a statewide lack of accountability regarding the use of federal funds. 3. The third ethical issue involved the conflict that occurs when two equally indigent populations need primary care services, but inadequate money is available to subsidize both.

History of Public Health and Public and Community Health Nursing: Mary Lipsky has worked for the county health department in a major urban area for almost 2 years. Her nursing responsibilities include a variety of services, including consultations at a senior center, maternal/newborn home visits, and well-child clinics. As she leaves work each evening and returns to her own home, she keeps thinking about her clients. Why is it so difficult today to qualify a new mother and baby to receive WIC nutrition services? Why must she limit the number of children screened for high lead levels, when last year the health department screened twice as many children? Several children last money last month seemed asymptomatic, but the laboratory found levels that were high enough to cause damage. One of the mothers Ms. Lipsky is acquainted with is having a difficult time emotionally. Why is it so difficult to find a behavioral health provider for her? And the health department still cannot find a new dentist! And families on welfare cannot find a private dentist to take care of their children. B. What information would you need to build an understanding of the policy background for each of these various populations?

A historical approach will build understanding of the public policy elements limiting care of various populations by exploring what attempts have been made in the past to innovate or reform services for these populations; determining what has limited these attempts; and identifying examples of programs or policies that have been successful.

Evidence-Based Practice: A nurse who is the director of public health clinic is in the process of analyzing how best to expand services to operate as a full-time clinic in the most cost-effective and clinically effective manner. The director gathers evidence from the literature on public health clinics in rural settings to evaluate cost and clinical effectiveness of various models. The nurse also considers evidence from the following sources in the decision-making process: client satisfaction research data, knowledge of clinic staff, expert opinion of community advisory board members, evidence from community partners, and data on service needs in the state. Having examined the evidence, the nurse decides that incremental (step-by-step) growth toward full-time status is warranted. Evidence of needs in the community and analysis of statistical data indicate that the addition of wellness services for children is a priority, and a pediatric nurse practitioner is hired as a first step to assist the public health nurses while planning for full-time status continues. A. Evaluation of the evidence gathered demonstrates which of the following? 1. Effectiveness of the intervention in communities 2. Application of the data to populations and communities 3. Existence of positive or negative health outcomes 4. Economic consequences of the intervention 5. Barriers to implementation of the interventions in communities

All of the answers are correct.

Population-Based Public Health Nursing Practice- The Intervention Wheel: Outreach locates populations of interest or populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Outreach activities may be directed at whole communities, at targeted populations within those communities, and/or at systems that impact the community's health. Outreach success is determined by the proportion of those considered at risk that receive the information and act on it. The chance of a 20 year old woman developing breast cancer within the next 10 years is 1 in 1681. At age 30, a woman's chance of developing breast cancer within the next 10 years is 1 in 225; at age 40, it is 1 in 69; at age 50, it is 1 in 44; at age 60, is is 1 in 29; and at age 70, it is 1 in 26. A health system decided to offer mammograms in recognition of National Breast Cancer Month. They sponsored a mobile mammography van at a large shopping mall every Saturday in October. The van offered mammograms to everyone, regardless of age. The health system advertised the service by placing windshield flyers on all the cars in the shopping mall parking lot. The van provided 180 mammograms, mostly to women in their 30s who had health insurance that covered preventative services. B. Did the mammograms in the parking lot reach population?

Although the mammograms provided in the van may have benefited some of the individuals who received them, public health nursing practice focuses on populations, not individuals. Outreach success is determined by the proportion of those considered at risk who receive the information and act on it. The mammograms in the parking lot did not reach the population most at risk.

Achieving Cultural Competence in Community Health Nursing: Mr. Nguyen, a 64-year-old man from rural Vietnam, entered the US with his family three years ago through the refugee program. Mr. Nguyen was a farmer in his homeland, and since his arrival he has been unable to obtain a stable job that would allow him to adequately care for his family. His financial resources are limited, and he has no insurance. He speaks enough English to interact directly with people outside his family and community. His oldest daughter, Aeyoung, is enrolled in a 2-year program to become a registered nurse. The Nguyen family attends the neighborhood church with other Vietnamese families. Mr. Nguyen has been attending the clinic at the hospital but refuses to discuss with his family, even with Aeyoung, the reason for these visits. Aeyoung became increasingly concerned as she observed her father to have insomnia, retarded motor activity, an inability to concentrate, and weight loss. However, Mr Nguyen denied that he was not well. Aeyoung decided to discuss her concerns with a nurse, with whom she had developed an attachment, at the church. She invited the nurse to her home for lunch on a Saturday so she could meet her father and validate her impressions. After several visits with the family, the nurse was able to establish a close enough relationship with Mr. Nguyen so that she could engage him in a discussion in his health. Because of her extensive work with other Vietnamese immigrants, the nurse was familiar with themes of loss and decided to focus her conversation with Mr. Nguyen on his adjustment to his new community living, gains and losses as a result of immigration, and coping strategies. After several discussions, Mr. Nguyen confided in the nurse that he feared that he was dying because he had been diagnosed with cancer of the small intestine. He further revealed because he did not want them to know of his "bad news." Mr. Nguyen had refused treatment because he know that people never get better when they have cancer; they always die. C. Which resources should a community health agency have available to assist Mr. Nguyen with his health care concerns?

