Exam 1
CHN in the 18th century
formal notions of community health industrial revolution = city slums government initiatives for sanitation, tracking diseases life span averaged 30 years Ed Jenner = small pox inoculation, researched immunity creating and maintaining a database for collection of health related info
aging family
from retirement to death of both spouses
Utilitarian
good, lowest harm
What did public health and community health nursing evolve from?
home nursing practice, community organizations, and political interventions on behalf of aggregates
Public health nursing
improve the health of communities by identifying and directing resources to subgroups which have a high risk of illness, disability and or premature death
What did health reform lead to?
improved conditions; however, poorer segments of society continued to suffer disproportionately
caring for caregivers in hospice care
physical and mental health: comfort level to perform skills understand main goal is for client's comfort, no 'wrong'
Barriers to family health
poverty health care access limit resources to health promotion and disease prevention
complete case studies ch 1-3 on evolve
practice NCLEX review questions of both chapters
Nuclear family
traditional family - decreasing increasing number of teen mothers
launching family
youngest child leaves home
A nurse is preparing to teach a mental health course at a community health center. What information should the nurse include as one of the most effective ways to limit the occurrence of mental illness in the community? 1 Developing multiple coping strategies 2 Reporting strange behaviors by others 3 Correcting myths about mentally ill people 4 Addressing genetic issues related to mental illness
1
Inclusive definition of family
- Includes persons related by blood, marriage, or adoption. - Also includes sets of interdependent but independent persons who share common goals, common resources, and a commitment to each other. -Family members are simultaneously autonomous and dependent.
List types of home health agencies
- official agencies - nonprofit agencies - proprietary or "for profit" agencies - home health chains - hospital-based agencies
purposes of the family
-to meet the needs of society -to meet the needs of individual family members
A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much." What stage of health behavior change has the client reached? 1 Action stage 2 Preparation stage 3 Maintenance stage 4 Contemplation stage
1
During a health symposium a nurse teaches the group how to prevent food poisoning. Which statement by one of the participants indicates the teaching is understood? 1 "Meats and cream-based foods need to be refrigerated." 2 "Once most food is cooked, it does not need to be refrigerated." 3 "Poultry should be stuffed and then refrigerated before cooking." 4 "Cooked food should be cooled before being put into the refrigerator."
1
What purpose does a community health center serve in preventive and primary care services? 1 Community health centers are outpatient clinics that provide primary care to a specific population. 2 Community health centers aim to increase worker productivity, decrease absenteeism, and reduce the use of costly medical care. 3 Community health centers emphasize program management, interdisciplinary collaboration, and community health principles. 4 Community health centers include a complete program designed for health promotion and accident or illness prevention in the workplace.
1
What should the community nurse teach about the risk of adolescent pregnancy? 1 Risk for premature birth 2 Risk for having a large baby 3 Risk for chromosomal defects 4 Risk for increased weight gain
1
The nurse is teaching campfire safety to a group of community members and includes information about what to do if a person catches on fire. The nurse teaches the most effective method for putting out the flames. Which information from the group members indicates successful learning? 1 Wrap hand with towel and slap at the flames. 2 Instruct the victim to roll on the ground. 3 Pour cold liquid over the flames. 4 Remove the victim's burning clothes.
2
The nurse teaches a health class about communicable diseases and states that the virus that causes chickenpox can also cause another disease. Which disease is the nurse describing? 1 Athlete's foot 2 Herpes zoster 3 German measles 4 Infectious hepatitis
2
What is the professional nurse's legal responsibility regarding child abuse? 1 Honor the request of the parents not to report the suspected abuse. 2 Report any suspected abuse to local law enforcement authorities. 3 Return the child to the legal parent even if he or she is suspected of abuse. 4 Provide the parents with a copy of the child's medical record.
