Community final exam Questions with Answers, Exams of Nursing

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Community final exam Questions with

Answers

ATI chapter review questions:

Chapter 1 A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community oriented nursing, the nurse should include which of the following situations as example of community- based nursing? (Select all that apply) A. home health nurse performing wound care for a client who is immobile a. An occupational health nurse providing classes on body mechanics at a local industrial plant b. A school nurse teaching a student who has asthma about medications c. A parish nurse teaching a class on low-sodium cooking techniques d. A mental health nurse discussing stress management techniques with a support group

2. A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles. a. Distributive justice b. Fidelity (Keep promise) c. Respect for autonomy d. Veracity (Truth)
3. A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following factors as agents? (Select all that apply.) a. Resources availability b. Ethnicity c. Toxins d. Bacteria e. Altered immunity 4) A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners. a. Showing informational videos b. Providing equipment to practice hands-on skills c. Supplying outlines for note-taking d. Facilitating small group discussion
4. A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? a. Performing a home safety check at a client’s home (Secondary) b. Teaching healthy nutrition to clients who have hypertension (Tertiary)

Chapter 2 c. Providing influenza immunizations to employees at a local preschool d. Implementing a program to notify individuals exposed to a communicable disease (Secondary)

1. A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following factors are influenced by an individuals culture (Select all that apply.) Exam a. Nutritional practices b. Family structure c. Health care interactions d. Biological variations e. Views about illness

2. A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? a. Determine the client’s perception of his current health status b. Gather data about the client’s cultural beliefs. c. Determine how the client’s culture can affect the effectiveness of nursing actions. d. Gather information about previous client interactions with the health care system
3. A nurse is using the I PREPARE mnemonic to asses a client’s potential environmental exposures. Which of the following questions should the nurse ask when assessing “A” in the mnemonic? a. What do you like to do for fun? (Activities) b. What year was your residence built? (R) c. What jobs have you had in the past? (P) d. What industries are near where you live? (E - environment)
4. A nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health department to provide? (Select all that apply) a. Managing the women, infants and children program (State department of health) b. Providing education to achieve community health goals c. Coordinating directives from state personnel d. Reporting communicable diseases to the CDC (State department of health) e. Licensing of registered nurses (Board of nursing)
5. A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? a. I don’t drive and my son is only available to take me places in the mornings b. I can’t take off during the day and the local after-hours clinic is no longer in operation

Chapter 3 c. Only one doctor in my town is a designated provider by my health maintenance organization d. I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English.

1. A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? (Select all that apply) EXAM a. Ethnicity of community members b. Individuals who hold power within the community c. Natural community boundaries d. Prevalence of disease e. Presence of public protection 2. A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first? a. Determine health patterns within collected data b. Compile collected data into a database c. Ensure a data collection is complete d. Identify health needs of the local community
2. A nurse is planning a community health program. Which of the following actions should the nurse include as part of the evaluation plan? a. Determine availability of resources to initiate the plan b. Gain approval for the program from local leaders c. Establish a timeline for implementation of interventions d. Compare program impact to similar programs
3. A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community? EXAM a. Key informant interviews b. Participant observation c. Focus groups d. Health surveys
4. A nurse is collecting data to identify health needs in the local community. Which of the following examples should the nurse identify as secondary data? a. Birth statistics b. Previous health survey results c. Windshield survey d. Community forum e. Health records

Chapter 4

1. A nurse is talking to a client who asks for additional information about hospice. Which of the following statements should the nurse make? a. Clients who require skilled nursing care at home qualify for hospice care b. One function of hospice is to provide teaching to clients about lie-sustaining measures c. Hospice assists clients to develop the skills needed to care for themselves independently d. A component of hospice care is to control the client’s manifestation
2. A school nurse is scheduling visits with a physical therapists for a child who has cerebral for a child who has cerebral palsy. In which of the following roles is the nurse functioning? a. Direct caregiver b. Consultant c. Case manager d. Counselor
3. An occupational health nurse is consulting with senior management of a local industrial facility. When discussing work-related illness and injury, the nurse should include which of the following factors as physical agents? (Select all that apply) a. Noise b. Age c. Lighting d. Viruses e. Stress 4. A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following information should the nurse determine when conducting a work site survey? a. Work practices of employees b. Past exposure to specific agents c. Past jobs of individual employees d. Length of time working in current role 5. A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? a. Placing posters with images of appropriate hand hygiene near restrooms (1ry) b. Routinely checking students for pediculosis throughout the school year (2ry) c. Implementing age-appropriate injury prevention programs for each grade level. (1ry) d. Working with a dietitian to determine carbohydrate counts for students who have diabetes mellitus (3ry)

