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CommunityATI1,3,7,6 – Flashcards

Steven Colyer

7 July 2022

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Nightingale's Environmental Theory

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● Highlights the relationship between an individual's environment and health. ● Depicts health as a continuum. ● Emphasizes preventive care.

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Health Belief Model

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● Purpose is to predict or explain health behaviors. ● Assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease. ● Emphasizes change at the individual level. ● Describes the likelihood of taking an action to avoid disease based on the following. ◯ Perceived susceptibility, seriousness, and threat of a disease ◯ Modifying factors (e.g., demographics, knowledge level) ◯ Cues to action (e.g., media campaigns, disease effect on family/friends, recommendations from health care professionals) ◯ Perceived benefits minus perceived barriers to taking action

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Determinants of health

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are factors that influence the client's health. These can include nutrition, stress, education, the environment, finances, and social status/stigma (prejudice).

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Health indicators (mortality rates, disease prevalence, levels of physical activity, obesity, tobacco or other substance use)

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describe the health status of a community and serve as targets for the improvement of a community's health.

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Nurses

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determine a community's health by examining the degree to which the community's collective health needs are identified and met.

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Community

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is a group of people and institutions that share geographic, civic, and/or social parameters. Communities vary in their characteristics and health needs

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Community health nursing

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involves a synthesis of nursing and public health theory.

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The goals of community health nursing

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are to promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to influence "community health."

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Community health nurses

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are nurses who practice in the community. They usually have a facility from which they work (community health clinic, county health department), but their practice is not limited to institutional settings. Care is often delivered in a setting that is part of the client's environment (home, school, workplace).

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The community or a population

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(an aggregate who shares one or more personal characteristics) within the community is the "client" in community health nursing.

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Public health nursing

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is population-focused, and involves a combination of nursing knowledge along with social and public health sciences. The goal of public health nursing is promoting health and preventing disease.

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ASSESSMENT: Using systematic methods to monitor the health of a population

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● Monitor health status to identify community health problems. ● Diagnose and investigate health problems and health hazards in the community

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POLICY DEVELOPMENT: Developing laws and practices to promote the health of a population based on scientific evidence

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● Inform, educate, and empower people about health issues. ● Mobilize community partnerships to identify and solve health problems. ● Develop policies and plans that support individual and community health efforts.

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ASSURANCE: Making sure adequate health care personnel and services are accessible, especially to those who might not normally have them

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● Enforce laws and regulations that protect health and ensure safety. ● Link people to needed personal health services and ensure the provision of health care when otherwise unavailable. ● Ensure a competent public health and personal health care workforce. ● Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

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Population-focused nursing includes

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assessing to determine needs, intervening to protect and promote health, and preventing disease within a specific population (individuals at risk for hypertension, individuals without health insurance, individuals with a specific knowledge deficit).

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Community partnership occurs

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when community members, agencies, and businesses actively participate in the processes of health promotion and disease prevention. The development of community partnerships is critical to the accomplishment of health promotion and disease prevention strategies.

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KEY PRINCIPLES OF PUBLIC HEALTH NURSING

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● Emphasize primary prevention. ● Work to achieve the greatest good for the largest number of individuals. ● Recognize that the client is a partner in health. ● Use resources wisely to promote the best outcomes.

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Community‑oriented nursing

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Aggregates, communities, populations (public health) Can include at‑risk or unserved individuals and families Health promotion and disease prevention Usually indirect (program management) Can include direct care of at‑risk individuals and populations

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Community‑based nursing

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Individuals and families Management of acute or chronic conditions Direct (one‑on‑one) Illness care: Management of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)

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Principles guiding community health nursing Factors to consider when providing community health nursing practice include the following.

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● Ethics ● Advocacy ● Evidence-based practice ● Quality ● Professional collaboration and communication

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The Public Health Code of Ethics identifies

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the ethical practice of public health. Ethical considerations include preventing harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity, and providing confidentiality, competency, trustworthiness, and advocacy.

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Community health nurses are concerned

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with protecting, promoting, preserving, and maintaining health, as well as preventing disease. These concerns reflect the ethical principle of promoting good and preventing harm. Balancing individual rights vs. rights of community groups is a challenge.

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Public health nurses can apply ethical principles

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through core functions as they collect and manage information (assessment), develop policies that are in the best interest of the people in an area (policy development), and create interventions that promote healthcare equality across population groups (assurance).

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ADVOCACY

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The nurse plays the role of informer, supporter, and mediator for the client.

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Respect for autonomy

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Individuals select those actions that fulfill their goals. SITUATIONS: Respecting a client's right to self‑determination (making a decision not to pursue chemotherapy)

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Nonmaleficence

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No harm is done when applying standards of care. SITUATIONS: Developing plans of care that include a system for monitoring and evaluating outcomes

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Beneficence

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Maximize possible benefits and minimize possible harms. SITUATIONS: Assessing costs, risks and benefits when planning interventions

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Distributive justice

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Fair distribution of the benefits and burden in society is based on the needs and contributions of its members. SITUATIONS: Determining eligibility for health care services based on income and fiscal resources

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Evidence-based practice involves using

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best practices, expert opinion, and client preferences to change the delivery of client care. The goal is to improve client outcomes.