Available resources should include an interpreter, a culture care specialist, and expert, caring nurses. The client has limited English language skills. An interpreter could help him understand the meaning of medical terms. Culture care specialists would help him form a bridge from health care in his country of origin to the health care in America and provide necessary information for him and his family to make decisions. Caring nurses are also important because they would help him communicate his needs appropriately.

Public Health, Primary Care, and Primary Health Care Systems: During a well-child clinic visit, Jenna Wells, RN, met Sandra Farr and her 24-month-old daughter, Jessica. The Farrs had recently moved to the community. Mrs. Farr stated that she knew that Jessica needed the last in a series of immunizations and because they did not have health insurance, she brought her daughter to the public health clinic. On initial assessment, Mrs. Farr told the nurse that her husband would soon be employed, but the family had no health care coverage for the next 30 days. The Farrs also needed to decide which health care package they wanted. Mr. Farr's company offers a preferred provider organization (PPO), a health maintenance organization (HMO), and a community nursing clinic, and they are not sure what services are provided. Mrs. Farr asks Nurse Wells what she should do. Nurse Wells should do which of the following? A. Encourage Mrs. Farr to choose the HMO because it will pay more attention to the family's preventative needs, and direct Mrs. Farr to other sources of health care should the family need to see a provider while they are uninsured. B. Encourage Mrs. Farr to choose the PPO because it will have a greater number of qualified providers from which to choose, the family need to see a provider while they are uninsured. C. Encourage Mrs. Farr to choose the local community nursing center because it is staffed with nurse practitioners who are well qualified to provide comprehensive health care with an emphasis on health education, and direct Mrs. Farr to other sources of health care should the family need to see a provider while they are uninsured. D. Explain the differences between PPO, HMO, and community nursing clinic and encourage Mrs. Farr to discuss the options with her husband about signing up for a health insurance plan under the ACA plans, and direct Mrs. Farr to other sources of health care should the family need to see a provider while they are uninsured.

D. Explain the differences between PPO, HMO, and community nursing clinic and encourage Mrs. Farr to discuss the options with her husband about signing up for a health insurance plan under the ACA plans, and direct Mrs. Farr to other sources of health care should the family need to see a provider while they are uninsured. The nurse's responsibility is to educate clients about appropriate health care resources in their community and to allow families to choose care based on their own unique needs and preferences.

Program Management: The following is a real life example of the application of the program management process by an undergraduate nursing student. This activity resulted in the development and implementation of a nurse-managed clinic for the homeless. This example shows how students as well as providers can make a difference in health care delivery. It also illustrates that no mystery surrounds the program management process. Eva was listening to the radio one Sunday afternoon and heard an announcement about the opening of a soup kitchen within the community for the growing homeless population. She was beginning her public health nursing course and wanted to find a creative clinical experience that would benefit herself as well as others. The announcement gave her an idea. Although it mentioned food, clothing, shelter, and social services, nothing was said about health care. Eva was interested in finding a way to provide nursing and health care services at the soup kitchen. Which of the following should she do? A. Talk with key leaders to determine their interest in her idea. B. Review the literature to find out the magnitude of the problem. C. Survey the community to determine if others are providing services. D. Discuss the idea with members of the homeless populations. E. Consider potential solutions to the health care problems. F. Consider where she would get the resources to open a clinic. G. Talk with church leaders and nursing faculty members to seek acceptance for her idea.

