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CMN 420 E1 Questions With Complete Solutions
identification of needs, along with the protection and improvement of collective health, within a geographically defined area. - community health the science and art of preventing disease, prolonging life, and promoting health and efficiency - public health Explain the concept of community - A collection of people who share some important features of their lives. People who interact with one another and whose common interests or characteristics form the basis for sense of unity or belonging. Name 3 of the 10 leading health indicators. - Access to health services, clinical preventative services, environmental quality Discuss ways that public health nursing practice is linked to acute care nursing practice. - Community health nurses tend to continuous needs, such as assistance with providing a toddler- proof home, and episodic needs, such as a diagnosis of tuberculosis. Discuss the two main components of community health practice (health promotion and disease prevention). - a. Health Promotion - includes all efforts that seek to move people closer to optimal well-being or higher level of wellness. Goal is to raise levels of wellness for individuals, families, populations, and communities.
b. Disease Prevention - anticipating and averting problems or discovering them as early as possible in order to minimize potential disability and impairment. measures taken to keep illness or injuries form occurring, such as vaccines, using safety devices, and habitual healthy behaviors. - primary level of prevention efforts to detect and treat existing health problems at the earliest possible stage, when disease or impairment is already present, such as hypertension and cholesterol screenings. - secondary level of prevention reduce the extent and severity of a health problem to its lowest possible level, so as to minimize disability and restore or preserve functions, such as PT to reduce impairment after a stroke. - tertiary level of prevention eight characteristics of community health nursing - a. The client or "unit of care" is the population b. Primary obligation is to achieve the greatest good for the greatest number of people or the population. c. Public health nurses collaborate with the client as an equal partner. d. Primary prevention is the priority in selecting appropriate activities. e. Focusing on selecting strategies that create healthy environmental, social, and economic conditions in which populations may thrive.
Lucile Petry leone - becomes the CNO of PUH Analyze the impact of societal influences on the development and practice of community health nursing. - a. Advanced technology improved health care, nutrition, and lifestyle, and increased life expectancy. b. Progress in causal thought established that disease could be spread or transmitted from patient to patient or from nurse to patient by contaminated hands or equipment. c. Changes in education help people's understanding of their environment grow, which in turn increases understanding of health. d. Demographic changes, such as shifts in immigration, births/deaths, and a rapidly increasing population of elderly persons affect community health nursing. Women have increasingly become more financially independent with the profession. e. The consumer movement includes health care consumers becoming active members of the health team demanding high quality of service. f. Economic forces affect the number of people with health insurance and access to health care. Explore the academic and advanced professional preparation of community health nurses. - a. All skills learned in a basic bachelor's degree nursing program are needed. Continuous professional development and training must meet requirements of employers and state regulation. Graduate level education is needed to become an advanced practice nurse.
ID the three core public health functions basic to community health nursing. - a. Assessment - gather and analyze information that will affect the health of people to be served. b. Policy development - nurse provides leadership in convening and facilitating community groups to evaluate health concerns and develop a plan to address those concerns. c. Assurance - activities that make certain that services are provided, such as providing services to target populations 7 roles of community health nurse - a. Clinician - nurse ensures health services are provided not just to individuals and families, but also to groups and populations. b. Educator - Health teaching c. Advocate- pleading the cause of their clients or acting on their behalf d. Manager - exercises administrative direction toward the accomplishment of specified goals by assessing clients' needs, planning and organizing to meet those needs, directing and leading to achieve results, and controlling and evaluating the progress to ensure that goals are met. e. Collaborator - working jointly with others in a community endeavor, cooperating as partners. f. Leadership - focuses on effecting change, seeks to initiate changes that positively affect people's health g. Researcher - engaging in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice. 7 seven settings in which community health nurse practices - a. Homes - all the public health nursing roles are performed to varying degrees
c. Search for and collect the most relevant best evidence d. Critically appraise the evidence e. Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change f. Evaluate outcomes of the practice decision or change based on evidence g. Disseminate the outcomes of the EBP decision or change quantitative data - concerns data that can be quantified or measured objectively. It is helpful in ID'ing a problem or a relationship between two or more variables. Qualitative data - emphasizes subjectivity, asks "how" or "why". This information is much richer because it is not elicited from a forced-choice questionnaire; it is prompted by open-ended questions ad follow-up questions in a n effort to discover feelings and beliefs. 9 steps of research process - a. Identify an area of interest b. Formulate a research question or statement c. Review the literature d. Select a conceptual model e. Choose a research design f. Obtain IRB or HSC approval g. Collect and analyze data h. Interpret results i. Communicate findings Analyze the potential impact of research on community health nursing practice. - a. Gain new knowledge that will improve