Chapter 5

1. A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following manifestations as a possible indication of child neglect? a. Underweight b. Healing spiral fracture of the arm (Physical abuse) c. Genital irritation (Sexual abuse) d. Burns on the palms of the hands (Physical abuse) e. Poor hygiene

2. A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings should the nurse identify as a manifestation of withdrawal? ( Tachycardia, dilated pupils and increase BP) a. Decreased blood pressure b. Diaphoresis c. Pinpoint pupils d. Bradycardia
3. A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following information should the nurse include when discussing nicotine and smoking? a. Smoking is the fifth-most preventable cause of death in the United States b. Nicotine is a central nervous system depressant c. Withdrawal effects from smoking are minimal d. Tolerance to nicotine develops quickly 4. A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? a. Providing support programs for new parents (1ry) b. Screening a client whose partner recently died for suicide risk (secondary) c. Teaching a client who has schizophrenia about medication interactions d. Discussing stress reduction techniques with employees at an industrial site (1ry) 5. A nurse at an urban community health agency is developing an about homelessness. Which of the following groups should the nurse include as the fastest-growing segment of the homeless population?EXAM a. Families with children b. Adolescent runaways c. Intimate partner abuse survivors d. Older adults

Chapter 6

1. A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following illnesses as airborne? a. Cholera b. Malaria c. Influenza d. Salmonellosis
2. A home health nurses is discussing portal of entry with a group of newly hired assistive personnel. Which of the following locations should the nurse include as a portal of entry? (Select all that apply.) a. Respiratory secretions b. Skin c. Genitourinary tract d. Saliva e. Mucous membranes
3. A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? EXAM a. Outlining specific roles of community agencies b. Identifying community vulnerabilities c. Prioritizing care of individuals d. Providing stress counseling
4. Bioterrorism is category A biological agent a. Hantavirus Category C b. Typhus Category B c. Plague d. Tularemia e. Botulism
5. A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? a. Metronidazole b. Ciprofloxacin c. Zanamivir d. Fluconazole Chapter 7
6. A nurse is creating partnerships to address health needs within the community. The nurse should get aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.) a. Being a leading partner with decision-making authority b. Flexibility among partners when considering new ideas c. Adherence of partners to ethical principles

d. Varying goals for the different partners e. Willingness of partner to negotiate roles

2. A nurse is reviewing the various roles of a community health nurse. Which of the following actions is an example of a nurse functioning as a consultant? a. Advocating for federal funding of local health screening programs b. Updating state officials about health needs of the local community c. Facilitating discussion of a client’s ongoing needs with an interprofessional team d. Performing health screenings for high blood pressure at a local health fair. 3. A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationships with the client, the nurse is engaging in the referral process. Which of the following actions should the nurse take first? a. Monitor the client’s satisfaction wit ha the referral b. Provide the client information to referral agencies c. Review available resources with the client d. Identify referrals that the client needs. 4. A nurse developing a community health program is determining barriers to community resource referrals. Which of the following factors should the nurse include as an example of a resource barrier? a. Costs associated with services b. Decreased motivation c. Inadequate knowledge of resources d. Lack of transportation

5. A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following actions should the nurse take in the implementation phase of the case management process? a. Coordinating services to meet the client’s needs Implementation b. Comparing outcomes with original goals (evaluation) c. Determining the client’s financial constraints (Assess) d. Clarifying roles of interprofessional team members (Planning)

Power point slides

Chapter 19 Historic Overview 🞄 Red Cross Rural Nursing Service (1912) 🞄 Before this, care of the sick in small communities was provided by informal social support systems. 🞄 Problems in rural communities for generations 🞄 Mal-distribution of health professionals 🞄 Poverty 🞄 Limited access to services 🞄 Ignorance 🞄 Social isolation Definitions of Terms 🞄 Rurality: a subjective concept – defined in terms of geographic location & population density. 🞄 Rural-urban continuum – both highly diverse & vary in demographic, environmental, economic, and social characteristics. Rurality: A Subjective Concept 🞄 Increasing urban influence 🞄 Differences in rural versus urban less significant now 🞄 Rural = multiple definitions 🞄 Farm residency versus non-farm residency 🞄 Each town is distinct. 🞄 Relative nature of ruralness 🞄 Rural-urban continuum 🞄 Rural and urban residencies not opposing lifestyles 🞄 Must be seen on a wider range 🞄 Remote farm to village to small town to larger town or city to large metropolitan area with a core inner city.