2
Which activity by the community nurse can be considered an illness prevention strategy? 1 Encouraging the client to exercise daily 2 Arranging an immunization program for chicken pox 3 Teaching the community about stress management 4 Teaching the client about maintaining a nutritious diet
2
Which role does a nurse play when helping clients to identify and clarify health problems and to choose appropriate courses of action to solve those problems? 1 Educator 2 Counselor 3 Change agent 4 Case manager
2
Family theory
Explains patterns of living among the individuals who comprise family systems
What services do community health centers provide in preventive and primary care services? Select all that apply. 1 Day care 2 Health screenings 3 Physical assessments 4 Disease management Incorrect5 Acute and chronic care management
2, 3, 4
A home health nurse on a first visit checks the client's vital signs and obtains a blood sample for an international normalized ratio (INR). After these tasks are completed, the client asks the nurse to straighten the blankets on the bed. What is the nurse's mostappropriate response? 1 "I would, but my back hurts today." 2 "Okay. It will be my good deed for the day." 3 "Of course. I want to do whatever I can for you." 4 "I would like to, but it is not in my job description."
3
A nurse helps a client to clarify health problems and choose appropriate courses of action. What competency in community-based practice is the nurse exercising? 1 Educator 2 Caregiver 3 Counselor 4 Epidemiologist
3
A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? 1 Inhibin 2 Estrogen 3 Prolactin 4 Progesterone
3
A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. 1 Age 2 Height 3 Weight 4 Smoking 5 Family history
3, 4
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2 Tube is flushed with air after medication is given. 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.
4
A community health nurse makes a home visit to a disabled 13-year-old client who has a 6-month-old infant sister. The infant lies quietly in her crib and rarely smiles or vocalizes; it appears that the infant barely has her basic needs met. What is the nurse's mostappropriate intervention? 1 Advise the parent that the infant will be retarded if not stimulated. 2 Ask the disabled client to spend more time playing with the sister. Incorrect3 Encourage purchasing toys that are appropriate for the infant's age level. 4 Determine whether there is anyone who can help with chores and the infant's care.
4
Genogram
A family diagram that depicts each member of the family and shows connections between the generations.
Developmental theory
A group of ideas, assumptions, and generalizations that interpret and illuminate the thousands of observations that have been made about human growth. A developmental theory provides a framework for explaining the patterns and problems of development.
transactional model
A model that emphasizes the bidirectional effects of parents and adolescents on each other.
Healthy people 2030 goals
Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. Create social, physical, and economic environments that promote attaining full potential for health and well-being for all. Promote healthy development, healthy behaviors and well-being across all life stages. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.
Lillian Wald
Born in 1867 Heart for the poor and needy "public health nurse" and "nursing without walls" US Children's Bureau National organization of PHN
Clara Barton
Civil war Red Cross 1881 - convinced the government to train nurses
sandwich generation
Group of people who are caring for both their parents and their children.
social and structural constraints
Identify what prevents families from receiving needed health care or achieving a state of health Usually based on social and economic causes: literacy education, employment; if disadvantaged, often unable to buy health care from private sector; hours of service, distance and transportation, availability of interpreters and criteria for receiving services (age, sex, income barriers)
Egalitarian
equally provide
social network framework
Involves all connections and ties within a group; social support
CHN in the 20th century
Over 20 visiting nurse agencies 3 year diploma nurses nurse specialists emerging WWI - 2 year programs to combat shortage Social Security Act 1935 1965 medicare and medicaid
Microscopic approach
examines individual, and sometimes family, responses to health and illness often emphasizes behavioral responses to individual's illness or lifestyle patterns Nursing interventions are often aimed at modifying an individual's behavioral through changing his or her perceptions or belief system
Cohabitant
Two unrelated adults, living together for a substantial period of time, with an intimate relationship - increasing Including LBGTQ
Application of the changing family to practice
Understand the difference of family role in blended, extended, same gendered, and cohabitant family Accept diversity
ecological framework
a blend of systems theory and developmental theory, with the addition of an understanding of one's own environment
Home health care
a system in which people who are homebound or have disabilities are provided health care and social services in their homes rather than in medical facilities
healthy people 2030
access to quality healthcare affects: prevention of disease and disability, quality of life, preventable death, overall life expectancy
Identify mutual goals for client's care
after performing an assessment followed by identification of health needs and verification of those needs with the client, the nurse, in consultation with the client, will identify goals and develop a plan for achieving those goals
How do you define the term family?
