Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2001), community health nurses must align themselves with public health programs that promote and preserve the health of popu
sociocultural issues.
(human rights, homelessness, violence, and stigma of illness)
An example of primary disease prevention is:
teaching people with diabetes how to prevent complications.
administering vaccines to children before kindergarten.
checking the skin of farm workers for signs of skin cancer.
identifying and testing individual
administering vaccines to children before kindergarten.
Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include:
Select all that apply.
morbidity.
mortality.
birth rates.
life expectancy.
cancer incidence rates.
morbidity.
mortality.
life expectancy.
cancer incidence rates.
Which of the following is an example of "community health nursing" rather than "community-based nursing"?
An RN assisting a doctor in a pediatrician's office
An RN visiting a home-bound patient to monitor for congestive heart failure
An RN reviewing schoo
An RN reviewing school clinic records to determine which children are not up to date on their immunizations
An example of a health service that targets the larger community, rather than individuals, is:
Select all that apply.
providing well-infant care.
a mobile immunization clinic.
condemning or repairing unsafe housing.
encouraging family planning.
airing a w
a mobile immunization clinic.
condemning or repairing unsafe housing.
airing a weekly public service announcement to remind women to do breast self-examination.
Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to:
achieve access to preventive services of all Americans.
improve the
improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident.
Which of the following entities strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities?
Managed care organizations (MCOs)
Medicare
Public health system
Affor
Public health system
Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a:
neigh
food bank in a local church.
Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by:
supporting political activities to improve social and environmental conditions of immigrant families.
administering b
supporting political activities to improve social and environmental conditions of immigrant families.
focuses on groups of people, with the primary responsibility being the population as a whole. Care typically focuses on health promotion and illness prevention
Community health nursing
specific and emphasizes care to individuals
, often in homes and ambulatory clinics, and typically addresses acute and chronic health conditions.
Community-based nursing
Focus of public health is on
prevention and promotion of population health at the federal, state, and local levels
(gov't funded)
Discuss determinates of health and indicators of health and illness from a population perspective.
-Biology and Genetics (Ex: breast cancer gene)
-Individual Behaviors (Ex: smoking)
-Social Environment (Ex: dorm / common living)
-Physical Environment (Ex: pollution)
-Health Services (Ex: access to care)
-Policies and Interventions
*
LEVELS OF PREVENTION
*
Primary:
Prevent
(Immunizations, exercise, not smoking)
Secondary:
screen
/
detect
(Screening for STDs)
Tertiary: treat/teach
(Teaching insulin administration in the home, physical therapy)
...
science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort
public health
community health
community based nursing
public health
(gov't funded)
extends public health to include private efforts like AHA and Red Cross
public health
community health
community based nursing
community health
focuses on more individualized care within the community setting
public health
community health
community based nursing
community based nursing
(hospice, home health)
core functions of community/public health
assessment, policy development, assurance
Intervention wheel is population focused on 3 levels of practice
community, systems, and individual / families
tracking communicable diseases w/in community
surveillance
locates populations of interest or at risk -provides info about nature of the concern, what can be done, and how services can be obtained
outreach
(immunizations, screenings)
figuring out where diseases started
case finding
(following up w/ STD person to find source)
aggregates
common characteristics
Top 10 Public Health Achievements
-Vaccinations
-Motor Vehicle Safety
-Safer workplaces
-Control of infectious disease
-Decline in deaths from coronary heart disease / stroke
-Safer / healthier foods
-Healthier mothers and babies
-Family planning
-Fluoridation of drinking water
-Tobacco c
mother of epidemiology�environment--preventative care
Florence Nightingale
House on Henry Street Settlement: focused on all aspects of community: health care, food, shelter, bathing, arts (painting and dancing), resources to get a job, house, etc.�later called visiting nurse association
Lillian Wald
Mother of school nursing; went to schools and decreased absent rates
Mary Brewster
(memory trick: think of an old teacher in
school
you didn't like, now imagine her as a witch.. riding a broom stick...-
School-->Teacher-->Witch-->Broomstick-->
Brewster
))
always present in a population (colds, pna)
endemic
disease that are not always present in a populations but flare up on occasion (measles, ebola)
epidemic
existence of disease in a large proportion of the population (HIV/AIDS, annual outbreaks of influenza A)
pandemic
When nonindustrial cultures adopt Western customs and transition into urban environments, Western diseases begin to appear. Epidemiologic studies suggest that common risk factors that contribute these health conditions include:
Select all that apply.
chan
changes in diet.
environmental alterations.
increased population density.
occupational hazards.
Modern community health nursing requires the nurse to __, which empowers people to understand and address their health issues and disease.
practice from a population focus
adopt a medical model of care
return to earlier models of prevention
focus on the i
practice from a population focus
Lillian Wald and Mary Brewster's Henry Street Settlement was a model of modern health care. Which of the following services was provided to people living in the Lower East Side of New York City by the Henry Street Settlement nurses?
Select all that apply.