health services and promote the public's health and has the potential to enhance nursing's status and influence ID the community health nurse's role in conducting research and using research findings to improve his or her practice. - Critically examine research reports and apply study findings to improve the public's health and apply the results of other investigator's research and systematic reviews Describe the nature of values and value systems and its influence on community health nursing - a. Values motivate people to behave in certain ways that are personally or socially preferable b. Values systems are considered organizations of beliefs that are of relative importance in guiding individual behavior Articulate the impact of key values on professional decision- making. - a. Background information: database plus selection of relevant information b. Identification and clarification of ethical components c. Rights, duties, and authority, and capabilities of the decision makers d. Options; possible courses of action and projected outcomes e. Reconciling facts and values: holding multiple values in tension f. Resolution social expectations and legal requirements lead to ACTION
- Discuss the application of ethical principles to community health nursing decision-making. - respect autonomy
Describe the meaning and effects of ethnocentrism on community health nursing practice - a. Expression of the belief that one's culture of origin is the best approach to life; a reflection of judgement on the beliefs and practice of others using our native culture as a reference point b. Ethnocentrisms blocks effective communication by creating biases and cause serious damage to interpersonal relationships and interfere with the effectiveness of nursing interventions
- ID five characteristics shared by all cultures. - Culture is learned, integrated, shared, tacit, and dynamic i. Prefer traditional healing practices and folk medicine; rely on traditional remedies before going to a health clinic ii. Earth considered a living organism that should be treated with respect, as should the body; practice purification rituals, such as water immersion and sweat lodges to cleanse the body and spirit
- Native American Indians, Aleut, and Eskimo communities i. View health as a sign of harmony with nature and illness being evidence of disharmony placed on someone by evil spirits, God's punishment, or a hex ii. Healers treat body, mind, and spirit; use prayer, laying on of hands, magic, rituals, special diets, wearing preventive charms, copper bracelets, ointments iii. Church attendance associated with positive health care practices, such as mental health conditions - b. Blacks or African Americans i. Yin (cold) and yang (hot) referring to the opposite forces of the universe regulating normal flow of energy; a balance of yin
and yang is "qi"; illness occurs when an imbalance is present; "Cold" foods: vegetables, fruits; "hot" foods: rice, chicken, eggs, pork ii. Traditional healers like acupuncturists, herbalists, herb pharmacist, spirit and magic experts, shaman iii. Dermabrasive techniques: coining, cupping, pinching, rubbing, burning to relieve s/s such as headache, sore throat, cough, fever, and diarrhea by bringing toxins to the skin surface or compensating for heat lost - asian americans i. Believe in the submission to the will of God and that illness may be a form of "castigo" (punishment); religion determines rituals used in healing ii. Have" curanderos" (native healer); some believe that "brujeria" (witchcraft) and "mal de ojo" (the evil eye) are supernatural causes of illness; sometimes use "hot" and "cold" foods to influence their diet during illness - hispanics i. Believe in predestination (life is determined beforehand) and attribute the occurrence of disease to the will of Allah; cleanliness is paramount and ritualistic ii. Left hand is used for cleaning genitals and the right hand is used for eating, hand shaking, and other hygienic activities - arabs and muslims susceptible human or animal who harbors and nourishes a disease-causing agent - host factor that causes of contributes to a health problem or condition
cross immunity - situation in which a person's immunity to one agent provides immunity to related agent as well; infection with cowpox can give immunity to smallpox define heard immunity - immunity level that is present in a population group; a population with high herd immunity is one in which the immune people in the group outnumber the susceptible people which decreases the incidence of a particular disease
- Explain how epidemiologists determine populations at risk. - Population at risk is a collection of people among whom a health problem has the possibility of developing certain influencing factors are present Relative risk ratio=(Incidence in exposed group)/(Incidence rate in unexposed group) 4 stages of disease or health condition - a. Susceptibility stage - disease not present and individuals have not been exposed b. Subclinical disease stage - begins when individuals have been exposed to a disease but are asymptomatic c. Clinical disease stage - s/s of disease or condition develop d. Resolution stage - disease or health condition causes sufficient anatomic/functional changes to produce recognizable s/s
- List the major sources of epidemiologic information. - a. Existing data - vital statistics, census data, reportable diseases, disease registries, surveillance systems, environmental
monitoring, national center for health statistics health surveys, CDC prevention reports b. Informational observational studies c. Scientific studies incidence vs prevalence - a. Incidence - all new cases of a disease or health condition appearing during a given time b. Prevalence - actual number of cases alive, with the disease either during a period of time or a particular date in time Discuss types of epidemiologic studies that are useful for researching aggregate health. - a. Prevalence study - patterns of occurrence b. Case-control study - compares people who have a health or illness condition with those who lack this condition c. Cohort study - group of people who share a common experience in a specific time period