Eva would include all the steps in planning her project. She contacted the pastor of the church who was planning to open the soup kitchen to discuss the issue (formulation and assessment). She found him most receptive to the idea of developing a solution to the health care needs of the homeless. In her assessment, Eva found that no other health services were available to the homeless in the community. She looked at national data to estimate needs and size of the population. She talked with the community health nursing faculty to discuss potential solutions to the problem. She talked to members of the homeless population to get their perceptions of their needs. On completing her assessment, Eva conceptualized the solutions. Several solutions were possible: work with the health department, attempt to provide better care through the local medical center, or open a clinic on-site at the soup kitchen where most of the people gathered so that transportation would not be a problem. After considering the solutions, Eva detailed the plan, looking at the resources needed for opening a clinic at the soup kitchen. She considered supplies, equipment, facilities, and acceptability to the clients. She also considered the time involved, the activities required to implement a program, and funding sources. In evaluating the possibilities, Eva considered the cost, the benefits for the client and community, and the acceptability to clients, self, faculty, and the church. Although it would have been easier for her to choose to work with the health department or the medical center, she knew that the solution most acceptable to the clients would be to have a clinic located at the soup kitchen. The clinic would be more accessible, transportation would not be needed, and health services through the clinic could possibly prevent more costly hospital and emergency care (value). Eva presented her plan to the faculty and the church. She convinced them that it would not be a costly endeavor. She enlisted the help of volunteer nurses in the community, she recruited a carpenter to donate his time to build an examining room in the back of the soup kitchen, and she had equipment promised to her by community physicians. The client assessment indicated that a first aid and health assessment clinic was what was most needed. With approval from all (implementation), Eva began the clinic in 1981, seeing 25 to 35 clients a week, 1 hour per day for 5 days per week. Eva evaluated the relevance of the program via the needs assessment process. She tracked the progress of the program by keeping records of her activities. She kept track of the resources in relation to the number of persons served (efficiency) and used these data to convince the church and the college of nursing to fund the ongoing clinic operation after she graduated. A summative evaluation of the clinic was completed by the faculty at the end of 4 years. The program's impact was outstanding. The clinic had grown. The client demand was high; most of the health problems could be handled at the clinic, which eliminated the cost burden to the community for more expensive health care; and it was highly acceptable to the clients (effectiveness). This clinic began as a service to 25 people for 1 hour per day. Today this clinic is open all day, 5 days per week, has more than 900 clients per year, and provides for more than 5,000 client visits per year. The success of this clinic shows the effect that one community health nursing student can have on a community.

Evidence-Based Practice: A nurse who is the director of public health clinic is in the process of analyzing how best to expand services to operate as a full-time clinic in the most cost-effective and clinically effective manner. The director gathers evidence from the literature on public health clinics in rural settings to evaluate cost and clinical effectiveness of various models. The nurse also considers evidence from the following sources in the decision-making process: client satisfaction research data, knowledge of clinic staff, expert opinion of community advisory board members, evidence from community partners, and data on service needs in the state. Having examined the evidence, the nurse decides that incremental (step-by-step) growth toward full-time status is warranted. Evidence of needs in the community and analysis of statistical data indicate that the addition of wellness services for children is a priority, and a pediatric nurse practitioner is hired as a first step to assist the public health nurses while planning for full-time status continues. B. Explain how this examples applies principles of EBP.

Evidence-based practice (EBP) in nursing takes into account the best evidence from research findings and evidence from community knowledge and experience to make decisions that promote the health of the community in a culturally appropriate manner.

Population-Based Public Health Nursing Practice- The Intervention Wheel: Outreach locates populations of interest or populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Outreach activities may be directed at whole communities, at targeted populations within those communities, and/or at systems that impact the community's health. Outreach success is determined by the proportion of those considered at risk that receive the information and act on it. The chance of a 20 year old woman developing breast cancer within the next 10 years is 1 in 1681. At age 30, a woman's chance of developing breast cancer within the next 10 years is 1 in 225; at age 40, it is 1 in 69; at age 50, it is 1 in 44; at age 60, is is 1 in 29; and at age 70, it is 1 in 26. A health system decided to offer mammograms in recognition of National Breast Cancer Month. They sponsored a mobile mammography van at a large shopping mall every Saturday in October. The van offered mammograms to everyone, regardless of age. The health system advertised the service by placing windshield flyers on all the cars in the shopping mall parking lot. The van provided 180 mammograms, mostly to women in their 30s who had health insurance that covered preventative services. C. What types of outreach would PHNs conduct to reach the population at risk?

Examples of public health nursing outreach that have been effective: 1. Provide information on mammography and low-cost mammograms to older women at craft fairs, senior living facilities, and congregate dining centers. 2. Collaborate with pharmacists and grocers to prominently display information on mammography screening in the section where feminine hygiene products are sold. 3. Distribute mammography information posters to owners of local dress shops and department stores to display in the women's clothing dressing rooms; public service announcements on the local news programs; set up a booth at a local festival with literature on breast cancer and mammography.