🞄 Rural is defined in terms of the geographic location and population density, or it may be described in terms of the distance from (e.g., 20 miles) or the time (e.g., 30 minutes) needed to commute to an urban center. Geographic Entities 🞄 Core-based statistical area 🞄 Collective term for metro and micro areas 🞄 Metropolitan area 🞄 Core urban area of 50,000 or more 🞄 Micropolitan area 🞄 Urban core of at least 10,000 but less than 50, 🞄 About 60% of the total non-metro population 🞄 Non-core area 🞄 No urban core, but on average 14,000 residents 🞄 Suburbs “Doughnut effect” Which makes up about 60% of the total non-metro population? A. Metropolitan area B. Micropolitan area C. Non-core area D. None of the above Population Characteristics: Rural 🞄 More whites 🞄 Higher proportion of younger (under 18 years of age) and older residents (over 65 years of age) 🞄 More likely to be married 🞄 More likely to be widowed 🞄 Some rural counties have a significant minority population.

🞄 More likely to be poorer 🞄 Fewer years of formal education 🞄 At risk for being underinsured or uninsured

Rural Perspectives

- Patterns of health service use – once a year- despite more chronic disease

• Maternal-infant health – reports in literature conflict; however, high level of infant & maternal morbidity & mortality. Extreme variations in pregnancy from one part of country to another.
• Health of children – regional variations & conflicting data. GP vs Pediatrician - Mental health – endemic level of depression among residents of an economically stressed rural areas. When mental health services available, residents delay seeking care until it is crisis level.
• Health of minorities –rural homeless or migrant farmworkers. Local families whose homes have been foreclosed. May in some cases allowed to live in home.
• Environmental and occupational health risks – high risk occupations mostly in rural areas. Mining,forestry, marine & agriculture. Family owned higher risk as not subject to Federal rules.
• Several states in Northwest & intermountain states have the best pregnancy outcomes. Several other counties in same states have worst outcome.. Highest Indian reservations, migrant workers, & minorities. - Rural children less likely to have a pediatrician. More a GP. School nurses play a big role in children's health QUESTION A community health nurse is developing strategies to prevent or improve mental health issues in the rural area of Kentucky. In which of the following areas is the nurse implementing a tertiary strategy for endemic depression in the community? A. Discussing stress reduction techniques with employees at an industrial site B. Providing support programs for the newly unemployed C. Teaching a client who is depressed the importance of not skipping a dose of a new medication D. Screening a an unemployed client whose partner has recently committed suicide The bureau of Primary Care and Rural Health is dedicated to improving the health status of Louisiana residents in rural and underserved areas: 🞄 Perceived health status 🞄 Higher Infant mortality 🞄 Higher rates of diabetes 🞄 Higher rates of obesity 🞄 Less likely to meet physical activity recommendations 🞄 Higher rate of suicide 🞄 Increased rate of trauma 🞄 Increased Occupational – associated risk 🞄 Chronic illness 🞄 Rural-urban health disparities 🞄 Physical limitations

🞄 Availability and access of health care 🞄 Health professional shortage area (HPSA) 🞄 Less likely to seek preventive care. 🞄 Rural adults are more likely than urban adults to have one or more of the following chronic conditions: heart disease, chronic obstructive pulmonary disease, hypertension, arthritis, rheumatism, diabetes, cardiovascular disease, and cancer. Trauma/injuries from lightening, farm machinery, drowning & boating, snowmobile all terrain vehicle & motorcycle crashes

Rural Health Care Delivery Issues and Barriers to Care

🞄 Lack of health care providers and services 🞄 Great distances to obtain services 🞄 Lack of personal transportation 🞄 Unavailable public transportation 🞄 Lack of telephone services 🞄 Unavailable outreach services 🞄 Inequitable reimbursement policies for providers 🞄 Unpredictable weather or travel conditions 🞄 Inability to pay for care/lack of health insurance 🞄 Lack of “know how” to procure publicly funded entitlements and services 🞄 Inadequate provider attitudes and understanding about rural populations 🞄 Language barriers (caregivers not linguistically competent) 🞄 Care and services not culturally and linguistically appropriate Nursing Care in Rural Environments 🞄 Theory, research, and practice 🞄 Research needs 🞄 Preparing nurses for rural practice settings Body of literature on rural health is growing 🞄 Most publications focused on hospital practice, but information is applicable to both community agencies and community-focused nursing. Physical isolation 🞄 Professional isolation for nurses and practitioners 🞄 Scarce financial, human, and health care resources 🞄 Broad scope of practice Research Needs 🞄 Greater recognition for rural nurses 🞄 Stressors and rewards of rural practice 🞄 Empirical data on particular community nursing needs of rural-client systems 🞄 International perspective 🞄 Most efficient and effective way to use technology in rural health care 🞄 Distance learning 🞄 Rural-urban disparities in health status Preparing Nurses for Rural Practice Settings

