exam 2 community

What is an aggregate?

A group of people who share one or more common characteristics.

What is a community of solution?

People brought together by a common health problem or concern.

What 3 major dimensions define a community?

Location, population, and social system.

What does a community’s social system represent?

Relationships among aggregates that allow the community to function.

What major areas should a community assessment examine?

Environment, education, safety, transportation, government, services, communication, economics, and recreation.

What is a windshield survey?

An organized walking/driving observation of a community and its environment.

What should a nurse observe during a windshield survey?

Housing, environment, businesses, services, transportation, resources, and hazards.

Why are census data useful in community assessment?

They show population characteristics and changes over time.

What are vital statistics?

Official records of births, deaths, marriages, divorces, and adoptions.

What is the purpose of a community needs assessment?

To identify health needs from the community’s perspective.

What methods can nurses use for a needs assessment?

Key informants, community forums, focus groups, and surveys.

Why should community members participate in a needs assessment?

To identify actual community priorities instead of assumed needs.

What 4 elements make up a community diagnosis?

Problem/risk, affected population, cause/etiology, and supporting evidence.

What is the basic format of a community diagnosis?

Risk of ___ among ___ related to ___ as demonstrated by ___.

What does “community as client” mean?

The entire community or population becomes the focus of the nursing process.

What are the 4 stages of the Health Planning Model?

Assessment → Planning → Intervention → Evaluation.

What occurs during community assessment?

Collect data, identify strengths/problems, research needs, and prioritize.

How do expressed, normative, perceived, and relative needs differ?

Expressed = demand; normative = professional standard; perceived = community wants; relative = disparity.

Residents say they need a free clinic. What type of need is this?

Perceived need.

Residents are heavily using/requesting a service. What type of need?

Expressed need.

Vaccination rates are below professional guidelines. What type of need?

Normative need.

One neighborhood has much less healthcare access than another. What need?

Relative need.

What factors help determine community health priorities?

Preferences, number affected, severity, solutions, skills, time, and resources.

What key principle guides community involvement?

“Start where the people are.”

What are the 5 spheres of empowerment?

Interpersonal, intragroup, intergroup, interorganizational, and political action.

How does a goal differ from an objective?

Goal = broad desired result; objective = specific, measurable step.

How do primary, secondary, and tertiary prevention differ?

Primary prevents; secondary detects early; tertiary limits complications.

Vaccinations are what level of prevention?

Primary prevention.

Blood pressure screening is what level of prevention?

Secondary prevention.

Stroke rehabilitation is what level of prevention?

Tertiary prevention.

What occurs during implementation?

Planned interventions are carried out using appropriate strategies and resources.

How do formative and summative evaluation differ?

Formative evaluates the process; summative evaluates final outcomes.

A nurse asks whether a program was delivered as planned. What evaluation?

Formative/process evaluation.

A nurse determines whether obesity rates decreased after a program. What evaluation?

Summative/outcome evaluation.

What 4 factors should program evaluation consider?

Adequacy, efficiency, appropriateness, and cost-benefit.

What does PRECEDE examine?

Predisposing, reinforcing, and enabling factors affecting health behavior.

What are predisposing factors?

Knowledge, attitudes, beliefs, and values influencing behavior.

What are reinforcing factors?

Consequences and social support that encourage or discourage behavior.

What are enabling factors?

Resources or barriers that make behavior change possible or difficult.

What does PATCH emphasize?

Community participation, data, priorities, interventions, and evaluation.

What does APEX-PH emphasize?

Community/organizational assessment, improvement planning, and reevaluation.

What is health education designed to accomplish?

Predispose, enable, and reinforce voluntary health-promoting behaviors.

What are the major goals of community health education?

Promote health, prevent disease, manage illness, decrease disability, and empower learners.

What does humanistic learning theory emphasize?

Self-direction, holistic growth, and reaching personal potential.

What does cognitive learning theory emphasize?

Thinking, learning, feeling, and problem solving.

What does social learning theory emphasize?

Self-efficacy, expected outcomes, incentives, and learned behavior.

How do adults generally learn best?

In facilitative, nonrestrictive environments that use their experiences.

What adult characteristics influence learning?

Need to know, self-concept, experience, readiness, orientation, and motivation.

What does the Health Belief Model explain?

Why a person chooses to perform or avoid a health behavior.