an aggregate made up of a body of units, the individuals that represent the whole, or the family. Family fulfills two important purposes
Three primary functions of public health
assessment, assurance, policy development
Standards of CHN practice
assessment, dx, outcome, plan, assurance, and evaluation nursing process focused (family/community) 2 levels of practice (generalist/specialist)
Three primary core functions of public health
assessment, policy development, assurance
Macroscopic approach
examines interfamily and intercommunity themes in health and illness delineates factors in the population that perpetuate the development of illness or foster the development of health emphasizes social, economic, and environmental precursors of illness nursing interventions may include modifying social or environmental variables May involve social or political action
external structure
extended family and larger systems (work, health, welfare) context: ethnicity, race, social class, religion, environment
Lewis Pasteur
bacteria theory and sterilization in the 19th century
Limited resources
basic services to the whole population
System Theory
behaviors and family members' responses influence patterns
Distributive
fairly provide
internal structure
family composition, gender, rank order, functional subsystem, and boundaries
Family health tree
family's medical and health histories
Public health strategy
changing a "no" to "yes" fo rate greater good
Downstream interventions
characterized by efforts to modify individuals' perceptions of health
What is the greatest threat to aggregate health?
chronic disease
Where are CHN employed?
community mental health and substance abuse correctional hospice occupational health school health state and local health departments and community and rural health centers home health
Family nursing
consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness
Contemporary issues
continue to include communicable disease concerns, environmental concerns, societal issues, and the cost of health care
CHN goals
decrease preventable disease decrease disability decrease premature death relieve illness, vulnerability and suffering
Upstream interventions
designed to alter the precursors of poor health
Ecomap
diagram used to identify the direction and intensity of family relationships between members and/or community institutions of importance to the family
Roles of the CHN
direct care referral and advocacy teaching monitoring and evaluation enforcer case manager researcher and quality control manager of environments
public health nursing home visits
directed toward provision of health education and primary prevention services
expressive functioning
emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions
Community health nursing
focuses on care to individuals, families, aggregates, and communities to improve the health of the total population
historical definitions of family
-The environment affecting individual clients -Small to large groups of interacting people -A single unit of care with definable boundaries -A unit of care within a specific environment of a community or society
A nursing student lists the preventive and primary care services available in schools, primary healthcare provider's offices, occupational health clinics, community health centers, and nursing centers. Which service provided by these centers is most expensive? 1 Running errands 2 Health education 3 Disease management 4 Routine physical examinations
3
The home health nurse provides education to a client with cancer of the tongue who will begin gastrostomy feedings at home. Which statement by the client indicates teaching by the nurse is effective? 1 "Before I start the procedure, I will don sterile gloves." 2 "Before I start the procedure, I will obtain my body weight." 3 "Before I start the procedure, I will measure the residual volume." 4 "Before I start the procedure, I will instill one ounce (30 mL) of a carbonated liquid."
3
The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make? 1 "Join a gym." 2 "Drink fewer diet sodas." 3 "Decrease fast food intake." 4 "Take a multivitamin daily."
3
A community healthcare nurse is conducting a survey about homeless children in the community. Which finding helps the nurse distinguish absolute homelessness from relative homelessness? 1 The children are under-immunized and at a risk for childhood illnesses. 2 The children are more likely to drop out of school and become unemployable. 3 The children have access to healthcare only through the emergency department. 4 The children do not have a physical shelter and may sleep outdoors or in vehicles.
4
The nurse at a community healthcare center focuses on providing primary preventive care. What is the focus of primary preventive care? 1 Rehabilitating the client 2 Treating early stages of disease 3 Preventing complications from illness 4 Promoting health in healthy individuals
4
The nurse at a health fair has taken a client's blood pressure twice, 10 minutes apart, in the same arm while the client is seated. The nurse records the two blood pressures of 172/104 mm Hg and 164/98 mm Hg. What is the appropriate nursing action in response to these readings? 1 Refer the client to a nutritionist after providing health teaching about a low-sodium diet. 2 Place the client in a recumbent position and call the paramedics for transport to the hospital. 3 Talk with the client to assess whether there is stress in the client's life and refer to a counseling service. 4 Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible.
