Community Nursing Exam 1
Policy assessment
Stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness
Adjusted rate
Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one to another
Epidemiology
Study of the distribution and determinants of states of health and illness in human populations
Public Health
What society does collective to ensure the conditions exist in which people can be healthy
The most effective way to conduct an initial assessment of a community that you wish to evaluate for the development of a community based nursing care is...
Complete a windshield survey
In the intervention of case management, the nurse...
Coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way -tertiary prevention
The United States Department of Health and Human Services (USDHHS)
Federal agency nurses should use to coordinate an initiative int he community to make sure that the healthcare needs of local refugees and asylums are recognizes and addressed.
Ratio
Fraction that represents the relationship between two numbers
Organization of Economic Cooperation and Development (OECD)
Group that collects data related to healthcare use across a variety of professional and service parameters
It is predicted that in the near future the number of community health nurses will...
Increase substantially
The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community.
Internet - aggregate data -to begin the assessment, the nurse should use the Internet and aggregate data from these resources, which include local demographics, such as death rates, causes of death, marital status, gender, age, ethnicity, and density of the population.to gather objective data.
In the intervention of outreach, the nurse...
Locates populations at risk, provides information, identifies possible actions, and identifies access to services
What is the World Health Organization's definition of health?
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Sensitivity
Ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present
The case manager works with a 10-year-old girl who has asthma. Because the client's family has trouble affording inhalers. The case manager researches client assistance programs through which they could receive free medications. This aspect of case management is known as...
Advocacy -the case manager researches client assistance programs through which they could receive free medications and the case manager through his/her actions is portraying advocacy.
Nongovernmental organization
Agency that acquires resources to help others from private rather than public services -voluntarily use their resources to address a variety of healthcare intiatives
Where the most common places that people fall in the home?
-Living room (31%) -Bedroom (30%) -Kitchen (19%) -Bathroom (13%) -Hallway (10%)
Ten new focal areas were added to Healthy People 2020, beyond those included in Healthy People 2010 include...
-adolescent health -blood disorders and blood safety -dementias (Alzheimer disease) -early and middle childhood -genomics -global health -health care-associated infections -health-related quality of life and well-being -lesbian, gay, bisexual, and transgender health -older adults -preparedness -sleep health -social determinants of health -diabetes and nutrition and weight status were focal areas that were already included in Healthy People 2010
What are characteristics of health care providers in France?
-unevenly distributed between rural and urban areas -about 50% of healthcare providers are women -healthcare provider visits can take 15 to 30 minutes -healthcare providers see about 10 clients per day -advancement is based on seniority
The community health nurse works in a community recently devastated by a tornado. Many of the survivors are cared for in their homes. Care is needed for those who are ill, recovering, or in hospice. To provide the most holistic and effective care to the community, the nurse should...
Collaborate with other healthcare workers and clients -the action taken by the nurse to prioritize and provide the most holistic and effective care to the community would be to collaborate with other healthcare workers and the clients.
The community is concerned about public safety and the care of their elders living at home. When the nurse assesses the community, the nurse finds there is potential to solve their problems within the community setting without outside resources. The plans to meet the community needs are accepted by the members of the community. Which action has been most successfully demonstrated in your assessment of this community?
Make the assessment process empowering to the community -the action that has been most successfully exhibited in this nurse's assessment of this community is to make the assessment process empowering to the community.
Prevalence rate
Measure of the number of people in a given population who have an existing condition at a given point in time -example: if a nurse is concerned there has been an increase in the number of influenza cases in the county over the last year when compared with last year
Incidence rate
Measure of the probability that people without a certain condition will develop that condition over a period of time -utilizes when the nurse wishes to calculate the probability of persons in the county developing COPD over the course of a year
Incidence density
Measure the number of cases of staph infection that occur in a hospital over the course of 1 year per total client days during that year
In the intervention of surveillance, the nurse...
Monitors health events through ongoing, systemic collection, analysis, and interpretation of health data -primary prevention
The shorter length of stay in acute care (not long-term care) facilities, as well s the increase in ambulatory surgery and outpatient clinics, have resulted in...