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The nurse should appraise data collected from

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research to measure whether bias was minimal (quality), the number of studies, participants, or strength of effect (quantity) and whether the results are repeatable (consistency). The nurse then analyzes the data for application to practice.

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Quality care is promoted through

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licensure and credentialing of health care providers, adherence to facility policies, professional development, and compliance with legal guidelines. Specialty certification is available for many community health roles.

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Nurses can evaluate quality by examining the following aspects of care. Effectiveness:

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providing services to those who will benefit

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Nurses can evaluate quality by examining the following aspects of care. Timeliness:

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reducing waits and harmful delays in providing and receiving care

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Nurses can evaluate quality by examining the following aspects of care. Client-centered:

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ensuring client values guide decision-making

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Nurses can evaluate quality by examining the following aspects of care. Equity:

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providing equal care without discriminating against gender, race, sexual orientation, socioeconomic status

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Nurses can evaluate quality by examining the following aspects of care. Safety:

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avoiding injuries to clients from the care intended to help them

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Nurses can evaluate quality by examining the following aspects of care. Efficiency:

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avoiding waste in supplies, ideas, or energy

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Nurse leaders use professional communication in roles such as

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mentoring, coaching employees, managing conflict, and supervising programs.

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BENEFITS OF PROFESSIONAL COMMUNICATION

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● Increased client adherence to prescribed treatment plan ● Reduced admissions to acute care ● Reduced cost of care ● Shared decision-making with client and family ● Reduced medication errors

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In designing community education programs, nurses must take into account the barriers that make learning difficult. Some of these obstacles include

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age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation. Effective community health education requires planning.

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Behavioral theory:

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Use of reinforcement methods to change learners' behaviors

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Cognitive theory:

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Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors

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Critical theory:

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Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors

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Developmental theory:

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Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge

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Humanistic theory:

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Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest

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Social learning theory:

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Links information to beliefs and values to change or shift the learners' expectations

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Visual learners:

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Learn through seeing and methods such as note taking, video viewing, and presentations. These learners "think in pictures."

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Auditory learners:

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Learn through listening and methods such as verbal lectures, discussion, and reading aloud. These learners "interpret meaning while listening."

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Tactile-kinesthetic learners:

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Learn through doing and methods such as trial and error, hands-on approaches, and return demonstration. These learners gain "meaning through exploration."

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Cognitive domain:

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Involves knowledge and the development of intellectual skills; for example a client discusses how sodium intake will affect blood pressure.

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Affective domain:

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Involves a change in attitude and development of values; for example a client expresses acceptance of having a colostomy and maintains self-esteem.

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Psychomotor domain:

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Involves the performance of a skill; for example, the community nurse teaches a client how to self-administer insulin.

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DEVELOPMENT OF A COMMUNITY HEALT H EDUCATION PLAN

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● First, identify population‑specific learning needs. ● Consider population‑specific concerns and effects of health needs on the population to determine the priority learning need. ● Select aspects of learning theories (behavioral, cognitive, critical, developmental, humanistic, social learning) to use in the educational program based on the identified learning need. ● Identify barriers to learning, and learning styles (visual, auditory, tactile‑kinesthetic).

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Design the educational program.

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◯ Set short- and long-term learning objectives that are measurable and achievable. ◯ Select an appropriate educational method based on learning objectives and assessment of participants' learning styles. ◯ Ensure written educational materials are at a 5th to 6th grade readability level. ◯ Select content appropriate to learning objectives and allotted time frame. ◯ Select an evaluation method that will provide feedback regarding achievement of short-term learning objectives, and long-term impact on behavior.

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Implement the education program.

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Ensure an environment that is conducive to learning (minimal distractions, favorable to interaction, learner comfort, readability). ● Evaluate the achievement of learning objectives and the effectiveness of instruction.

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Epidemiology is the study of health-related trends in populations for the purposes of

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disease prevention, health maintenance, and health protection.

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EPIDEMIOLOGICAL TRIANGLE (1.3)

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● The agent is the physical, infectious, or chemical factor that causes the disease. ● The host is the living being that an agent or the environment influences. ● The environment is the setting or surrounding that sustains the host.

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INCIDENCE AND PREVALENCE RATES

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Incidence: Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000 Prevalence: Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000

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MORTALITY RATES

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Crude mortality rate: Number of deaths ÷ population total x 1,000 = _____ per 1,000 Infant mortality rate: Number of infant deaths before 1 year of age in a year ÷ numbers of live births in the same year x 1,000 = _____ per 1,000

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Epidemic:

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Occurs when the rate of disease exceeds the usual (endemic) level of the condition in a defined population

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Pandemic:

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Condition occurs when an epidemic occurs in multiple countries or continents.

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Attack rate:

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Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed

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THE EPIDEMIOLOGICAL PROCESS

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Determine the nature, extent, and possible significance of the problem. During this phase of the process, the nurse collects information from as many sources as possible. This information is then used to determine the scope of the problem. Using the gathered data, formulate a possible theory. At this time, the nurse projects and explores the possible explanations. Gather information from a variety of sources in order to narrow down the possibilities. The nurse assesses all possible sites for amassing information related to the disease process. The nurse evaluates the plausibility of the proposed hypothesis. Make the plan. In this phase of the process, the nurse focuses on breaking the cycle of disease. The nurse should identify and consider all factors influencing the spread of the disease. The nurse establishes priorities to break the chain of transmission and to control the spread of the disease. Put the plan into action. Using all available means, the nurse puts the plan for controlling the disease into action. Evaluate the plan. The nurse gathers pertinent information to determine the success of the plan. Using this plan, the nurse evaluates the success in prevention of the spread of the disease. Report and follow up. The nurse synthesizes evaluation data into a format that is understandable. Then the nurse evaluates successes and failures and bases follow-up on the evaluation information.