History of Public Health and Public and Community Health Nursing: Mary Lipsky has worked for the county health department in a major urban area for almost 2 years. Her nursing responsibilities include a variety of services, including consultations at a senior center, maternal/newborn home visits, and well-child clinics. As she leaves work each evening and returns to her own home, she keeps thinking about her clients. Why is it so difficult today to qualify a new mother and baby to receive WIC nutrition services? Why must she limit the number of children screened for high lead levels, when last year the health department screened twice as many children? Several children last month seemed asymptomatic, but the laboratory found levels that were high enough to cause damage. One of the mothers Ms. Lipsky is acquainted with is having a difficult time emotionally. Why is it so difficult to find a behavioral health provider for her? And the health department still cannot find a new dentist! And families on welfare cannot find a private dentist to take care of their children. A. Why might it be difficult to solve problems at the individual level, on a case-by-case basis?

It is easier to use a population-focused approach to solving these problems. If you can show through a community needs assessment that these are problems for a large number of people in the community and are putting the community at risk for increased health problems, more costly health care, and less social and economic growth, then you can convince policy makers to establish programs directed at these problems. With limited health care dollars, the emphasis is on the greatest good for the greatest number.

Achieving Cultural Competence in Community Health Nursing: Mr. Nguyen, a 64-year-old man from rural Vietnam, entered the US with his family three years ago through the refugee program. Mr. Nguyen was a farmer in his homeland, and since his arrival he has been unable to obtain a stable job that would allow him to adequately care for his family. His financial resources are limited, and he has no insurance. He speaks enough English to interact directly with people outside his family and community. His oldest daughter, Aeyoung, is enrolled in a 2-year program to become a registered nurse. The Nguyen family attends the neighborhood church with other Vietnamese families. Mr. Nguyen has been attending the clinic at the hospital but refuses to discuss with his family, even with Aeyoung, the reason for these visits. Aeyoung became increasingly concerned as she observed her father to have insomnia, retarded motor activity, an inability to concentrate, and weight loss. However, Mr Nguyen denied that he was not well. Aeyoung decided to discuss her concerns with a nurse, with whom she had developed an attachment, at the church. She invited the nurse to her home for lunch on a Saturday so she could meet her father and validate her impressions. After several visits with the family, the nurse was able to establish a close enough relationship with Mr. Nguyen so that she could engage him in a discussion in his health. Because of her extensive work with other Vietnamese immigrants, the nurse was familiar with themes of loss and decided to focus her conversation with Mr. Nguyen on his adjustment to his new community living, gains and losses as a result of immigration, and coping strategies. After several discussions, Mr. Nguyen confided in the nurse that he feared that he was dying because he had been diagnosed with cancer of the small intestine. He further revealed because he did not want them to know of his "bad news." Mr. Nguyen had refused treatment because he know that people never get better when they have cancer; they always die. B. The way in which the nurse poses questions to Mr. Nguyen is very important and determines the kind of responses should the nurse pose to Mr. Nguyen to get the best response from him?

Open-ended questions allow the client to select from a full range of responses, which would give the impression that the nurse is interested in what the client has to say.

Promoting Healthy Communication: Nurses working with communities to implement the CHPM are most effective when they do which of the following? a. Begin where the community is and then work to facilitate implementation of all nine steps. b. Serve in the role of expert resource, spearheading the community's work. c. Teach basic community and public health concepts before teaching the Health Communities Model. d. Work with community leaders to begin with step one and progress through step nine of the model.

a. Begin where the community is and then work to facilitate implementation of all nine steps. Nurses should begin where the community is. Nurses help facilitate implementation of the model, coaching community leaders so they understand and implement all steps of the model. Nurses are most effective when they serve as facilitators and coaches.

Program Management: The new public health nurse is planning to obtain key informant opinions before planning a new program. The nurse manager tells the nurse that while important, one disadvantage to monitor for is which of the following? a. Bias in the informant's opinions b. Exaggeration of community need c. Limited access to real data d. Rejection of the nurse's ideas

a. Bias in the informant's opinions While a vital resource to include when planning for community needs, the key informant may be biased. This might include an exaggeration of the community's needs but can involve other biases as well. The nurse will monitor for this occurring.

Achieving Cultural Competence in Community Health Nursing: The nursing student learning about cultural variations would need to study which of the following topics? (Select all that apply.) a. Biological variations b. Personal space c. Time perception d. Social organizations e. Communication patterns

a. Biological variations b. Personal space c. Time perception d. Social organizations e. Communication patterns Cultural variations include biological variations, personal space, time perception, social organizations, communication patterns, and environmental control.

