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1. What is the primary reason that Americans are so concerned about health care?
Our national health care costs keep increasing.
Although politicians and media do continue to discuss our health care system and people worry about the uninsured, the primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. Families worry they cannot afford care; politicians and media discuss the problem, as easy answers seem elusive
2. What is the reason nurses are encouraged to get involved in discussions about our health care system?
Nurses are the largest group of health care providers.
As the largest group of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasizes, usually believe that health care is a right, not a privilege. Therefore nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration.
3. What conclusion can be drawn from examining where nurses are employed?
There is an increased emphasis on community-based health care.
MCOs are employing nurses in many capacities. While hospitals are closing and acute care is increasingly found in central medical centers, an equal trend may be seen in an increase in neighborhood-based practice centers. While positions are cut in most industries, health care is recognized as an area where growth in employment is expected. However, nurses are increasingly employed in community settings as opposed to hospitals. This change reflects the move toward community-based care rather than hospital-based tertiary care. To help decrease the continued rise in health care costs, the increased emphasis is on disease prevention rather than high-cost treatment.
4. Which ethical belief would be most helpful in the current health care crisis?
Emphasis should be on social justice and collective responsibility.
Public health recognizes the necessity of collective action in keeping the environment safe and in egalitarian tradition and vision. An overinvestment in technology and seeking of cures within the market justice system has stifled the evolution of a health system to protect and preserve the health of the population. Although individual autonomy and freedom of choice are important, so is the recognition of collective responsibility in ensuring social justice, which entitles all people to basic necessities.
5. What is the primary problem seen in Healthy People 2020's emphasis on choosing healthy lifestyle behaviors, such as daily exercise or healthy food choices?
Public policy emphasizes personal responsibility but ignores social and environmental changes needed for well-being.
Although all responses are accurate, the primary problem is the emphasis on personal choices in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for community responsibility and action that addresses environmental or cultural restraints to health.
6. What responsibility does the ANA Code of Ethics require of the nurse beyond giving excellent care to clients?
Support health legislation to improve accessibility and cost of health care.
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. The Code does not directly address workplace issues such as work schedules or need for overtime.
7. What is the community health nursing definition of health?
Health is families and aggregates choosing actions to ensure safety and well-being.
The text stresses that health is not just the result of an individual's choices, but individuals', families', groups', and communities' choices and actions that lead to health.
8. How does community health nursing define community?
A group of persons share a common identity and environment
Community health nurses work with both geopolitical groups (within specific geographic boundaries) and phenomenological groups (who have a common identity based on culture, history, or goals). A particular phenomenological group may or may not have been a planned group—that is, a group that came together to resolve a recognized common problem or to meet a common goal. However, of all the choices, a group of persons who share a common identity (phenomenological group) and environment (which implies specific geographic setting) is the broadest and most complete definition.
9. Which variable has a major influence on a community's health?
Behavior choices made by persons in the community
Individual behavior choices and environmental factors are responsible for about 70% of health outcomes. Individual choices are affected through interaction with other individuals and their mutual social and physical environments. Health care providers are responsible for only 10% of the outcome.
10. What change could most effectively lead to a longer life span in Americans?
The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm
Smoking is responsible for about 20% of all deaths in the United States. Although smoking is an individual's choice, all people are affected by social norms.
11. What is the health issue causing the most concern in the United States today?
Increase in obesity
The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue.
12. What factors are most responsible for the increasing length of life of Americans over the past 100 years?
Better nutrition and family planning options
Average increased life span over the past 100 years can be largely attributed to higher standards of living, better nutrition, a healthier environment, and having fewer children. Public health efforts such as immunization and medical care have also contributed.
13. Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level?
To be able to observe the community's statistics over time and compare the community with other communities
Although being informed is always preferred and nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop.
14. How do public health efforts differ from medical efforts in improving the health of our citizens?
Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention.
Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government such as veterans administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only individuals or only aggregates.
15. Which primary prevention would the school nurse choose to address the school's number of unwed pregnancies?
Convince the school board to allow sex education classes to include birth control measures
Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies.
16. What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations?
Immunizations are a specific protection effort as part of primary prevention.
17. Which action would probably result in the largest change in health care outcomes for Americans?
Redirect a large portion of federal funding from acute care to health promotion activities
Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate.
18. Which task will be most helpful in meeting the public health agency's goals?
Actively participate in community agencies' collaborative action plan to meet the community's health goals for the year
Although all tasks may be necessary and important, intra-agency cooperation to meet the health goals of the community as a whole is more central to the agency's mission than other choices that meet the needs of individuals or groups rather than the community as a whole.
19. A community health nurse is overwhelmed with all that needs to be done in one day. Which task could most easily be postponed?
Reviewing the most recent hospital patient data collected by the local college of nursing
All of the tasks are related to assessing needs, implementing new care options, or evaluating health outcomes measures in the community except reviewing hospital patient data. Hospital patient data may be helpful but not directly related to the agency's ability to promote primary health and prevent disease.
20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit to make a home visit to a patient who had been discharged the previous day and to give follow-up care (for overload pay). What kind of nursing would this nurse be doing?
The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere in the community. As the nurse is not focusing on the health of the community but on an individual, it is not community or public health nursing. It is not acute care hospital nursing because the nurse is seeing the patient in his or her home.
21. Which task is most crucial for the community health nurse to do very well?
Give testimony regarding proposed state health legislation
Public health's core functions are assurance, assessment, and policy development. Giving testimony regarding legislation directly reflects policy development, which would have a wider impact than the other options, which are more local and narrow in focus.
22. A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nurse can feel prepared?
Meet members of the community to determine their culture and values
Community health nurses must work with the community. It is essential to assess an aggregate's needs and resources and identify its values.
23. Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions?
Populations are not homogeneous, and resources are limited.
Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later.
24. A nurse works very hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called?
By definition, the nurse's actions are coalition building. Although collaboration has a very similar meaning, Table 1-5 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, not yet working with them toward a goal.
25. After completing a master's degree, a nurse took a course in marketing. Should the agency reimburse the nurse's tuition costs?
Yes, the nurse could use such information in social marketing for the agency.
Social marketing tools utilizing marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices.
26. Which factor is most responsible for differences in an individual's health?
Individual's education and income
Factors that contribute to wide variations in health disparities are education, income, and occupation.
1. What are the leading health indicators found in Healthy People 2020? Select all that apply.
Health systems issues, Individual behaviors, Physical and social environmental factors
Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues.
2. What historically have been public health nurses' two most important priorities? Select all that apply.
Engaging in political activity to improve living conditions, Working with the community to confront health issues and poverty
Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty.
3. As in Healthy People 2010, what are the two primary goals of Healthy People 2020? Select the two that apply.
Eliminate health disparities, Increase quality and years of healthy life
As published, the two goals are to increase quality and years of healthy life and eliminate health disparities.
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