🞄 Rural nurses need broad knowledge, including knowledge in these areas: 🞄 Health promotion, primary prevention, pediatrics, rehabilitation, obstetrics, medical-surgical care 🞄 Planning and implementing community assessments 🞄 Understanding the public health risks and needs for emergency preparedness in a particular state 🞄 Telehealth: uses a variety of technological solutions to provide preventive, and curative aspects of health care 🞄 Nursing Interventions for Rural Health 🞄 Assist clients with identifying and applying for assistance programs 🞄 Use cultural competence when planning interventions 🞄 Establish trusting partnerships with key individuals in the community 🞄 Use existing relational ties between residents tp foster community outreach activities. Examples of telehealth solutions:

• Communicating by e-mail with clients
• Ordering medications from a pharmacy
• Consulting with other health care providers
• Accessing advanced or continuing education offered by a university located some distance from the receiving site Telecommunication technology could be as simple as nurses in two or more different public health settings consulting over the telephone or via computer video conferencing coordinating local health fairs, or as complex as nurse scholars collaborating with international peers on a community health–focused research project or a medical specialist located at a health science center completing complex robotic surgical technology on a client who is located in another country. Future Perspectives 🞄 Scarce Resources and Comprehensive Health Care Continuum 🞄 Healthy People 2020 National Health Objectives Related to Rural Health 🞄 The Delta Rural Access Program (DRAP) provides preventive services for individuals at- risk of developing chronic health conditions and increases access to prescription drugs for residents in the Delta region. Scarce Resources and Comprehensive Care Continuum 🞄 Needed in most rural areas 🞄 School and parish nurses 🞄 Family planning services 🞄 Prenatal and postpartum services 🞄 Resources for clients with HIV/AIDS and families 🞄 Emergency medical services 🞄 Resources for families of children with special needs, including those who are physically and mentally challenged 🞄 Mental health services 🞄 Resources for older adults Healthy People 2020 🞄 CDC’s Healthy Communities Initiative

🞄 When implementing community-focused health plans that emerge from Healthy People 2020 , consideration must always be given to the rural context, such as these: 🞄 Sparse population 🞄 Geographic remoteness 🞄 Scarce resources 🞄 Personnel shortages 🞄 Physical, emotional, and social isolation Healthy People 2020 Goal These selected objectives pertain to residents of both rural and urban areas:

• AHS-3 : Increase the proportion of persons with a usual primary care provider.
• IVP-13: Reduce motor vehicle crash–related deaths.
• MHMD-9: Increase the proportion of adults with mental disorders who receive treatment.
• HDS-2: Reduce coronary heart disease deaths.
• IVP-1: Reduce fatal and non-fatal injuries. Building Professional-Community-Client Partnerships in Rural Settings: 🞄 Case management 🞄 Community-oriented primary health care Case Management 🞄 A client-professional partnership that can be used to do the following: 🞄 Arrange a continuum of care for rural clients, with the case manager tailoring and blending formal and informal resources. 🞄 Allow clients’ participation in their care plan. 🞄 Outcomes are often remarkably different when case management is used. Community-Oriented Primary Health Care (COPHC) – A GROUP ORIENTATION [Community BASED = treating the INDIVIDUAL/FAMILY] 🞄 Effective model for delivering services to vulnerable, underserved populations 🞄 Emphasizes the following : 🞄 Flexibility 🞄 Professional-community partnerships 🞄 Inter-professional involvement 🞄 Problem-oriented approach 🞄 Community/grassroots involvement 🞄 Blends 🞄 Primary care 🞄 Public health 🞄 Prevention services 🞄 All of which are all offered in a familiar and accessible setting 🞄 Ch. 19: Levels of Prevention Rural Health 🞄 Primary 🞄 Public health nurse partners with women’s organization in faith community located in small Midwestern town to instruct

members on meal planning as strategy to offset tendency to develop diabetes in family members 🞄 Public health nurse advocates for policy changes regarding sexual education content (to include information on contraception that goes beyond abstinence) in schools with district commissioners of education 🞄 Secondary 🞄 PHN screens congregation members of faith community in Midwestern town for presence of diabetes 🞄 PHN partners with local critical access hospital to offer free cholesterol, blood pressure, and blood sugar screening as well as influenza vaccine (becomes secondary when applies to more than 1 person) to adults attending annual county health fair 🞄 Tertiary 🞄 PHN collaborates with senior center in small community town, which provides meals on routine basis to elderly, to reach individuals with diabetes diagnosis 🞄 PHN provides consultation on diabetic nutrition, exercise habits, foot care, and if needed, assists clients in obtaining medications through mail order pharmaceutical vender 🞄 Rehabilitation*** QSEN Targeted Competency: Quality Improvement  Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Important aspects of quality improvement include:  Knowledge: Explain importance of variation and measurement in assessing quality of care.  Skills: Use quality measures to understand performance.  Attitudes: Value measurement and its role in good client care. Quality improvement Questions  Examine health statistics and demographic data in your geographic area to determine which vulnerable groups re predominant. Look on the web for examples of agencies you think provide services to these vulnerable groups. If the agency has a web page, read about the target population they serve, the types of service they provide, and how they are reimbursed for services. Learn about different agencies and share results during class. Based on your findings, identify gaps or overlaps in services provided to vulnerable groups in your community. Which data do these agencies collect to