More acute and chronically ill people residing int he community who need professional nursing care
Cause-specific mortality rate
Probability of death from a specific cause
Risk
Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem
Politics
Process of influencing the allocation of scarce resources, including financial, resources, Human Resources, and time
Policy adoption
Process of selecting the policy that will be implemented
The role of the community health nurse in a low-income country working to decrease the incidence of diarrheal illness would be...
Providing sanitized drinking water to achieve the best results
Relative risk ratio
Ratio of the incidence rate in the exposed group to the incidence rate in the non-exposed group
Multilateral agency
Receives funding from both governmental and non-governmental sources
Tertiary prevention
Long-term management and treatment of clients with conditions examples -HIV/AIDS -cancer -rehabilitation
The leading cause of death in 1900 was...
Major cardiovascular-renal disease
What is the first step in the policy-making process?
Setting an agenda involves: -considering the significance of the problem -political support for addressing the problem -ability to perceive the viability of proposed alternative solutions for the problem
Interdisciplinary collaboration
Sharing of evidence-based practice and skills by several disciplines as an integration strategy with clients and families in homes and other healthcare settings. -for example, the case manager for a 10-year-old female who is obese and pre-diabetic. To help the client develop a diet that will promote weight loss and control of his glucose level, the case manager decides to consult with a dietitian, who provides several current journal articles that present findings on various diets.
Who was Clara Barton?
She made history by distributing supplies to wounded soldiers and caring for the casualties with the help of a team or nurses -occurs during the civil war -recognizing the need for a neutral relief that could be activated during war which led to the foundation of the AMERICAN RED CROSS
Who was Lillian Wald?
She was the founder of public health nursing
When the community collaborates in a plan to create services and education to enhance their health and well-being, the plan is most likely to...
Shift the focus from dependency to empowerment -a goal to shift the focus from dependency to empowerment will most likely be achieved by this plan.
Determinants of Health
Social conditions in which people live and work -have an impact on the extent to which a person or community possesses the physical, social, and personal resources necessary to have and maintain health -income -social status -education -literacy -home and work environment -gender -culture -availability of health services
Addressing the client's financial needs and obtaining financial assistance is the role of who?
Social worker, NOT the nurse
Policy implementation
Stage in which the selected policy is carried out by using human and financial resources
Policy formulation
Stage in which various policy options are identified and explored
Assisted living
Type of community-based care that combines quasi-independent living with the availability of nursing care onsite and through home care visits. -tt is generally a level of care for people who cannot live on their own but are not yet ready for a nursing home. this type of living arrangement is different from living independently in one's own apartment, such as living in a senior living facility, in that many activities are provided communally (e.g., eating, recreation) and there is an organized effort to create a "caring community" where residents' needs are supervised and met.
Telehealth
Use of electronic information and telecommunication to support long disease clinical healthcare, client and professional health-related education, public health, and health administration
Who was Florence Nightingale?
Used statistics to improve public health in England
Philanthropic organization
Uses endowed funds or private fundraising to address the needs for individuals, families, and populations
An example of a primary prevention intervention for a community is...
Water fluoride supplementation for children
What is the relationship between ethics and a community health nursing practice?
Ethics is constantly involved in nurses' clinical decisions
Demographic transitions
-high fertility and high mortality (slow population growth) -improvement in hygiene and nutrition (decreased burden of infectious disease) -declines in mortality (declines in fertility)
World Health Organization's (WHO) considers the following as important requirements for the effective management of health workforce shortages...
-increased investment in education and training -career incentives to attract health workers to rural disadvantaged areas -attracting women to health professions and addressing retirement -health promotion and prevention strategies to reduce demand for health services
What are the six areas identified by the DOH that have oversight and require effort to reduce disparities?
-infant mortality -cancer screening -cardiovascular disease -diabetes -HIV/AIDS -immunizations
Eight Principles of Public Health Nursing Practice
1. Seeing the population as client or unit of care 2. The primary obligation is to achieve the greatest good for the greatest number of people or number of people as a whole 3. Public health nurses collaborate with the client as an equal partner 4. Primary prevention is priority in selecting appropriate activities 5. Public health nursing focuses on strategies that create environmental, social, and economic conditions in which populations may thrive 6. A public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service 7. Optimal use of available resources and creation of new evidence-based strategies is necessary to assure the best overall improvement in the health os populations 8. Collaboration with other professions, populations, organizations and stakeholder groups is the most effective way to promote and protect the health of the people
How long do provider visits take in France?