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Healthy People serves as a

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measure for quality of health. The national health goals guide the nurse in developing health promotion strategies to improve individual and community health

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Preventive services include

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health education and counseling based on scientific evidence, immunizations, taking preventive medication, lifestyle changes and other actions that aim to prevent a potential disease or disability.

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Primary prevention

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Prevention of the initial occurrence of disease or injury ● Nutrition education ● Family planning and sex education ● Smoking cessation education ● Communicable disease prevention education ● Education about health and hygiene issues to specific groups (day care workers, restaurant workers) ● Safety education (seat belt use, helmet use) ● Prenatal classes ● Providing immunizations ● Advocating for access to health care, healthy environments

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Secondary prevention

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Early detection and treatment of disease with the goal of limiting severity and adverse effects ● Community assessments ● Disease surveillance (communicable diseases) ● Screenings ● Cancer (breast, cervical, testicular, prostate, colorectal) ● Diabetes mellitus ● Hypertension ● Hypercholesterolemia ● Sensory impairments ● Tuberculosis ● Lead exposure ● Genetic disorders/metabolic deficiencies in newborns ● Control of outbreaks of communicable diseases

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Tertiary prevention

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● Maximization of recovery after an injury or illness (rehabilitation) ● Nutrition counseling for management of Crohn's disease ● Exercise rehabilitation ● Case management (chronic illness, mental illness) ● Physical and occupational therapy ● Support groups ● Exercise for a client who has hypertension (individual)

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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 an example of community‑based nursing? (Select all that apply.) A. A home health nurse performing wound care for a client who is immobile B. An occupational health nurse providing classes on body mechanics at a local industrial plant C. A school nurse teaching a student who has asthma about medications D. A parish nurse teaching a class on low‑sodium cooking techniques E. A mental health nurse discussing stress management techniques with a support group

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A. CORRECT: The nurse should include wound care to an individual in the home as an example of community‑based nursing, which involves management of acute and chronic conditions in a community setting. B. The nurse should include teaching a class in the occupational setting as an example of community‑oriented nursing, which involves health care of individuals, families and groups to improve the collective health of the community. C. CORRECT: The nurse should include teaching a single student in the school setting as an example of community‑based nursing, which involves management of acute and chronic conditions in a community setting. D. The nurse should include teaching a class to members of a faith community as an example of community‑oriented nursing, which involves health care of individuals, families and groups to improve the collective health of the community. E. The nurse should include discussion with a group in the mental health setting as an example of community‑oriented nursing, which involves health care of individuals, families an

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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 C. Respect for autonomy D. Veracity

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A. CORRECT: The nurse is advocating for the leaders to uphold the ethical principle of distributive justice, which is the fair distribution of benefits and burden in society. B. The nurse is not advocating for the leaders to uphold the ethical principle of fidelity, which involves keeping commitments and following through with promises. C. The nurse is not advocating for the leaders to uphold the ethical principle of respect for autonomy, which is supporting the rights of individuals to determine and pursue personal health care goals. D. The nurse is not advocating for the leaders to uphold the ethical principle of veracity, which is the concept of telling the truth.

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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. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity

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A. The nurse should include resource availability as an environmental factor when discussing the epidemiological triangle. B. The nurse should include ethnicity as a host factor when discussing the epidemiological triangle. C. CORRECT: The nurse should include toxins as an agent when discussing the epidemiological triangle. D. CORRECT: The nurse should include bacteria as an agent when discussing the epidemiological triangle. E. The nurse should include altered immunity as a host factor when discussing the epidemiological triangle.

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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 discussions

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A. The nurse should show informational videos as an appropriate learning strategy for clients who are visual learners. B. The nurse should provide equipment to practice hands‑on skills as an appropriate learning strategy for clients who are tactile‑kinesthetic learners. C. The nurse should supply outlines for note‑taking as an appropriate learning strategy for clients who are visual learners. D. CORRECT: Facilitating small group discussions provides an opportunity for clients who are auditory learners to learn as they listen to information. This is an appropriate strategy for the nurse to include for this group.

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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 B. Teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. Implementing a program to notify individuals exposed to a communicable disease

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A. The nurse is using secondary prevention when performing a home safety check. B. The nurse is using tertiary prevention when teaching healthy nutrition to clients who have hypertension. C. CORRECT: The nurse is using primary prevention when providing influenza immunizations to employees at a local preschool because the goal is to prevent the occurrence of disease or injury. D. The nurse is using secondary prevention when implementing a program to notify individuals exposed to a communicable disease.