Health Equity and Care of Vulnerable Populations: Ms. Green, a 46-year-old farm worker pregnant with her fifth child, has come to the clinic requesting treatment for swollen ankles. During your assessment, you learned that she had seen the nurse practitioner at the local health department two months ago The nurse practitioner gave her some sample vitamins, but Ms. Green lost them. She has not received regular prenatal care and has no plans to do so. Her previous pregnancies were essentially normal, although she said she was "toxic" with her las child. She said that her middle child was "not quite right." He is in the 7th grade at age 15. Ms. Green is 5'2", weighs 180 lbs, and has a BP of 160/90. She has pitting edema of the ankles and a mild HA. Ms. Green says that she usually takes chlorpromazine hydrochloride (Thorazine) but has run out of it and can't afford to have her prescription refilled. She says that she has been in several mental hospitals in the past and that she has been more agitated lately, and now has problems managing her daily activities. As her agitation grows, she says that she usually hears voices and this makes her aggressive. Non of her children lives with her, and she has no plans for taking care of the infant. She thinks she will ask the child's farther, a race track worker, to help her, because she usually travels around the country with him. B. What nursing activities are suggested by her history, physical, and psychological description?

The nurse should do everything she can to minimize the "hassle factor." She could set up home health care so Ms. Green can receive prenatal care, as well as care for her other health issues, in her home. She could also set up clinic visits so Ms. Green's prenatal care and mental health care can be addressed during the same visit. The nurse needs to talk to Ms. Green about her plans for the baby and refer her to adoption services as appropriate. Ms. Green should be taught about signs of preeclampsia and what symptoms should be reported to the clinic.

Population-Based Public Health Nursing Practice- The Intervention Wheel: Outreach locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Outreach activities may be directed at whole communities, at targeted populations within those communities, and/or at systems that impact the community's health. Outreach success is determined by the proportion of those considered at risk that receive the information and act on it. The chance of a 20 year old woman developing breast cancer within the next 10 years is 1 in 1681. At age 30, a woman's chance of developing breast cancer within the next 10 years is 1 in 225; at age 40, it is 1 in 69; at age 50, it is 1 in 44; at age 60, is is 1 in 29; and at age 70, it is 1 in 26. A health system decided to offer mammograms in recognition of National Breast Cancer Month. They sponsored a mobile mammography van at a large shopping mall every Saturday in October. The van offered mammograms to everyone, regardless of age. The health system advertised the service by placing windshield flyers on all the cars in the shopping mall parking lot. The van provided 180 mammograms, mostly to women in their 30s who had health insurance that covered preventative services. A. What is the population most at risk of breast cancer?

The population most at risk of breast cancer is women ages 50 and older.

Public Health, Primary Care, and Primary Health Care Systems: Benefits of an electronic health record in the public health system include: (Select all that apply.) a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. d. increased privacy. e. consistently reliable internet resources.

a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. Benefits of an electronic record in public health include 24-hour availability of records with downloaded laboratory results and up-to-date assessments; coordination of referrals and facilitation of interprofessional care in chronic disease management; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors.

Public Health, Primary Care, and Primary Health Care Systems: Which of the following groupings of health care trends will have the greatest influence on the health care transformation process? (Select all that apply.) a. Aging of the population and medical technology advances b. Funding levels, political structure, and professional licensure requirements c. Longevity, population diversity, and funding sources d. Managed care, workforce shortages, and level of education of the population

a. Aging of the population and medical technology advances c. Longevity, population diversity, and funding sources Increases in the number of aging baby boomers as well as the longevity of the elderly, advances in medical technology such as telehealth, and electronic medical record keeping are currently having the greatest impact on the transformation of our health care system. This involves the reallocation of resources, standardization of information transfer, and funding challenges. As a percentage of gross domestic product (GDP), publicly funded programs are outpacing the tax and revenue sources for these programs.

Promoting Healthy Communication: Primary health care seeks to provide affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns. Which principle does is this model of primary health care incorporate? a. Appropriate technology b. Community participation c. Equity d. Multisectoral participation

a. Appropriate technology The principles of primary health care and the Ottawa Charter for Health Promotion were influential in the development of the HCC movement. The principles of primary health care include equity, health promotion, community participation, multisectoral cooperation, appropriate technology, and international cooperation. Appropriate technology refers to the provision of affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns.

Public Health Foundations and Population Health: 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. Which core public health function does this represent? 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.

Public Health Foundations and Population Health: 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. Which public health core function does the nurse apply in this situation? 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.

History of Public Health and Public and Community Health Nursing: Which are major accomplishments of the National Organization for Public Health Nursing (NOPHN)? (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. 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 d. Responded to the 1918 worldwide influenza pandemic in the United States 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.