- Discuss the nurse's role in communicable disease control. - a. Notify the local health department/agency of the communicable disease, work individual cases of a disease, ID additional people who might be infected, determining source of infection and means of transmission, ID'ing others at risk, preventing further transmission, and monitoring response to interventions. 3 modes of transmission - a. Airborne - through droplet nuclei (the small residues that result from evaporation of fluid from droplets emitted by an infected host) b. Vector - transmitted through a bite of an insect or animal or exposure to the infected animal's body fluids, such as urine
Discuss specific ways to prevent STD's, including HIV/AIDS - a. Promoting healthy sexual behaviors b. Increasing access to quality services c. Strengthening the community's ability to transport and provide sexual education and birth control
- Discuss the consequences of biologic terrorism with weapons such as anthrax and smallpox. - a. Fatality rate for cutaneous anthrax is 5-20%; inhalation has an 85% fatality rate b. Smallpox transmitted person to person and causes 104 Fever, malaise, HA, abdominal pain, and vomiting that leads to a macular and popular rash that scab over and fall off 3-4 weeks after onset
- Discuss the ethical issues affecting communicable disease and infection control. - a. Enforced compliance: public health officials have the power to enforce compliance with treatment or restrict the activity of infectious people to protect the welfare of others, but only of the methods are demonstrably effective and grounded in ethical principles b. Confidentiality, privacy, discrimination: HIPAA notes that reports must be made to public health in order to protect the public's health; this allows for disclosure of only info needed to protect the public without disclosing identifying info
- Discuss concepts of prevention and upstream approaches to health impact and environmental health. - a. Upstream approach considers socioeconomic factors and the environmental origins of disease and health problems; moves our thinking to factors that are the institutional and system level rather than looking solely at healthy lifestyle issues
b. Health disparities- great inequities occur between the environments of people with higher incomes, and those of low- income communities, people of color, and tribal populations. c. Social determinants of health- conditions in which people are born, grow, live, work and age. They are shaped by the distribution of money, power and resources at global, national, and local levels. d. Environmental justice - fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to development, implementation, and enforcement of environmental laws, regulations, and policies.
- Discuss guiding documents for public health nursing - a. Nurses are guided by public health documents, including the federal guidelines from the surgeon general report on Healthy People and the core functions of public health Discuss how the core functions of public health can be applied to public health nursing. - a. Assessment - investigation of health hazards, surveillance of health issues, such as disease or injury, examining causes, and assessing needs. b. Policy development- relies on science for decision-making and educates people to create community involvement in order to develop policies. c. Assurance - seeks innovative solutions to health issues, guarantees necessary services are provided, and provides oversight to policy implementation. review that effects of environmental hazards to human health -
b. Resistance to change - change agents can expect people to resist change c. Proper timing - other projects/activities in which the client system is currently engaged may compete for energy and other resources, depleting the energy and resources needed to make the proposed change successful d. Interdependence - a change in one part of a system affects its other parts, and a change in one system may affect other systems e. Flexibility - nurse needs to be able to adapt to unexpected events and make the most out of them f. Self-understanding - the community nurse should be able to clearly define his or her role and seek to understand how others define it ID educational activities for the nurse to use that appropriate for each of the three domains of learning. - a. Cognitive domain: recall or recognition of knowledge and the development of intellectual abilities and skills b. Psychomotor: infant bathing, temperature taking, range-of- motion exercises, walking with crutches c. Affective: develop the ability to accept ideas that promote healthier behaviors, even if those ideas conflict with the clients' own values
- ID health teaching models for use when planning health education activities. - a. Health belief model - explaining the behaviors and actions taken by people to prevent illness and injury b. Pender's health promotion model - exploring health-related behaviors within a nursing and behavioral science context
c. Transtheoretical/stages of change model - recognizes the human frailty and addresses it by anticipating relapses and recognizing them as an opportunity to better plan for how to sustain the needed change in future attempts ID teaching strategies for the community health nurse to use when encountering clients with special learning needs. - a. Thorough prep is important for successful learning to occur - find out whether teaching in English or other languages need to be used, develop a teaching plan b. Obtain info regarding interests and abilities of members c. With unexpected behaviors - give recognition sought by the person while also setting limits
- Classify health problems based on their changeability. - a. More changeable: diet choices, stress, sedentary activities b. Less changeable: school food, limited PE classes
- ID barriers to solving health problems - minimal funds, resisting change
- Discuss the role of the nurse within quality measurement and improvement programs in community/public health nursing. - a. Nurses must provide priority services that promote the highest possible level of personal and group function and health
- Describe the relationship between social policy and health outcomes - Health and social policy create conditions in which people can be healthy by addressing the social factors determinants of health in addition to the physiological and behavioral determinants.