15 to 30 minutes
Personal Responsibility
A strategy for nurses to implement if the nurse implementing and persuades an obese client to perform -involves active participation in one's own health through education and lifestyle changes
During the diagnosis phase of the epidemiological process...
A tentative hypothesis is formulated -during the diagnosis phase of the nursing process, healthcare needs and assets are identified and goal sand objectives for care are established
A woman arrives at the clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She is currently involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe sex practices due to her significant other's preferences and feels uncomfortable asking him to wear a condom. To promote health you stated to her "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)."
Although both the woman and her partner are already HIV positive, they can still transmit different strains of HIV to each other, as well as other STIs and can then go on to infect others. Thus, they are not "safe" and the woman should be encouraged to advocate for herself by insisting that her partner wear a condom.
Who sets the scope of standards of all professional practice?
American Nurses Association (ANA) -articulates the essentials of public health nursing, including the activities and accountabilities that are characteristic of practice at all levels and settings -LEGAL STANDARD!!
The nurse works to discover epidemiological transitions in the community. Which factor exemplifies an epidemiological transition?
An example of an epidemiologic transition is high and fluctuating mortality, due to poor health, epidemics, and famine, progressive declines in mortality as epidemics become less frequent, further decline in mortality, increasing life expectancy, and predominance of noncommunicable disease
What is the minimum educational credential a nurse will require to obtain entry into public health nursing practice?
BSN, baccalaureate degree
Bilateral agency
Based in one country but provides services to many other countries
As a nursing student, close to graduation, you are exploring the various options for employment. Which option should you prioritize if becoming involved with a bilateral agency?
Bilateral agencies and organizations conduct their services within on specific country -USAID is a good example in the US ---committed initiative that works with developing countries to enhance systems to fortify the health and welfare of international populations
Nurses coordinating a plan to bring vaccination in a cost-effective way to rural community that currently lacks access to them uses...
Case management intervention -in the intervention of case management, the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way
The nurse is leading a discussion at the local library centering on improving health in a local community. Which Health People 2020 goal would the nurse utilize?
Creating social and physical environments that promote good health for all Other goals: -attain high-quality longer lives free of preventable disease, disability, injury, and premature death (not just to decrease the incidence of these) -achieve health equity, eliminate disparities, and improve the health of all groups -promote healthy development and healthy behaviors across every stage of life, not just older adults
During the assessment phase of the epidemiological process...
Data is gathered from reliable sources
Wheel of Causation
De-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments
Quality of care
Defined by the Institute of Medication as the degree to which health service for individuals and populations increase the likelihood of desired outcomes and are consistent with current knowledge -A nurse has just finished providing teaching and care to a child with type 1 diabetes. These indicators of quality care should be apparent after this teaching if safely self-injected insulin in the office, client has maintained an appropriate blood glucose level consistently for 6 months, received care that was identical to that provided to six other clients of various racial backgrounds and received instructions directly from the nurse in the office, not via a parent
The nurse has determined the specific indicators and focal areas that are needed to establish immunization and well-child clinics in a low-income neighborhood, therefore the nurse will...
Develop a plan to meet the costs and promote the benefits and meet the health outcomes of the project
Absenteeism due to illness has increased recently in the local middle school. The increase is related to the exacerbation of asthma symptoms in the student population. The community health nurse would...
Develop an asthma education and surveillance program that addresses students, families, and faculty in decreasing absenteeism among this population -community health nurses are forced specifically on modifiable risks of acquiring disease. this requires nurses to analyze trends in risk surveillance data and consider the physical, emotional, and psychosocial challenges people face when confronting disease, physical stressors, and the possibility of premature death
The community health nurse is responsible for the general health of the community on multiple levels. The nurse discovers an increase in the number of sick days used by children aged 7 to 11 years at the local elementary school in recent weeks. Research indicates that the families of asthmatic children tend to be less educated and less likely to comply with current treatment plans. Which step should the nurse employ to continue following the care plan using an epidemiologic approach?