History of Public Health and Public and Community Health Nursing: 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 her 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. Community health's focus on teaching and prevention b. Establishment of settlement houses e. Middle and upper class fear of diseases 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.

Program Management: Which of the following are the major sources of information for program evaluation? (Select all that apply.) a. Community indices b. Media reports c. Program clients d. Program providers e. Program records

a. Community indices c. Program clients e. Program records Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiologic data).

Public Health Foundations and Population Health: A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing what type of care? a. Community-oriented b. Community-based c. Secondary care d. Tertiary care

a. Community-oriented 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.

Program Management: To engage in a formative program evaluation, which action by the nurse is best? a. Conduct medical record audits for quality assurance. b. Make a home visit before a client is discharged from the program. c. Participate in a new client evaluation. d. Write a policy for risk management.

a. Conduct medical record audits for quality assurance. Process evaluation, also referred to as formative evaluation, occurs during program implementation and makes it possible to make midterm corrections to ensure the achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it will address the efficiency and effectiveness of the program in meeting its goals. Quality assurance programs are examples of program evaluation in health care delivery.

Program Management: A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be through which method? a. Cost studies b. MAPP model c. PATCH method d. Tracer method

a. Cost studies Cost studies are essential to show the value of nursing in the marketplace now and in the future. Cost studies help identify program benefits and objectiveness and would be a good tool for this required part of a grant application.

Program Management: Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. Which tool will the nurse use to demonstrate the program's efficiency? a. Cost-benefit analysis b. Cost-efficiency analysis c. Relevance assessment d. School records audit

a. Cost-benefit analysis Cost studies help identify program benefits, effectiveness, and efficiency. A cost-benefit analysis will compare the costs of the program against the benefits of its services and would be used to demonstrate a need for continued funding.

Promoting Healthy Communication: The aspects of the locality development model or bottom-up approach that have been integrated can best be described as which of the following? (Select all that apply.) a. Emphasizing consensus and cooperation b. Building a sense of community c. Using a rational-empirical approach d. Producing fundamental social change e. Rational-empirical problem solving by outside experts

a. Emphasizing consensus and cooperation b. Building a sense of community Different models of community practice exist. The locality development model is a process-oriented model that emphasizes consensus, cooperation, and building of group identity and a sense of community. The social planning (top-down approach) model stresses rational-empirical problem solving, usually by outside professional experts. Social planning does not focus on building community capacity or fostering fundamental social change. The social action model concentrates on increasing the problem-solving ability of the community through concrete actions that attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. The Community Health Improvement Model aims at creating partnerships within the community and focuses on community leadership development for health while using a bottom-up approach like the locality development model. This multisectoral cooperation (primary health care principle) by all parties in a community, from local government officials to grassroots community members, creates a stronger foundation for health-promoting public policy development, the highest-priority health-promotion action identified for producing sustainable community health change.

History of Public Health and Public and Community Health Nursing: Which of the following are recommendations of the 1850 Shattuck Report that represented major innovations in public health? (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. 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 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.

Achieving Cultural Competence in Community Health Nursing: A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. Which assessment should the nurse conduct first? a. General cultural assessment b. Head-to-toe assessment c. In-depth cultural assessment d. Nonverbal communication assessment

a. General cultural assessment During initial contacts with clients, especially when the client is from an unfamiliar culture, nurses should perform a general cultural assessment to obtain an overview of client characteristics. The data gathered from a brief assessment, will help to determine if there is need for additional information which would be gathered during an in-depth cultural assessment.

Promoting Healthy Communication: The Healthy Communities and Cities (HCC) movement can best be described as which of the following? a. International movement of communities and cities focused on mobilizing local resources to improve the health of the community. b. Movement that began in the United States that targets health promotion in community practice. c. Movement that focuses on the effective development and use of public policy as the primary means for improving health. d. Program that uses the principles of primary, secondary, and tertiary prevention to mobilize citizens to improve the health of their communities.

a. International movement of communities and cities focused on mobilizing local resources to improve the health of the community. The goal of this international movement was to promote health through community engagement and collaboration to activate and diffuse local changes that support good health. The premise was that community members must be involved in identifying the need for health programs and in developing programs to meet those needs.

Application of Ethics in the Community: How does virtue ethics differ from other ethical theories or principles? a. It focuses on character development. b. It views consequences as natural occurrences. c. It is core to developing distributive justice. d. It works from the principle of egalitarianism.

a. It focuses on character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness.