demonstrate the efficacy of their services? How could you deal with these gaps ad overlaps to help clients receive needed services. o Box 19-2: Disparities among US Urban (Metropolitan) and Rural (Micropolitan) Residents’ Health Status o Residents of fringe counties (typically the healthiest cities) near large metro areas have the following:  Lowest levels of premature mortality, partly reflecting lower death rates for unintentional injuries, homicide, and suicide  Lowest levels of smoking, alcohol consumption, and childbearing adolescents  Lowest prevalence of physical inactivity during leisure time among women  Lowest levels of obesity among adults  Greatest number of physician specialists and dentists per capita (healthcare access)  Lowest percentage of population without health insurance  Lowest percentage of population who had no dental visits o Residents in the most rural counties have the following:  Highest death rates for children and young adults  Highest death rates for unintentional and motor vehicle traffic-related injuries  Highest death rates among adults for ischemic heart disease and suicide  Highest levels of smoking among adolescents  Highest levels of physical activity (likely occupation related) during leisure time among men  Highest levels of obesity among adults  Highest percentage of adults with activity limitations caused by chronic health conditions  Fewest physician specialists and dentists per capita  Least likely to have seen a dentist  Highest percentage of population without health insurance o Box 19-3: Rural-Urban Disparities: Lifestyle and Health Behaviors  Residents in any rural areas are more likely to report fair to poor health status (19.5%) than were residents of urban counties (15.6%)  Rural residents are more likely to report having diabetes (9.6%) versus urban adults (8.4%)  Rates of diabetes are markedly higher among rural American Indians (15.2%) and African American adults (15.1%)  Rural residents are more likely to be obese (27.4%) versus urban residents (23.9%)

 Rural black adults are particularly at risk for obesity: ranging from 38.9% in rural micropolitan counties to 40.7% in remote rural counties  Rural residents are less likely to meet CDC recommendations for moderate or vigorous physical activity (44%) versus urban residents (45.4%)  Rural African American adults are less likely to meet recommendations for physical activity than other rural residents; this different persists across all levels of rurality o Access to Health Care Services  Rural residents are more likely to be uninsured (17.8%) versus urban residents (15.3%)  Hispanic adults are more likely to lack insurance, with uninsured rates ranging from 40.8% in rural micropolitan counties to 56.1% in small remote counties  Most rural residents (81%) and urban residents (79.4%) report having a personal health care provider. However, residents in remote rural counties were least likely to have a personal physician (78,7%)  Rural white adults are more likely to have a personal health care provider than were other adults. Among Hispanic adults, the proportion with a personal provider ranged from 60.5% in rural micropolitan counties to 47.7% in remote rural counties  Rural adults are more likely than urban adults to defer seeking health care because of cost (15.1% vs 13.1%)  Rural adult African Americans, Hispanics, and American Indians are more likely to report having deferred care due to cost compared with white rural residents o Receipt of Preventive Services  Rural women are less likely (70.7%) than urban women (77.9%) to be in compliance with mammogram screening guidelines Rural women are less likely (86%) than urban women (91.4%) to have had a Pap smear within past 3 years  Rural residents over age 50 years are less likely (57.7%) to have had a colorectal screening versus urban counterparts (61.4%) o Quality of Diabetes Care  The proportion of adults with diabetes who reported receiving at least two hemoglobin A1c tests within past year was low among both rural (33.1%) and urban residents (35%)  White rural residents with diabetes were more likely than African American or Hispanic residents to receive at least two hemoglobin A1c test in past year

 Only 64.2% of rural and 69.1% or urban residents with diabetes reported receiving an annual dilated eye examination