Develop school-based education programs for both the children and their caregivers -Principles of epidemiology are used throughout the development, planning, implementation, and evaluation phases of the community assessment process. -Epidemiologic methods can help identify patterns of health and social inequity and determine trends in three ways: ----Describing the disease or disability ----Determining relationships that can predict health or health disparities ----Developing and testing interventions. -By noting that families of asthmatic children tend to be less educated and less likely to comply with current treatment plans, you have already determined relationships that can predict the health disparity. Therefore, the next step would be to develop and test an intervention on the basis of these findings. The school-based education program is the only intervention listed that directly addresses the cause of the health disparity and that may be tested.
When a nursing instructor is comparing the nursing process to the epidemiological process to a group of nursing students, it is important to teach them that...
During the implementation phase of the epidemiological process, actions are initiated to implement and carry out the plan
What do the two broad goals of Health People 2010/2020 focus on?
Eliminating health disparities and increasing quality years of healthy life
Web of Causation
Epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness -based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor
The first step a nurse would do if he/she has heard tumors in the hospital of an Ebola outbreak in the community and decides to investigate it further would be to...
Establish the existence of the outbreak
The nurse works with a 68-year-old client who is having great difficulty managing his blood glucose level. The nurse finds that the client is not following the diet that he had agreed to follow and is eating portions that are far too large. He apologizes and explains that he is grieving the loss of his wife, who died 2 weeks ago. In this scenario, the nurse is using which principal approach in motivational interviewing?
Expressing empathy -the nurse shares condolences with him on his loss and explains that it is perfectly understandable to have trouble following a new diet while grieving and expressing empathy.
Determinants of health
Factors that affect outcomes of health status, such as -physical environment -social environment, -health behaviors -individual health -broader factors such as access to health services and overall health policies and interventions
As nurses, the best way of providing a client to practice client-centered care in the hospital would be...
Having a client complete a self-reported functional status indicator and then reviewing it with the client -patient/client-centered care considered cultural traditions, personal preferences, values, families, and lifestyles -clients become more active participants in their own care -to help clients and their healthcare providers make better decisions, the Agency of Healthcare Research and Quality has developed a series of tools that empower clients and assist providers (SHARE APPROACH)
In the intervention of screening, the nurse...
Identifies individuals with unrecognized risk factors or asymptomatic conditions -secondary prevention
Nurse's asked to join the team which will be conducting a community assessment will help...
Identify a method to improve the health of at-risk with this group to potentially affect the future of the community
There are 12 students with confirmed cases of H1N1 flu in grades 6 to 8 at the local middle school in the community. The community nurse advices the caregivers of the ill children to keep the children for a minimum of 5 to 7 days. The nurse's next step would be to...
Implement education in the setting regarding respiratory and hand hygiene
While completing a community assessment, the nurse notes that the computer companies in the community hire a disproportionate number of their employees from loan suburban communities rather than the community in which the company is housed. Which individuals should the nurse should to create an accurate community assessment?
Includes people who work within the community who do not necessarily live there, as well as those living close to community boundaries who visit the communities to purchase goods or use facilities for nonwork activities. Thus, the nurse should collect data on all of the company's employees and include those living outside the community as part of the aggregate.
Rate
Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness
The nurse utilizes the web os causation when exploring all of the possible factors that contribute to coronary artery disease int he community as...
Links in multiple interrelated chains
Policy
Principles that govern an action to achieve a given outcome -direct individual's behaviors toward a specific goal -deliberate courses of action chosen by an individual or group to confront problems
Epidemiological research has established the...
Natural history of most illness -refers tot he course of disease or condition from the onset to the resolution includes; -pathological onset stage -pre-symptomatic stage -manifestation of clinical disease
Risk factor
Personal habits and behaviors, environmental conditions, or inborn or inherited characteristics that are known to affect health-related conditions -risk factor categories found to be associated with overall health include childhood and maternal undernutrition; other nutrition-related risk factors and inactivity; additive substances; sexual and reproductive health; and environmental risks (such as air pollution).