What are the major Health Belief Model components?

Susceptibility, severity, benefits, barriers, self-efficacy, and cues to action.

“I might develop diabetes.” Which HBM concept?

Perceived susceptibility.

“Diabetes could cause serious complications.” Which HBM concept?

Perceived severity.

“Exercise will lower my risk.” Which HBM concept?

Perceived benefit.

“I cannot afford a gym.” Which HBM concept?

Perceived barrier.

“I know I can exercise every day.” Which HBM concept?

Self-efficacy.

A family member’s MI motivates someone to get screened. Which HBM concept?

Cue to action.

What does the Health Promotion Model explain?

Why individuals engage in health-promoting actions.

Can a nurse simply give empowerment to a community?

No. The nurse facilitates conditions that help people gain control themselves.

What does Freire’s problem-solving approach emphasize?

Dialogue, participation, reflection, critical thinking, and empowerment.

How does Freire’s approach differ from the banking model?

Freire uses active learners; banking treats learners as passive recipients.

What is case management?

Collaborative assessment, planning, coordination, evaluation, and advocacy of services.

What are the major goals of case management?

Quality, safety, access, coordination, improved function, and cost-effective care.

How do case management, care management, and care coordination differ?

Case management is broad; care management manages enrolled clients; coordination organizes services across care.

Who especially benefits from care coordination?

Chronically ill patients at risk for poor outcomes and costly care.

What is transitional care management?

Post-discharge follow-up and coordination designed to prevent readmission.

When should transitional care follow-up occur according to the PowerPoint?

Within 7–14 days after discharge.

What should transitional care reinforce?

Disease knowledge, medications, discharge instructions, care, and resources.

What populations were historically associated with case management?

People with mental illness, older adults, and community-based populations.

What was the forerunner of public health case management?

Community service coordination.

What is the purpose of a Case Management Tracking System?

Ensure follow-up and identify patients who are not improving.

What is disease-specific case management designed to accomplish?

Keep high-risk/high-cost patients stable and healthy in their home environment.

What is utilization review?

Evaluation of the medical necessity and appropriateness of care.

What phrase summarizes utilization review?

Right care at the right time.

What are the 6 components of case management?

Identification, assessment, care plan, implementation, monitoring/evaluation, and closure.

What is a nurse case manager’s major role?

Coordinate care, resources, education, advocacy, and follow-up.

What is policy?

A course of action used to achieve a desired effect.

What is public policy?

Standards/actions established by government that affect the public.

What is health policy?

A decision about a healthcare goal and plan for achieving it.

What is nursing policy?

Nursing leadership that influences health policy and nursing practice.

What is an institutional policy?

Rules governing a workplace or institution.

What is a statute?

A law enacted by a legislative body.

What are the 3 branches involved in health policy?

Legislative, executive/administrative, and judicial.

Which branch makes laws and statutes?

Legislative.

Which branch implements laws and creates regulations?

Executive/administrative.

Which branch interprets laws?

Judicial.

How can nurses influence health policy?

Advocacy, data, testimony, professional organizations, legislators, and civic participation.

Why is Florence Nightingale important to health policy?

She used health data and outcomes to influence government policy.

What important connection did Lillian Wald recognize?

The relationship between health and social conditions.

What 3 major problems challenge the U.S. healthcare system?

Cost, quality, and access.

What are the 2 major U.S. healthcare subsystems?

Private healthcare and public healthcare.

How do private and public healthcare primarily differ?

Private focuses mainly on individual services; public focuses on populations and environments.

What are the 3 broad functions of public health?

Protect, promote, and restore health.

At what 3 levels does the public health system operate?

Federal, state, and local.

What federal department coordinates many U.S. health programs?

Department of Health and Human Services (HHS).

What are examples of federal agencies affecting health?

EPA, OSHA, FEMA, VA, USDA, and Department of Education.

Why are interprofessional teams important in community health?

Population problems require multiple professions and coordinated services.

What roles can community health nurses perform?

Provider, educator, advocate, coordinator, case manager, collaborator, and leader.

What major factors contribute to rising healthcare costs?

Technology, aging, drugs, chronic disease, limited prevention, and fraud/abuse.

How can inadequate preventive care increase healthcare costs?

Disease may progress and require more expensive treatment later.

What is Medicare?

A federal health insurance entitlement program.