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RELATED CONTENT ● Define primary prevention. ● Define secondary prevention. ● Define tertiary prevention. NURSING INTERVENTIONS ● Include two primary prevention activities the nurse should plan. ● Include two secondary prevention activities the nurse should plan. ● Include two tertiary pre

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RELATED CONTENT Primary prevention: Strategies that prevent the initial occurrence of disease or injury Secondary prevention: Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects Tertiary prevention: Strategies that maximize recovery after an injury or illness NURSING INTERVENTIONS Primary prevention activities ● Teaching healthy heart curriculum (nutrition, exercise, not smoking) ● Educating about dental health ● Discussing safety (seat belts, bicycle helmets, stranger safety) ● Administering immunizations ● Teaching about communicable disease transmission ● Providing sex education ● Advocating for safe playground equipment ● Providing substance use prevention education Secondary prevention activities ● Performing tuberculin skin tests ● Performing routine checks for pediculosis ● Taking measures to control communicable disease outbreaks ● Screening for lead exposure ● Implementing scoliosis screenings ● Identifying students at risk for suicide or self‑harm ● Performing vision and hearing screenings ● Measuring heights and weights ● Identifying indicators of child abuse or neglect Tertiary prevention activities ● Teaching about allergic triggers for students who have asthma ● Administering medications to treat chronic conditions (asthma, attention deficit hyperactivity disorder, seizure disorders) ● Monitoring glucose levels and administering insulin to students who have diabetes mellitus ● Discussing and planning for nutritional needs of students who have cystic fibrosis ● Developing communication methods for students who have autism spectrum disorders

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FACTOR S TO CONSIDER When determining the health of a community

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Status: Epidemiological data, client satisfaction, mental health, crime rates Structure: Presence of health care facilities, service types and patterns of use, demographic data Process: Relationships, communication, commitment to and participation in health

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COMMUNITY ASSESSMENT COMPONENTS People

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Demographic: Distribution, mobility, density, census data Biological factors: Health and disease status, genetics, race, age, gender, causes of death Social factors: Occupation, activities, marital status, education, income, crime rates, recreation, industry Cultural factors: Ethnohistory, hierarchy and roles, language, religion and spirituality, values, customs, norms

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COMMUNITY ASSESSMENT COMPONENTS Place or environment

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Physical factors: Geography, terrain, type of community, location of health services, housing, animal control Environmental factors: Geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants

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COMMUNITY ASSESSMENT COMPONENTS Social systems

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● Health systems ● Economic systems/factors ● Education systems ● Religious systems ● Welfare systems ● Political systems ● Recreation systems/factors ● Legal systems ● Communication systems/factors ● Transportation systems ● Resources and services

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Informant interviews Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants

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STRENGTHS ● Minimal cost ● Participants serving as future supporters ● Offers insight into beliefs and attitudes of community members ● Reading/writing of participants not required ● Personal interaction can elicit more detailed responses LIMITATIONS ● Built-in bias ● Meeting time and place

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Community forum Open public meeting

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STRENGTHS ● Opportunity for community input ● Minimal cost LIMITATIONS ● Difficulty finding a convenient time and place ● Potential to drift from the issue ● Challenging to get adequate participation ● Possibility that a less vocal person can be reluctant to speak

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Secondary data Use of existing data (death, birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem The nurse must evaluate the reliability of secondary data obtained from the Web. Generally, websites with .edu, .org, and .gov URLs present reliable information.

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STRENGTHS ● Database of prior concerns/needs of population ● Ability to trend health issues over time LIMITATIONS ● Possibility that data might not represent current situation ● Can be time-consuming

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Participant observation Observation of formal or informal community activities

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STRENGTHS: Indication of community priorities, environmental profile, and identification of power structures LIMITATIONS ● Bias ● Time-consuming ● Inability to ask questions of participants

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Focus groups Directed talk with a representative sample

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STRENGTHS ● Possibility of participants being potential supporters ● Provides insight into community support ● Reading/writing of participants not required LIMITATIONS ● Possible discussion of irrelevant issues ● Challenging to get participants ● Requires strong facilitator ● Difficult to ensure that sample is truly representative of the overall community ● Time-consuming to transcribe discussion

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Surveys Specific questions asked in a written format

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STRENGTHS ● Data collected on client population and problems ● Random sampling ● Available as written or online format ● Contact with participants not required LIMITATIONS ● Low response rate ● Expensive ● Time-consuming ● Possibility of collection of superficial data ● Requires reading/writing abilities of participants

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Windshield survey Descriptive approach that assesses several community components by driving through a community

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STRENGTHS: Provides a descriptive overview of a community LIMITATIONS ● Need for a driver so the nurse can visualize and document the community elements ● Can be time-consuming ● Results based only on visualization and does not include input from community members

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STRATEGIE S AND BARRIER S

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HELPFUL STRATEGIES ● Thorough assessment ● Accurate interpretation of data ● Collaboration with community partners ● Effective outreach and communication patterns ● Sufficient resources ● Logical planning ● Skilled leadership BARRIERS ● Inadequate assessment ● Inadequate or misconstrued data ● No involvement with community partners ● Impaired communication ● Inadequate resources ● Lack of planning ● Poor leadership

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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.) 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

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A. CORRECT: The nurse should identify the ethnicity of the people visible in the community as a component of a windshield survey. B. Individuals who hold power are identified through formal and informal observations of community activities as a participant observer. C. CORRECT: The nurse should identify natural community boundaries as a component of a windshield survey. D. Prevalence of disease is incorrect. Disease prevalence is a component of secondary data and is identified through morbidity rates of the community. E. CORRECT: The nurse should identify the presence of public protection, such as police, fire, and animal control, as a component of a windshield survey.