Secondary prevention
Planned effort to minimize the impact of disease and injury once it is realized SCREENINGS examples: -pap smears -PKU in newborns -blood lead level screenings -mammograms
Public Health Nursing
Population based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community -distinguished from other specialties by adherence to eight principles
A 43-year-old African American client is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, the nurse finds her intelligent and goal oriented. In addition to her need for education and follow-up regarding her HIV diagnosis and treatment, another associated condition the nurse considers when caring for this client is that she is suffering from...
Post-traumatic stress disorder. -when providing physical care to clients with HIV and working to decrease communicability using the ecologic model, consider the client's mental health symptoms, severity/frequency of the effects from significant trauma, such as posttraumatic stress disorder, substance use and abuse, and addiction.
What is the fastest growing healthcare expenditure in the United States?
Prescription medicine
The development of culturally relevant and gender-sensitive intervention that demonstrate positive outcomes in health and well-being is the focus of...
Prevention efforts -approaching individuals and groups about behavior change must incorporate knowledge of diverse client perspectives and include the use of counseling skills and motivational interviewing -to address behavior change using motivational interviewing, the motivation comes from the client and is not imposed by a clinician
The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. Which assessment is the nurse basing this decision on?
Subjective data -community health nurses often use informal assessments, such as windshield surveys, to learn about the neighborhoods in which their clients live. These surveys involve subjectively observing the physical community on foot or through the windshield of a car. In this way, the nurse can assess the level of economic development of the community on the basis of its physical environment, educational systems, safety and transportation, health and social services, communication, and recreation. This type of assessment is not based on objective or "valid" data, as the means of the assessment are purely subjective. It also does not involve cognitive analysis.
The United States and its system of healthcare have historically given and continue to give stronger...
Support to individuals rather than community care and cure rather than prevention
What is TRICARE?
TRICARE provides civilian health benefits for military personnel, retirees, and dependents
The community health nurse learns that there are statistically high levels of obesity and elevated cholesterol in the community. In addition, the community has a disproportionately high number of fast food restaurants, compared with surrounding communities. Which would be the most appropriate next step, based on these data?
Target educations and support programs -the most appropriate next step, based on this data, would be to target education and support programs.
What is the agency known for having nurses visit their patients on horseback?
The Frontier Nursing Service
Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. What is the best action of the nurse?
The best action the nurse would take to revise the program and improve attendance to the clinic would be to interview members of the neighborhood to determine why they do not use the clinic.
Epidemiologic Triad
The classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor
The new community health nurse introduces herself to the local minister and attends various neighborhood meetings. The nurse learns about the ethics, values, and culture of the neighborhood. The community is vocal about the need for public safety and the care of the homeless, especially in the winter. Which is the best rationale for considering all of the influences in the neighborhood affecting their health and well-being?
The information will help to effectively assess the community -the best rationale for considering all of the influences in the neighborhood affecting their health and well-being will help to effectively assess the community.
A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update the care plan, and the client states that he knows that he will walk again. He asks for physical therapy schedules and timelines for prosthetics on the basis of the healing process. Which attitude will the nurse determine the client is exhibiting by his behavior when considering the theory of reasoned action?
The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior
Those covered by Medicaid have insurance but may experience problems assessing primary care due to...
Their inability to find a private healthcare provider who accepts medicaid patients -out-of-pocket expenses may also play a role in the ability to access care
A group of public health nurses are meeting to develop some goals for their community with the main goal of improving the health of their community. Which goal should this group prioritize to achieve this outcome?
To develop treatments and address symptoms related to chemotherapy
The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. Which approach will provider the most accurate assessment for this nurse?
Triangulation - use multiple methods or perspectives -triangulation is the use of multiple methods or perspectives to collect and interpret data about some phenomenon for the purpose of constructing an accurate representation of reality
Primary Prevention
When an individual person or a group is considered in good health and shows no signs or symptoms of disease or physical challenges, nurses in interdisciplinary teams and community partnerships examples: -immunizations -driver's safety classes -healthy water/air quality -fire safety -use of seat belts
The home care agency has just received a client referral from a healthcare provider and assigned the case. How long until they must visit the client after the referral?
Within 24 hours
The role performance model holds that health...
involves a fit between people and social roles -for example, some people, even if they have symptoms of disease, would classify themselves as unhealthy only if they could not fulfill their roles in life, such as mother and worker