Home visits to ill mothers and children
School health services
Industrial health services to local workers
Support programs for immigrants
In which of the following historical ages would people have had an increased risk for contracting salmonella, anthrax, Q fever, or tuberculosis from the proximity of domesticated animals and herds?
Hunting and gathering stage
Settled village stage
Preindu
Settled village stage
(
Hunting Gathering Stage
: scattered aggregates were small, nomadic, and separated from other aggregates)
(
Settled village stage
: people lived close proximity to animals... led to contamination)
(
preindustrial stage:
large urban
Which of the following was NOT a public health service provided by the Romans?
A supervisor of the public baths
Street cleaners
Supervision of the sale of food
Housing for the indigent population
Housing for the indigent population
The first visiting nurse in the United States was:
Lillian Wald.
Mary Brewster.
Florence Nightingale.
Francis Root.
Francis Root
A school nurse would fall under the __________ health category
community
this model predicts or explains health behaviors, it assumes that preventative health behaviors are taken for the purpose of avoiding disease and change occurs at the individual level
health belief model
Which theory is considered a macro theory?
Orem
Health belief model
Milio
Milio
(change at the community level, change in large number of people can lead to social change)
Traditional health care; individualized and focuses on what can be done to help the person:
Micro theory
Macro theory
micro theory
Takes a broader look into society; what influences health?
Micro theory
Macro theory
macro theory
What factors need to be placed individually in order to
promote health
and how nurses can impact that and change attitudes, beliefs, and perceptions to create health outcomes:
Pender's health promotion model
Health belief model
Transtheoretical model
Theo
pender's health promotion model
(key word:
promote health
)
modifying factors to improve health:
Pender's health promotion model
Health belief model
Transtheoretical model
Theory of reasoned action
health belief model
behavior changes take place over time, progressing through a sequence of stages. It assumes each stage is both stable and open to change:
Pender's health promotion model
Health belief model
Transtheoretical model
Theory of reasoned action
Transtheoretical model
predicts a person's intention to perform or not to perform a certain behavior:
Pender's health promotion model
Health belief model
Transtheoretical model
Theory of reasoned action
theory of reasoned action
**
HEALTH BELIEF MODEL
**
(modifying factors to improve health)
Susceptibility
: belief of chance of
getting a condition
(threat of disease)
Severity
:
seriousness
of a given condition
Benefits
: ability of an advised action to reduce the health risk or s
**
TRANSTHEORETICAL MODEL
**
(behavior changes over time)
Precontemplation
: no intention to take action in 6 mo.
Contemplation
: some intention to take action in 6 mo.
Preparation
: intends to take action w/in next mo.; has taken steps toward beh. change
State of complete physical, mental, social well being and not merely the absence of disease
health
any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health.
health promotion
behaviors one engages w/ the specific intent to prevent disease, to detect disease in early stages, or to maximize health w/in the constraints of the disease
health protection
probability that a specific event will occur in a given time frame
risk
(e.g. r/f heart disease/cancer... the risk factors would be family hx, work stress, age, gender)
Receiving immunizations, regular health screenings, and physical exams is an example of:
health promotion.
health protection.
secondary prevention.
health maintenance.
health protection.
(intent to prevent disease or catch it in early stages)
Which of the following "determinants of health" would include predisposition to prostate cancer and a history of depression?
Biology
Behaviors
Social environment
Physical environment
Biology
(Biology refers to an individual's genetic makeup, family history, and physical and mental health problems experienced over the course of life.)
A man has been smoking for 20 of his 40 years. He smokes a pack of cigarettes daily and states, "My dad smoked two packs a day and lived to be almost 90. Besides, I'm going to die from something anyway, so why quit"? He is in which "stage of change" in th
Precontemplation
Which of the following "determinants of health" refers to factors that are experienced with the senses-things that can be seen, touched, heard, and smelled?
Biology
Behaviors
Social environment
Physical environment
Physical environment
A risk factor refers to a(n):
probability that a specific event will occur in a given time frame.
exposure that is associated with a disease.
systematic way of distinguishing the risks posed by potentially harmful exposures.
proactive process in which ind
exposure that is associated with a disease.
(E.g. smoking, sedentary lifestyle, high salt diet, obesity)
(A
risk
is probability that a specific event will occur in a given time frame)
What is the most common chemical dependence in the United States?
Alcohol
Cocaine
Marijuana
Nicotine
Nicotine
A 22-year-old college student explains to the nurse at the health clinic that she drinks four to five beers when she goes out with friends on Saturday nights. Otherwise, she rarely drinks during the week because of her classes, studying, and part-time job
binge drinking.
A smoking cessation class stresses increased lung function, money saved that is not spent on cigarettes, and smelling clean and fresh as benefits to quitting smoking. These support which of the following concepts?
Perceived barriers
Decisional balance
Pre
Decisional balance
(weighing the benefits of a behavior change against the cost of behavior change)
According to the health belief model, the inconvenience of driving to a gym to exercise is an example of a:
perceived susceptibility.
perceived barrier.
perceived benefit.
cue to action.
perceived barrier.