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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 data collection is complete. D. Identify health needs of the local community.

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A. In order to determine health patterns within collected data, the nurse must take another action first. B. CORRECT: In order to adequately and appropriately analyze collected data, the nurse must first compile collected data into a database. C. In order to ensure data collection is complete, the nurse must take another action first. D. In order to identify health needs of the local community, the nurse must take another action first.

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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

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A. The nurse should determine availability of resources to initiate the program as part of the assessment phase. However, when evaluating sustainability of the program, the nurse should determine whether resources are available for continuing the program. B. The nurse should gain approval for the program from local leaders as part of the preplanning phase because plans for the program should not move forward without adequate community support. C. The nurse establishes a timeline for implementation of interventions after determining and selecting the best strategies for meeting the program's goals and objectives. D. CORRECT: The nurse should include a comparison of program impact to similar programs as part of the evaluation plan. This comparison assists with determining the efficiency of the program.

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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? A. Key informant interviews B. Participant observation C. Focus groups D. Health surveys

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A. CORRECT: Informant interviews are direct conversations with individual community members for the purpose of obtaining ideas and opinions. B. Participant observation is observing formal or informal community activities and does not involve direct conversations with individual community members. C. Focus groups are directed talks with a representative sample of a community, and do not involve direct conversations with individual community members

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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? (Select all that apply.) A. Birth statistics B. Previous health survey results C. Windshield survey D. Community forum E. Health records

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A. CORRECT: Birth statistics are an example of secondary data the nurse should review. B. CORRECT: Previous health survey results are an example of secondary data the nurse should review. C. Windshield surveys are a method of collecting direct data. D. Community forums are a method of collecting direct data. E. CORRECT: Health records are an example of secondary data the nurse should review

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A nurse collects the following data during a community assessment. ● Low crime rate ● Curbside garbage pick‑up ● Increased incidence of low infant birth weight ● Small amount of litter along the road ● Public transportation that operates 24 hr/day, 7 days/week ● Older playground equipment in need of repair ● High prevalence of diabetes mellitus ● Recreational trails that are in need of maintenance Use the ATI Active Learning Template: Basic Concept to complete this item. UNDERLYING PRINCIPLES: Identify possible methods of collecting the data resulting from the nurse's community assessment. NURSING INTERVENTIONS ● Name one action the nurse should take as part of the diagnosis phase of program development. ● Name three actions the nurse should take as part of the planning phase of program development

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UNDERLYING PRINCIPLES ● Curbside garbage pick‑up: windshield survey, key informant interview, focus group ● Increased incidence of low infant birth weight: secondary data from health statistics ● Small amount of litter along the road: windshield survey ● Public transportation that operates 24 hr/day, 7 days/week: windshield survey, key informant interview ● Older playground equipment in need of repair: windshield survey, key informant interview, focus group ● High prevalence of diabetes mellitus: secondary data from health statistics ● Recreational trails that are in need of maintenance: windshield survey, key informant interview, focus group NURSING INTERVENTIONS Diagnosis phase ● Analyze collected data to determine health needs within the local community. ● Work with community members, local health professionals and administrators to develop priorities and establish outcomes for identified health needs. Planning phase ● Determine possible solutions to meet health needs of the community and select the best option. ● Establish goals and objectives for the selected solution. ● Select strategies/interventions to meet the objectives. ● Establish a timeline for implementation of interventions. ● Identify resources that are available, and resources that are needed, to implement strategies. ● Determine funding opportunities for needed interventions and develop a budget. ● Plan for program evaluation.

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BARRIERS TO THE REFERRAL PROCESS CLIENT BARRIERS

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● Lack of motivation ● Inadequate information about community resources ● Inadequate understanding of the need for referral ● Accessibility needs ● Priorities ● Finances ● Cultural factors

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BARRIERS TO THE REFERRAL PROCESS RESOURCE BARRIERS

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● Attitudes of health care personnel ● Costs of services ● Physical accessibility of resources ● Time limitations ● Limited expertise working with culturally diverse populations

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Applying the nursing process during case management

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Assessment Clarify the problem by evaluating physical needs, psychosocial issues, functional ability, and financial constraints. Diagnosis Determine the cause and precipitating factors. Identify applicable nursing diagnoses based on assessment findings. Planning In conjunction with the interprofessional team, determine the following. Prioritization of identified problems Possible outcomes for the client ● Advantages and disadvantages of possible outcomes ● What role each participant will play in assisting the client to achieve desired outcomes ● Potential effect of the plan on the client Implementation Contact health care providers. Provide referral information. Coordinate all health care services and resources Evaluation (continued monitoring) Monitor the client to determine whether services are still needed. Monitor the care provided by the different facilities, comparing against the following. ● Original projected outcomes ● Physical needs ● Psychosocial needs ● Financial needs ● Client and family satisfaction

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Informatics

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is the combination of nursing science with information and communication technologies in the delivery of nursing care

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Electronic health records (EHR), electronic medical records (EMR), databases, and billing are

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commonly used within the current health care industry. Hand-held computers and smartphones, geographic information systems, and the Internet all play a role in the delivery of health care.