TB

1. Rurality is a subjective concept because: a. everyone has an idea as to what constitutes a rural setting. b. the differences between rural and urban areas are very distinct. c. rural health has not been very well researched. d. the demographic and social characteristics of urban people are similar. 2.A nurse visited a client living on a farm residency. Which of the following best describes the area the nurse visited? a. A region that has fewer than six persons per square mile b. A home outside areas zoned as “city limits” c. A county in a metro area with fewer than 1 million people d. An area adjacent to a highly populated city
2. A nurse builds a vacation home in a remote area having fewer than six people per square mile so he can “get away from it all.” Which of the following best describes the classification of this area? a. Standard metropolitan statistical area b. Metropolitan county c. Frontier d. Rural area percentage of U.S. residents living in rural settings is about: a. 5%. b. 15%. c. 20%. d. 40%. Which group is over-represented in rural areas when compared with urban areas? a. African Americans b. Asian-Pacific Islanders c. Caucasians d. Native Americans A nurse who had been working in an urban area is now employed in a rural area. Which of the following differences between the populations is the nurse most likely to notice? a. Increased number of residents under age 18 b. Increased number of residents over age 50 c. Increased number of residents who are married d. Increased number of residents who have more years of formal education Compared with urban Americans, rural residents: a. are more likely to engage in preventive health behavior. b. are less likely to be exposed to occupational and environmental hazards. c. have a higher rate of chronic illness. d. rate their overall health status more favorably. In comparison with urban adults, rural adults:

a. seek medical care more often. b. have poorer overall health status. c. are less likely to identify a usual source of medical care. d. are usually seen by a specialist rather than a general practitioner. A nurse provides care to rural adults after working in an urban clinic for many years. Which of the following considerations should the nurse make when working with this population? a. Rural adults are more likely to have health insurance. b. Rural adults are more likely to have access to health care providers. c. Rural adults are more concerned about their health status. d. Rural adults are more likely to experience mobility limitations. A nurse is assisting with recruitment of health care providers to a primary care facility. Which of the following facts about the rural population and their patterns of seeking medical care should be considered? a. Fewer rural adults seek medical care than urban adults. b. There is a greater population to serve in rural areas. c. Poor adults in urban areas have less access to care. d. Rural adults do not want to seek care. A nurse administrator is educating her new nursing staff about the use of health care by rural residents. Which of the following statements is she most likely to include in her presentation? a. “Rural adults are less likely to identify a particular medical provider.” b. “Rural adults are more likely to see general practitioners and advanced practice nurses than their urban counterparts.” c. “Rural adults are more likely to seek medical treatment from a specialist than those in urban areas.” d. “Rural adults usually have to travel an average of 60 minutes to see a provider.” A nurse is providing maternal-child care for rural women. The nurse would like to intervene with pregnant women who are at risk for poor health outcomes. Which of the following populations would be the target population for the nurse’s care? a. Latinos who live in urban environments b. Caucasians who live in remote areas c. Those who live on or near Indian reservations d. Those who seek health from general practitioners A client is suffering from stress related to the depressed lumber industry in his county. Which of the following best describes this client’s condition? a. Manic-depression b. Psychosis c. Anticipatory grieving d. Farm stress f the following describes a barrier to obtaining care in a rural area? a. Readily available transportation b. Inadequate provider understanding about rural health needs c. Short distances to health care facilities

d. Available specialists rse is providing care to a Native Alaskan client. Which of the following exposures should the nurse anticipate may require specialized community nursing care? a. Exposure to toxic substances b. Farmer’s lung c. Field sanitation d. Black lung Native Alaskans have special care needs related to exposure to toxic substances/contaminants, hypothermia, interpersonal/domestic violence, infectious diseases, dental caries/loss, and diabetes. Farmer’s lung is associated with farmers/ranchers. Field sanitation is associated with migrant farmworkers. Black lung is associated with coal miners. Which is a characteristic of nursing practice in rural environments? a. Anonymity b. Less autonomy c. Professional isolation d. Faster pace ANS: C Concerns with professional isolation are often noted in rural practice environments. However, technology continues to improve the problems with isolation. A nurse working in a rural environment has no anonymity, has greater autonomy, and works at a slower pace. A nurse is practicing in a rural environment. Which of the following opportunities exist for in the nurse’s practice? a. Variety/diversity in clinical experiences b. Slower pace c. Direct collaborative practice opportunities d. Abundant resources A nurse is planning to conduct research in a rural setting. Which of the following areas of research may be of most importance to rural nursing practice? a. Information about residents living in the intermountain and Midwestern regions b. Information on the stressors and rewards of rural practice c. Studies related to moving from rural environments to urban ones d. Studies about the effects of air pollution A nurse is planning care using the case management model. Which of the following interventions would be most appropriate when implementing this model of care? a. Providing a client-professional partnership b. Delivering accessible care to medically underserved areas c. Defining the characteristics of a community d. Evaluating the outcomes of rural programs