Achieving Cultural Competence in Community Health Nursing: A nurse who is ethnocentric in interacting with a client of a different culture. Which statement is most likely true about this nurse? a. Most likely has little experience and is uncomfortable with people from other cultures. b. Is appreciative of and inquisitive about 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 for best care outcomes.

a. Most likely has little experience 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.

Public Health Foundations and Population Health: 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 which functions? 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. The other options might be specific interventions a public health nurse could implement as part of broader programming.

Public Health, Primary Care, and Primary Health Care Systems: What is the major factor driving current discussions about a Medicare shortfall in the middle of the twenty-first century? a. Diversity of the U.S. health care workforce b. Longevity of the U.S. population c. Percentage of elderly in the U.S. population d. Percentage of foreign-born in the U.S. population

c. Percentage of elderly in the U.S. population Seventy-seven million babies were born between the years of 1946 and 1963, giving rise to the often-discussed Baby Boom generation (Centers for Disease Control and Prevention (CDC), 2009). The oldest of these Boomers reached 65 years of age in 2011, and they are expected to live longer than people born in earlier times. The impact on the federal government's insurance program for people 65 years of age and older, Medicare, is expected to be enormous. Medicare spending is expected to grow nearly 8% between 2021 and 2026.

Program Management: A nurse who is the program director for a new anti-smoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? a. Cost-benefit analysis b. Perspectives on the program c. Plan for the evaluation process d. Process evaluation

c. Plan for the evaluation process When the planning process begins, the plan for evaluating the program should also begin. Everyone who will be involved in implementing a program should be given the opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and the program is designed, the nurse must continue plans for program evaluation, such as ongoing process evaluation (formative evaluation) and summative evaluation.

Public Health, Primary Care, and Primary Health Care Systems: What is the major barrier to achieving the "Health for All in the 21st Century in the United States? a. Global indicators are not applicable to the United States. b. Healthy People 2020 is not consistent with the Declaration of Alma-Ata. c. Primary Health Care is not the primary delivery method for health care in the United States. d. The U.S public health system is not structured to provide PHC.

c. Primary Health Care is not the primary delivery method for health care in the United States. The WHO's Declaration of Alma-Ata (1978) identified "Health for All in the Year 2000" as its primary global goal. This was amended in 1998 to "Health for All in the 21st Century." Although the United States, a WHO member nation, has endorsed primary health care as the strategy for achieving the goal of health for all in the twenty-first century, Primary Health Care is not the primary delivery method for health care in the United States. This creates a significant barrier to the achievement of that goal, despite the leadership of the U.S. public health system in the Healthy People 2020 initiative.

Public Health, Primary Care, and Primary Health Care Systems: The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. What system does this best describe? a. Managed care b. Primary care c. Primary health care d. Private health care

c. Primary health care Nurse-managed clinics or centers incorporate primary care and public health care; consequently, they provide PHC when the broad range of services focuses on prevention, basic health services, and education and is provided at the community level, typically serving underserved populations.

Health Equity and Care of Vulnerable Populations: The nurse knows that which of the following is one of the primary contributors to vulnerability? a. Gender b. Race and ethnicity c. Resource limitations d. Urban or rural residency

c. Resource limitations Social determinants of health include a range of social, political, and economic factors that include socioeconomic status, living conditions, geographic location, social class, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk.

Health Equity and Care of Vulnerable Populations: 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. Frequently vulnerable people do not have the time or energy for coping with processes that are confusing, complicated, or include long wait times.

Public Health Foundations and Population Health: 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.

History of Public Health and Public and Community Health Nursing: The primary impetus for the school nurse program established by Lilian Wald 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 examinations 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.

Promoting Healthy Communication: A nurse expands a community exercise program to include a senior exercise program targeted at strength and balance training in response to the HCC initiative to address the needs of free-living elders in the local community. The nurse is most likely applying the Ottawa Charter for Health Promotion priority health-promotion activity of: a. developing personal skills. b. establishing health-promoting public policy. c. reorienting health services. d. strengthening community.

c. reorienting health services. Nurses participating in a CHPM collaborative partnership can redirect community health services toward local priorities and plans based on the HCC committee's desired actions for health. This redirecting of community health services is an example of "reorienting health services," a priority health-promotion action of the Ottawa Charter for Health Promotion.

Health Equity and Care of Vulnerable Populations: A new nurse is starting a job in public health working with vulnerable populations. What advice by the nurse manager would be most beneficial? a. "Be mindful of your documentation; we don't want reimbursement issues." b. "I'd encourage you to attend county board meetings." c. "It's important for you to get out there and network." d. "The first thing you need to do is to establish trust with clients."

d. "The first thing you need to do is to establish trust with clients." Due to disappointing encounters with health care providers and services in the past, many vulnerable people lack trust in the system. It is imperative that the nurse creates a trusting environment and relationship with his or her clients.