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Telehealth

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is the delivery of quality health care through the use of technology. ● Telehealth is particularly useful in rural areas. The ability to deliver specialized, skilled nursing through communication systems that transfer information easily between providers improves access to health care

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NURSES' ROLE IN HEALTH POLICY

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CHANGE AGENTS: Advocate for needed change at the local, state, or federal level. LOBBYISTS: Persuade or influence legislators. Individuals or professional nursing associations can participate in the lobbying process. COALITIONS: Facilitation of goal achievement through the collaboration of two or more groups. PUBLIC OFFICE: Serving society and advocating for change by influencing policy development through public service.

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A nurse is creating partnerships to address health needs within the community. The nurse should be 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 partners to negotiate roles

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A. Shared power must exist for a partnership to be successful. B. CORRECT: Flexibility must exist for a partnership to be successful. C. CORRECT: Integrity must exist for a partnership to be successful. D. Shared goals must exist for a partnership to be successful. E. CORRECT: Negotiation must exist for a partnership to be successful.

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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

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A. The nurse should identify advocacy as a function of a change agent. B. CORRECT: Updating officials about community health needs is an example of a nurse functioning as a consultant. Community health nurses serve as a consultant regarding the health care needs of individuals, families, and groups within the community served. C. The nurse should identify working with an interprofessional team as a function of a case manager. D. The nurse should identify performing health screening as a function of a caregiver.

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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 relationship 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 with the referral. B. Provide the client information to referral agencies. C. Review available resources with the client. D. Identify referrals that the client needs.

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A. The nurse should monitor the client's satisfaction with the referral as part of patient-centered care. However, another action must occur first in the referral process. B. The nurse should provide the client with information to referral agencies to enable the client to access needed services. However, another action must occur first in the referral process. C. The nurse should review available resources with the client to promote self-determination. However, another action must occur first in the referral process. D. CORRECT: Using the nursing process, the first action the nurse should take at this point in the referral process is to assess client needs. After gathering client data, the nurse should identify referrals that the client needs and prioritize plans. This allows the nurse and client to focus on specific needs while moving forward in the referral process

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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

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A. CORRECT: Costs associated with services are an example of a resource barrier to community referrals. B. Decreased motivation is an example of a client barrier to community referrals. C. Inadequate knowledge of resources is an example of a client barrier to community referrals. D. Lack of transportation is an example of a client barrier to community referrals.

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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 B. Comparing outcomes with original goals C. Determining the client's financial constraints D. Clarifying roles of interprofessional team members

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A. CORRECT: Coordinating services to meet the client's needs is an action the nurse should take in the implementation phase of the case management process. B. Comparing outcomes with original goals is an action the nurse should take in the evaluation phase of the case management process. C. Determining the client's financial constraints is an action the nurse should take in the assessment phase of the case management process. D. Clarifying roles of interprofessional team members is an action the nurse should take in the planning phase of the case management process.

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A nurse manager of a home health agency is preparing an in-service about informatics for a group of newly hired nurses. What should the nurse manager include in this presentation? RELATED CONTENT ● Define informatics. ● Define telehealth. UNDERLYING PRINCIPLES ● List two types of transmissible physical data. ● List two types of transmissible audio data. ● List two types of transmissible visual data. NURSING INTERVENTIONS: Include three methods of incorporating technology into health care delivery.

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RELATED CONTENT ● Informatics: The combination of nursing science with information and communication technologies in the delivery of nursing care ● Telehealth: The delivery of quality health care through the use of technology UNDERLYING PRINCIPLES Physical data ● Blood pressure ● Weight ● Blood oxygenation ● Blood glucose ● Heart rate ● Temperature ● ECG results Audio data ● Voice conversation ● Heart sounds ● Lung sounds ● Bowel sounds Visual data ● Wound images ● Surgical incision images NURSING INTERVENTIONS ● Electronic records, databases, and billing ● Internet availability of health information and education ● Electronic meetings and chat rooms ● Asynchronous discussions ● Web-based support groups ● Electronic orientation/training ● Health care access in rural areas

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Communicable diseases

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● Worldwide, communicable diseases are responsible for the deaths of millions each year. ● Leading causes of communicable disease deaths include acute respiratory infections (including pneumonia and influenza), HIV/AIDS, diarrheal diseases, tuberculosis, malaria, and measles. ● Other diseases that pose a significant threat to community health include viral hepatitis and sexually transmitted infections.

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The Centers for Disease Control and Prevention (CDC) recommend

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routine immunizations according to age. Recommendations include schedules/guidelines for children, adolescents, and adults. A "catch up" schedule and recommendations for health care personnel are also available.

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POPULATIONS AT RISK

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● Young children ● Older adults ● Immunosuppressed clients ● Clients who have a high-risk lifestyle ● International travelers ● Health care workers

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Airborne: inhaled by a susceptible host

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● Measles ● Chickenpox ● Tuberculosis (pulmonary or laryngeal) ● Pertussis ● Influenza ● Severe acute respiratory syndrome (SARS)

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Foodborne

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● Food infection (bacterial, viral, parasitic infection of food) ◯ Norovirus ◯ Salmonellosis ◯ Hepatitis A ◯ Trichinosis ◯ Escherichia coli (E. coli) ● Food intoxication (toxins produced through bacterial growth, chemical contamination, or disease‑producing substances) ◯ Staphylococcus aureus ◯ Clostridium botulinum

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Waterborne: fecal contamination of water