A nurse is providing care for at-risk minority groups in rural America. Which of the following health care needs are appropriate for the nurse to address? (Select all that apply.) a. Field sanitation b. Infectious diseases c. Maternal care services d. Oral/dental care e. Chronic diseases A nurse is planning interventions that will be used when providing care for a rural client. Which of the following characteristics of rural life should the nurse anticipate? (Select all that apply.) a. Lack of anonymity b. Higher prevalence of high-risk occupations c. Churches and schools as socialization centers d. Preference for interacting with outsiders e. Increased mobility

Chapter 20

Promoting Health Through Healthy Communities and Cities Issues in Public Health Nursing: Promoting Healthy Cities 🞄 “This is not your team of nurses—in fact, we’re not all nurses,” 🞄 “Working with the Healthy Cities initiative is the most fun you can have on the job as a nurse.” 🞄 Collaborative coalition made up of dedicated citizens and business and civic leaders who have come together to make their city a healthier place for everyone to live. Healthy Communities and Cities Movement: 🞄 1986: Ottawa Charter for Health Promotion 🞄 First worldwide action plan for health promotion 🞄 Building public health policy 🞄 Creating supportive environments 🞄 Strengthening community action 🞄 Developing personal skills 🞄 Reorienting health services Healthy Communities and Cities—Different Names Around the World 🞄 Healthy islands 🞄 Healthy villages 🞄 Healthy municipalities and communities Definition of Terms

🞄 Healthy place (Centers for Disease Control and Prevention [CDC] definition) 🞄 Primary health care 🞄 International cooperation 🞄 Equity 🞄 Health promotion 🞄 Community participation 🞄 Multisectoral cooperation 🞄 Appropriate technology 🞄 Healthy place is defined as one “ designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders —where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options” (CDC, Healthy Places, 201). 🞄 Primary health care refers to meeting the basic health needs of a community by providing readily accessible health services. Because health problems transcend international borders, international cooperation is important to ensure health. 🞄 Equity implies providing accessible services to promote the health of populations most at risk for health problems (e.g., the poor, the young, older adults, minorities, the homeless, and immigrants and refugees). 🞄 Health promotion and disease prevention focus on providing community members with a positive sense of health that strengthens their physical, mental, and emotional capacities. Individuals within communities become involved in health promotion through community participation , whereby well-informed and motivated community members participate in planning, implementing, and evaluating health programs. 🞄 Multisectoral cooperation is the coordinated action by all parts of a community, from local government officials to grassroots community members. 🞄 Appropriate technology refers to affordable social, biomedical, and health services that are relevant and acceptable to individuals’ health, needs, and concerns.

Models for Community Practice

🞄 Locality development 🞄 Process-oriented model 🞄 Consensus and group identity 🞄 Emphasizes consensus, cooperation, and building group identity and a sense of community. 🞄 Social planning 🞄 Rational-empirical problem solving 🞄 Planning stresses rational-empirical problem solving, usually by outside professional experts. 🞄 Social planning does not focus on building community capacity or fostering fundamental social change.

🞄 Social action ability by the community 🞄 Increase problem-solving ability of the community 🞄 Correct imbalance of power 🞄 Attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. The key models for community practice include the following:

1. Locality development is a process-oriented model that emphasizes consensus, cooperation, and building group identity and a sense of community.
2. Social planning stresses rational-empirical problem solving, usually by outside professional experts. Social planning does not focus on building community capacity or fostering fundamental social change.
3. Social action aims to increase the problem-solving ability of the community with concrete actions that attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. Which model of community practice stresses rational-empirical problem solving? A. Consensus/group identity B. Locality development C. Social planning D. Social action Which model of community practice stresses correcting the imbalance of power and privilege? A. Consensus/group identity B. Locality development C. Social planning D. Social action Healthy Communities and Cities in the United States 🞄 CDC’s Healthy Communities Program 🞄 Emphasizes policy, systems, and environmental changes 🞄 Focus is on chronic diseases 🞄 Encourage physical activity, healthy diet 🞄 Discourage tobacco use 🞄 “ Tools for community action ” The CDC has developed a set of “tools for community action” that can be used in developing healthy communities. Some of these tools are as follows:
4. Community Health Online Resource Center (formerly the Community Health Resources Database): see http://cdc.gov/DCH_CHORC/ to find assistance in planning, implementing, and evaluating community health interventions and programs that address their focus on chronic disease.