4
ANA definition of public health nursing
focuses on care to individuals, families, and groups within a community
APHA definition of public health nursing
focuses on care to the community as a whole
Beliefs of CHN
human rights self-responsibility independence and empowerment environment poverty and oppression - social barrier promote health, prevent sickness
Stages in disease history of humankind
hunting and gathering stage settled villages stage preindustrial cities stage industrial cities stage present stage
Family health needs
in family interviewing, the nurse cares for the family through applying general systems theory and family assessment to assess the family's response to events across lifespan, such as ___________
Healthy people 2020 two goals
increase quality and years of healthy life eliminate health disparities
What contributed to the decline in infectious disease-related deaths in the nineteenth and early twentieth centuries?
increased food production and better nutrition other factors: better sanitation through water purification, sewage disposal, improved food handling, and milk pasteurization
Single parents
increasing
who are the clients of hospice care?
individual family/caregivers
Comparison of individual and societal levels of change
individual - individual is the focus of change; microscopic; downstream activities emphasized; theories: Orem's self-care deficit theory of nursing, the health belief model (HBM) societal - society/community is the focus of change; macroscopic; upstream activities emphasized; theories - Milio's framework for prevention, Critical social theory perspective
Determinant of health
interaction of the factors that lead to health, disease, death, and disability
Structure of the family
internal external
Are treatment/prevention measures mandatory?
mandatory if that disease/issue will affect the population
family interviewing
manners therapeutic conversations venogram and ecomap therapeutic questions commending family or individual strengths issues in family interviewing - many locations, family informant, family health portrait, involvement of children
Population focused practice: theoretical perspective
microscopic approach macroscopic approach
CHN in colonial america
most care provided by docs and midwives in the home (not formally educated, no antiseptics or antibiotics) almshouses (for the poor) pest houses (contagious diseases) hospitals (first in Philadelphia - small pox then yellow fever, nurses untrained usually criminals)
Civil war
over 2000 untrained nurses helped care for the wounded more soldiers killed from disease than bullets
Pain control and symptom management
pain free misconception of using pain control medication: tolerance vs addiction
13 prerequisites for health
peace shelter education social security social relations food income empowerment of women stable ecosystem sustainable resource use social justice respect for human rights equity
a home visit: an open-door to family care
preparation referral initial contact environmental assessment building trust improving communication termination
Three levels of prevention
primary, secondary, tertiary
Reimbursement for home health care is through
private - 46%: self pay, private health insurance government - medicare: CMS-OASIS good samaritan
Education for CHN
refers to any nurse who works in a community setting (regardless of education)
middle-age family
remaining marital dyad to retirement
Education for PHN
requires additional education in epidemiology, health systems, high risk populations
Basic ethical principles
respect beneficence confidentiality justice
instrumental functioning
routine ADLs
HP 2020 - Leading health indicators
social determinant of health
What has the increases in industrialization and certain technologies resulted in?
the development of environmental pollution, particularly of air and water examples
why is it important for the CHN to work with families?
the family is a critical resource any dysfunction in a family unit will affect the members and the unit as a whole case finding can identify a health problem that leads to risks for the entire family nursing care can be improved by providing holistic care to the family and its members
What does theory-based practice guide?
the process of data collection and interpretation and facilitates appropriate problem diagnoses and planning of interventions for identified problems
What has been increasingly affecting community health?
the tendency throughout history of people and groups to live in increasingly closer proximity to one another - increased interaction has resulted in increases in communicable disease outbreaks and epidemics
current theorists definition of family
two or more individuals who depend on one another for emotional, physical, and economic support. members of family are self-defined the family is who they say they are
CHN in the 19th century
typhoid and typhus in Europe poor law led to the Public Health Act of 1848 and established a Board of Health Broad Street Pump (John Snow showed that water was causing the cholera) District nursing associations TB and neonatal deaths
Florence Nightingale
well to do Victorian studied in germany and then with the Sisters of charity proved to the army that many could be saved during the Crimean war by nursing assessment and intervention statistician first training school for nurses