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● Cholera ● Typhoid fever ● Bacillary dysentery ● Giardia lamblia

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Vector-borne: via a carrier such as a mosquito or tick

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● West Nile virus ● Lyme disease ● Rocky Mountain spotted fever ● Malaria

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Direct contact: transmission of infectious agent from infected host to susceptible host via direct contact

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● Sexually transmitted infections: HIV/AIDS, chlamydia, gonorrhea, syphilis, human papilloma virus (HPV), genital herpes, hepatitis B, C, D ● Infectious mononucleosis ● Enterobiasis (pinworms) ● Impetigo ● Lice, scabies

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PORTALS OF ENTRY

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● Respiratory passages ● Gastrointestinal tract ● Skin ● Mucous membranes ● Genitourinary tract ● Eyes ● Blood vessels

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PORTALS OF EXIT

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● Respiratory secretions ● Feces ● Blood ● Semen ● Vaginal secretions ● Saliva and emesis ● Skin lesion exudates

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Herd immunity:

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Protection due to the immunity of most community members making exposure unlikely

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Natural immunity:

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Natural defense mechanisms of the body to resist specific antigens or toxins

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Acquired immunity: Develops through actual exposure to the infectious agent

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● Active: Production of antibodies by the body in response to infection or immunization with a specific antigen ● Passive: Transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins

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Descriptive epidemiology

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is used to investigate disease patterns to identify whom it affected, where the issue is located, how it occurs, why or what the cause is, and when the condition started.

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Surveillance

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also helps management of a disease outbreak.

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PRIMARY PREVENTION

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● Prevent the occurrence of infectious disease. ● Educate the public regarding the need for immunizations, and federal and state immunization programs. ● Counsel clients traveling to other countries about protection from infectious diseases. Refer clients to the health department for information about mandatory immunizations. ● Educate the public regarding prevention of disease and ways to eliminate risk factors for exposure, such as hand hygiene, universal precautions, proper food handling and storage, use of insecticides, and use of condoms.

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SECONDARY PREVENTION

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● Increase early detection through screening and case finding. ● Refer suspected cases of communicable disease for diagnostic confirmation and epidemiologic reporting. ● Provide post‑exposure prophylaxis (hepatitis A, rabies). ● Quarantine clients when necessary. ● Use partner notification and contact tracing to identify and screen individuals who have been exposed to a communicable disease.

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TERTIARY PREVENTION

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● Decrease complications and disabilities due to infectious diseases through treatment and rehabilitation. ● Monitor treatment compliance, including directly observed therapy (DOT). ● Identify and link clients to needed community resources.

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disaster

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is an event that causes human suffering and demands more resources than are available in the community. A disaster can be naturally occurring, man-made, or a combination of both, such as a natural disaster causing technological failures.

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PHASES OF EMOTIONAL REACTION DURING A DISASTER

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● Heroic: Intense excitement and concern for survival. Often a rush of assistance from outside the area is present. ● Honeymoon: Affected individuals begin to bond and relive their experiences. ● Disillusionment: Responders can experience depression and exhaustion. Phase contains unexpected delays in receiving aid. ● Reconstruction: Involves adjusting to a new reality and continued rebuilding of the area. Counseling is sometimes needed. Those affected begin looking ahead.

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CATEGORY A BIOLOGICAL AGENTS

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● The highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates. ● Examples include smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (e.g., Ebola), and plague.

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CATEGORY B BIOLOGICAL AGENTS

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● The second-highest priority because they are moderately easy to disseminate, and have high morbidity rates and low mortality rates. ● Examples include typhus fever, ricin toxin, diarrheagenic E. coli, and West Nile virus.

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CATEGORY C BIOLOGICAL AGENTS

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● The third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ● Examples include hantavirus, influenza virus, tuberculosis, and rabies virus.

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Inhalational anthrax

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MANIFESTATIONS ● Headache ● Fever and chills ● Muscle aches ● Chest discomfort ● Severe dyspnea ● Shock PREVENTION ● Anthrax vaccine for those at high-risk for exposure to anthrax. ● Ciprofloxacin and doxycycline are recommended by the CDC for prevention of anthrax following exposure. TREATMENT: Antitoxin and IV antibiotics are administered if manifestations of an anthrax infection are present.

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Botulism

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MANIFESTATIONS ● Double or blurred vision ● Slurred speech ● Difficulty swallowing ● Progressive muscle weakness ● Difficulty breathing PREVENTION: No approved vaccine TREATMENT ● Airway management with possible mechanical ventilation ● Administration of antitoxin ELIMINATION OF TOXIN: Induction of vomiting, enemas, surgical excision of wound tissue SUPPORTIVE CARE: Nutrition, fluids, prevent complications

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Smallpox

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MANIFESTATIONS ● High fever ● Fatigue ● Head and body aches ● Rash that begins on face and tongue; quickly spreads to the trunk, arms, and legs, then hands and feet; then turns to pus‑filled lesions ● Vomiting PREVENTION ● Vaccine for those at high‑risk (provides 10 years of immunity); can vaccinate within 3 days of exposure ● Contact and airborne precautions TREATMENT: No cure SUPPORTIVE CARE: Hydration, pain medication, antipyretics, antibiotics for secondary infections