2. The Community Guide: see http://www.thecommunityguide./org/index.html to find evidence-based public health and community health interventions. 3. Community Health Assessment and Group Evaluation (CHANGE) Tool: Community leaders can use this tool to see what local policy, systems, and environmental strategies are currently in place in their communities and identify areas where health strategies are needed. CHANGE assists communities to define and prioritize areas for their own improvement. See http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/cha **nge/pdf/changeactionguide.htm.
3. Action Guides:** The Community Health Promotion Handbook: Action Guides to Improve Community Health (Partnership for Prevention, 2008)****. In collaboration with the Partnership for Prevention program, the CDC has developed a set of “how-to” guides for five community-level health promotion strategies related to its chronic disease prevention target areas of diabetes self-management, physical activity, and tobacco- use cessation. See http://www.prevent.org/Initiatives/Action-Guides.aspx for a list of specific guides.
4. Five areas of impact on health behavior :
   1. Individual
   2. Interpersonal
   3. Organizational
   4. Community
   5. Policy Using the Handbook: Steps to Determine Which Area to Target 🞄 Conduct needs assessment. 🞄 Set health priorities. 🞄 Pinpoint factors affecting each priority. 🞄 Pinpoint options for tackling priorities. 🞄 Evaluate acceptability and feasibility. Healthy Municipalities and Communities Movement’s Mission (PAHO) 🞄 Strengthen local implementation. 🞄 Make health promotion a high political priority. 🞄 Foster government involvement. 🞄 Foster active community participation. 🞄 Support dialogue. 🞄 Share knowledge and experiences. 🞄 Stimulate collaboration among communities and nations. Developing a Healthy Community 🞄 National Civic League 🞄 Address root causes 🞄 “Health” goes beyond “absence of disease.” 🞄 Collaborative , consensus based 🞄 Assets based

🞄 Defines people and relationships by their skills and abilities 🞄 Systems-level approach to challenges 🞄 Shared vision for the future In 2014, the National Civic League partnered with Community Commons to celebrate 25 years of Healthy Communities and to spread the ideas and insights in published and new online media. They emphasized the complexity of developing healthy communities and have identified five principles that they think should be applied in community work if the goal is to find solutions using a broad-based inclusive process. These principles are as follows:

• A broad definition of health that goes beyond the absence of disease to address the root cause of problems in communities and includes economy, education, parks and recreation, arts, mental health, and community spirit and unity
• A collaborative , consensus-based approach to problem solving that involves a diverse group of citizens from the community
• An assets-based approach to problem solving that defines people and relationships by their skills and abilitie s rather than their needs and deficits
• Addressing challenges at a systems level in the community rather than implementing just another short-term, low-impact project
• Creating a shared vision for the future that captures the hopes and dreams of the community and that guides collaborative work Other Principles Useful in Developing a Healthy Community 🞄 The whole is greater than the sum of the parts. 🞄 Change in one part affects the other parts. 🞄 Collaboration is central to development of a healthy community. 🞄 All systems have feedback loops. 🞄 Information from one area is fed back to the whole. 🞄 This feedback provides an opportunity for change or “course correction.” Models for Developing a Healthy Community 🞄 Successful models 🞄 Establish priorities after— 🞄 Careful assessment 🞄 A great deal of community involvement 🞄 Two examples 🞄 PAHO Healthy Municipalities and Communities movement (2012) 🞄 Community health promotion model 🞄 Institute for Action Research for Community Health/Indiana University (1994) PAHO General Model

1. Build a local support group.
2. Know about the Healthy Cities idea.
3. Know the city or community.

4. Gain financial support.
5. Decide where the organization for the project will be located.
6. Develop the proposal.
7. Appoint a project steering committee.
   8. Analyze the project environment.
   9. Define clearly the work of the project. 10.Set up the project office. 11.Plan a long-term strategy.
8. Build project capacity. 13.Establish accountability mechanisms. Community Health Promotion Model 1. Orient the community to the idea of community health promotion. 2. Build the partnership. 3. Develop a structure in the community for health promotion. 4. Determine who will lead the health promotion work. 5. Assess the community. 6. Plan for community-wide health. 7. Develop community action for health. 8. Provide information based on data to policy makers. 9. Monitor and evaluate the progress. Issues in Public Health Nursing: Promoting Healthy Cities “One of the things I like best about this job,” says David, “is the energy and exciting ideas that come from collaboration.” “No one group has a louder voice. Instead, all segments of the population, from leaders in business, to government, to public health nurses, to citizens groups—everyone’s input is important. I really think people feel that here. I look forward to every meeting.” QSEN As described in earlier chapters of the text, including chapter 2: History of Public Health and Public Health Nursing, there are six Quality and Safety in Nursing Competencies. All of the competencies could easily apply to Health Communities and Cities. However, safety is especially important for a health community program. Safety is an important competency for public health nurses who work in rural, suburban, and urban areas and for nurses who care for clients and communities in developed and less developed countries. Aspects of community safety include but are not limited to the following:  Knowledge: Learn about the potential threats to safety including from the physical and social environments including those at home, school, and at worksites.