One dimension of a community, which looks at personal characteristics and risks of a group, is called:
aggregate of people.
location in space and time.
social system.
census tract.
aggregate of people.
Epidemiologic data can be useful in the planning phase of the community assessment process because they:
help discover the patterns of health and illness distribution in a population.
help construct benchmarks to gauge achievement of program objectives.
i
help construct benchmarks to gauge achievement of program objectives.
Which of the following sources of information about a community's health would give the community health nurse information about births, deaths, and marriages and aid in providing indicators of population growth or reduction?
Census tracts
Vital statistic
Vital statistics
The steps in the community assessment process for community health nurses are:
Select all that apply.
writing a community diagnosis.
evaluating the outcomes.
collecting assessment data.
identifying the cause of the problem.
planning community intervention
writing a community diagnosis.
evaluating the outcomes.
collecting assessment data.
planning community interventions.
(
A
ssess,
D
iagnose,
P
lan,
E
valuate)
One of the first steps in community assessment may involve the community health nurse driving or walking through an area and making observations about such things as environmental layout and location of agencies, hospitals, industries, and so forth. This
windshield survey.
Identify the etiologic or causal statement component of the following community diagnosis: "There is an increased risk for undetected testicular cancer among young men related to insufficient knowledge about the disease and the methods for preventing and
Insufficient knowledge about the disease and methods of prevention
A community health nurse in the assessment phase of the nursing process conducted research to identify the distribution pattern of breast cancer within a population and the associated risk factors. This is called:
statistical analysis.
needs assessment.
c
epidemiology.
(discover the patterns of health and illness distribution in a population.)
Which of the following methods of gathering data is most effective for remote and vulnerable segments of a community and for those communities with underdeveloped opinions?
Interviewing community informants
Community forum
Focus groups
Telephone surveys
Focus groups
When writing a community diagnosis, the community health nurse notes that the "among" phrase:
presents a synthesis of all assessment data.
provides the supporting data.
specifies the aggregate that will benefit from the nurse's plan.
describes the cause o
specifies the aggregate that will benefit from the nurse's plan.
Which of the following groups is an example of a community of solution? A group:
that lives within a specific geographic location.
concerned with reducing teenage suicides.
with the same ethnic background.
in which all members enjoy hiking.
concerned with reducing teenage suicides.
Community as a client
people who are the focus of nursing service.
Steps in the health planning model
Assessment
Planning
Intervention
Evaluation
PRECEDE-PROCEED Model
P
redisposing,
R
einforcing & *E*nabling *C*onstructs in *E*ducational *D*iagnosis and
E
C
redisposing, *R*einforcing & *E*nabling *C*onstructs in *E*ducational *D*iagnosis and
E
D
redisposing, *R*einforcing & *E*nabling *C*onstructs in *E*ducational *D*i
predisposing factors in the PRECEDE-PROCEED
knowledge, attitudes, behavior, beliefs, values before intervention that affect willingness to change
Enabling factors in PRECEDE-PROCEED
environment or community of an individual that facilitates or presents obstacles to change
Which of following factors is NOT necessary to consider when determining priorities for health problem interventions?
The aggregate's preferences
The number of individuals affected by the health problem
The nurse's preferences
The availability resources
The nurse's preferences
In planning, it is important for the nurse to allow time for individual nursing assessment and education for children who are overweight or obese and to plan classroom education programs. The nurse is demonstrating an understanding of which important comm
Community as client
A community health nurse is using the health planning model to improve a client's health. The nurse prepares for unexpected problems or complications in the client's care. This attention to unexpected problems takes place during which step?
Assessment
Pla
Intervention
(the nurse must prepare for unforeseen problems or complications and consider alternatives to meet the client's needs.)
Public service announcements, dissemination of pamphlets, and focus groups are examples of measures that can be used by the community health nurse. These are also known as:
levels of intervention.
nursing assessment.
evaluation methods.
nursing interventi
nursing interventions.
The level of prevention that includes early diagnosis is:
primary prevention.
secondary prevention.
tertiary prevention.
supralevel prevention.
secondary prevention.
(Seconday: screen/detect)
The community health nurse understands that a client's health can be negatively or positively affected by his or her suprasystem. Which of the following correctly describes a client's suprasystem? The suprasystem includes:
only health-related resources, s
all resources available for use by the client, including health-related and non-health-related resources.
(suprasystem includes a variety of organizations and community resources)
Before participating in health care planning, a community health nurse must understand the concept of:
community as client.
individual as client.
family as client.
environment as client.
community as client.
upstream thinking is focused on
interventions that promote health or prevent illness
**
COMMUNITY HEALTH
**
-Goals: promote, preserve, maintain health of populations by delivery of health services to to people, families, & groups
-Practice: w/in the community
-Community is the "client"
geographically defined area
**
PUBLIC HEALTH
**
-Goal: promote health and prevent disease
-Population focused
-Conduct research to gain new knowledge and solutions to public health problems
-Monitors health of a population
-Diagnose/investigate health problems/hazards in the communi