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Ebola

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MANIFESTATIONS ● Fever ● Severe headache ● Joint and muscle aches ● Fatigue and weakness ● Hemorrhage ● Vomiting and diarrhea ● Shock PREVENTION ● No approved vaccine available ● Don impermeable gown or coverall; disposable gloves (two pairs), boot covers, and apron; and N95 mask. Recommend a second caregiver supervise doffing. Maintain droplet isolation precautions. TREATMENT ● Supportive care IV fluids, dialysis, airway management, psychological counseling. ● Minimize invasive procedures

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Plague

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MANIFESTATIONS These forms can occur separately or in combination. ● Pneumonic plague: fever, headache, weakness, pneumonia with shortness of breath, chest pain, cough, and bloody or watery sputum ● Bubonic plague: swollen, tender lymph nodes, fever, headache, chills, and weakness ● Septicemic plague: fever, chills, weakness, prostration, abdominal pain, shock, disseminated intravascular coagulation (DIC), gangrene of nose and digits PREVENTION ● Vaccine no longer available in the U.S. ● Contact precautions till decontaminated ● Droplet precautions till 72 hr after antibiotics TREATMENT: Gentamicin and fluoroquinolones

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Tularemia

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MANIFESTATIONS ● Sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, progressive weakness ● If airborne, life-threatening pneumonia and systemic infection PREVENTION: Vaccine under review by the Food and Drug Administration but not currently available TREATMENT ● Streptomycin or gentamicin is the antibiotic of choice. ● In mass causality, use doxycycline or ciprofloxacin.

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DELI VERY MECHANISMS FOR BIOLOGICAL AGENTS

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● Direct contact (subcutaneous anthrax) ● Simple dispersal device (airborne, nuclear) ● Water and food contamination ● Droplet or blood contact

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PRIMARY PREVENTION: Bioterrorism planning

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● Prepare with bioterrorism drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. ● Design a bioterrorism response plan using the most probable biological agent in the local area. ● Identify the chain of command for reporting bioterrorism attacks. ● Define the nursing roles in the event of a bioterrorism attack. ● Set up protocols for different levels of infection control and containment.

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SECONDARY PREVENTION: Early recognition

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● Activate bioterrorism response plan in response to a bioterrorism event. ● Immediately implement infection control and containment measures, including decontamination, environmental disinfection, protective equipment, community education/notification, and quarantines. ● Screen the population for exposure, assessing rates of infection and administering vaccines as available. ● Assist with and educate the population regarding identification of manifestations and management (immunoglobulin, antiviral, antitoxins, and antibiotic therapy, depending on the agent). ● Monitor mortality and morbidity.

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TERTIARY PREVENTION: Rehabilitation of survivors

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● Monitor medication regimens and referrals. ● Evaluate effectiveness and timeliness of the bioterrorism plan.

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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

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A. Cholera is waterborne illness. B. Malaria is a vector‑borne illness. C. CORRECT: Influenza is an airborne illness. D. Salmonellosis is a foodborne illness.

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A home health nurse is discussing portals 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

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A. Respiratory secretions are a portal of exit. B. CORRECT: Skin is a portal of entry. C. CORRECT: The genitourinary tract is a portal of entry. D. Saliva is a portal of exit. E. CORRECT: Mucous membranes are a portal of entry.

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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? A. Outlining specific roles of community agencies B. Identifying community vulnerabilities C. Prioritizing care of individuals D. Providing stress counseling

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A. Outlining specific roles of community agencies is a component of disaster preparedness. B. CORRECT: Identifying community vulnerabilities is a component of disaster prevention. C. Prioritizing care of individuals is a component of disaster response. D. Providing stress counseling is a component of disaster recovery.

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A community health nurse is educating the public on the agents of bioterrorism. Which of the following agents should the nurse include as Category A biological agents? (Select all that apply.) A. Hantavirus B. Typhus C. Plague D. Tularemia E. Botulism

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A. Hantavirus is a Category C biological agent. B. Typhus is a Category B biological agent. C. CORRECT: Plague is a Category A biological agent. D. CORRECT: Tularemia is a Category A biological agent. E. CORRECT: Botulism is a Category A biological agent.

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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

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A. Metronidazole is used to treat trichomoniasis, skin infections, and septicemia. B. CORRECT: Community members exposed to anthrax will need access to ciprofloxacin. This medication is used for the prophylactic treatment of anthrax. C. Zanamivir is used to treat influenza. D. Fluconazole is used to treat candidiasis

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A community health nurse is responding to a man‑made disaster in the local community. Use the ATI Active Learning Template: Basic Concept to complete this item. UNDERLYING PRINCIPLES ● Include three agencies involved in disaster response. ● List two questions to ask to determine the disaster's scope. NURSING INTERVENTIONS: Explain four disaster response nursing roles.

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UNDERLYING PRINCIPLES Involved agencies ● FEMA ● CDC ● U.S. Department of Homeland Security ● American Red Cross ● Office of Emergency Management Disaster scope ● How many people are affected? ● How many are injured or dead? ● How much potable water and food is available? ● What are the areas of risk or sanitation problems? NURSING INTERVENTIONS ● Activate the disaster management plan. ● Perform triage and direct disaster victims. ● Identify people who have serious vs. minor injuries. ● Prioritize care of those affected. ● Transfer those requiring immediate attention to medical facilities. ● Coordinate evacuation or quarantines. ● Open shelters.

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