Application of Ethics in the Community: A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using scented candles. Which is the most appropriate intervention for the nurse? a. Leave the matches and candles accessible to the client. b. Maintain the client's dignity by stating that she is capable of using them for now. c. Counsel the client of the dangers of her using candles and matches. d. Collaborates with the client to give the candles and matches to a family member who brings them during visits.

d. Collaborates with the client to give the candles and matches to a family member who brings them during visits. The best action is for the nurse to apply the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others.

Application of Ethics in the Community: Caring and the ethic of care were developed in the mid-1980s and early 1990s in response to and the desire of nurses to do which of the following? a. Apply gender-related voices to moral judgment. b. Apply principles of utilitarianism. c. Differentiate distributive justice from beneficence. d. Differentiate nursing practice from medical practice.

d. Differentiate nursing practice from medical practice. The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics. It posits that caring is the foundation of nursing.

Achieving Cultural Competence in Community Health Nursing: A nurse asks a couple who are new parents for their baby's full name. The parents reply that in their culture they are only supposed to give the baby its first name. What response by the nurse is most appropriate? a. Tell the couple that they are the child's parents and it is up to them to name their baby. b. Explain that the Bureau of Vital Statistics has a 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.

Promoting Healthy Communication: A nurse has decided to use a bottom-up approach of HCC to meet Healthy People 2020 goals for elders in the community setting. Which would be the most appropriate intervention? a. Design and implement a health-promotion activity that can be scheduled at a senior center. b. Organize a meeting of local politicians, clinicians, and community members to prioritize needs for elderly clients with diabetes. c. Recruit the mayor and city council to designate an annual Elder Health day. d. Include community members in multisectoral meetings to choose, design, and implement a culturally appropriate health-promotion activity for older adults.

d. Include community members in multisectoral meetings to choose, design, and implement a culturally appropriate health-promotion activity for older adults. Healthy People 2020 goals include establishment of educational and community-based programs that focus on disease prevention and health promotion. Goals for community settings and select populations include culturally appropriate community health-promotion and disease-prevention programs. Increasing the proportion of older adults participating in organized health-promotion activities is also a goal. Following the implementation steps of the Community Health Improvement Model: Development of Community Structure for Health Promotion, the nurse working to achieve Healthy People 2020 goals should mobilize local political, health professional, and community members, including members of the target population, to prioritize, design, and implement culturally appropriate health-promotion activities for seniors in the community.

Public Health Foundations and Population Health: A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. Which of the following is most likely to be the rationale for the lack of support? a. 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 direct client care and services.

d. Opinions that nursing should focus on 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.

Application of Ethics in the Community: One seminal event that significantly shifted nursing's focus to ethical decision making was the emergence of the field of bioethics. In conjunction with bioethics, what other event occurred to shape this agenda? a. Adopting the ANA's Code for Professional Nurses b. Adopting the American Public Health Association's Public Health Code of Ethics c. Promoting the International Council of Nurses' Code of Ethics for Nursing d. Returning ethics courses to nursing programs in institutions of higher education

d. Returning ethics courses to nursing programs in institutions of higher education In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values from religiously based programs to the explicit study of ethics and ethical decision-making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs.

Promoting Healthy Communication: The collaborative partnership best practice of "identifying specific community and system changes to be sought to effect widespread behavior change and community health improvement" would best apply to which concept of the Ottawa Charter for Health Promotion strategic framework? a. Creating supportive environments b. Establishing health-promoting public policy c. Reorienting health services d. Strengthening community action

d. Strengthening community action The Ottawa Charter for Health Promotion identified the strengthening of community action as a priority health-promotion action. The strengthening of community action refers to promoting the community's capacity, ability, and opportunity to take appropriate action to protect and improve the health of the community.

Health Equity and Care of Vulnerable Populations: A nurse uses the social-ecological model to guide care is planning an interpersonal level program for community-dwelling elders who frequent a community senior center. What program will the nurse plan? a. Bus transportation to the center b. Telehealth visits c. Volunteer opportunities d. Weekly social events

d. Weekly social events The interpersonal level of this model includes personal relationships and social networks and support systems that influence behavior and create circumstances that encourage or impeded health attainment. Family, friends, partners, peers, and formal or informal social networks reduce isolation. Isolation has shown to have the same health impact as smoking 15 cigarettes a day.

Public Health Foundations and Population Health: 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.