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midterm exam for community

Terms in this set (135)

public health policies and programs primarily responsible for increasing avg. life span d/t
improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children and improving nutrition
Leveraging existing data to develop a community profile refers to which of the following?
Secondary Data Analysis
Findings from a recent community health assessment showed that increasing STI rates in teenagers are attributed to policies prohibiting comprehensive sexual health education, a lack of awareness of where to find free or low-cost protective barriers, and high levels of discomfort discussing sexual health topics with parents. The community health assessment has applied which of the following:
Socio-Ecological Model
In 2019, the Philadelphia Department of Public Health reported that 58.8% of people living with HIV in the city had achieved an undetectable viral load, which is well below the 80.0% target suggested by the U.S. Department of Health and Human Services (HHS). These findings reflect what kind of need:
Normative
A community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who makes introductions between the nurse and the neighborhood residents who will partner together. The role of the pastor in this example is:
Gatekeeper
A nurse at a local hospital notices that many of her patients with chronic conditions are experiencing severe mental health issues. She has found several mental health care providers in the neighborhood who accept her patients' health insurance plans, but their hours of service are from 9AM to 5PM only. The scenario is best classified as which of the seven "A's"?
Availability
The most important aspect of the nursing community assessment phase can best be described as:
Formulating a community nursing diagnosis
When developing surveys for a community health assessment, it is important to use validated measures.The purpose of using validated measures is to:
All the above
Through a community health secondary data analysis, you found that a large number of people from a local neighborhood have extensive histories with traumatic events. To inform supportive services, you are interested in understanding how community members cope with or overcome the adverse health consequences linked to these events. Which of the following data collection methods would be the most appropriate?
Individual Methods (Surveys, Interviews)
Which of the following statements is a recommended practice for community dissemination?

A) Dissemination of CHA findings should be exhaustive

B) Technical language increases the credibility of CHA summary reports

C) Dissemination strategies do not require stakeholder-tailored messaging

D) Dissemination strategies should balance big picture recommendations with appropriate levels of detail
Dissemination strategies should balance big picture recommendations with appropriate levels of detail
Which of the following statements reflect an adequate community nursing diagnosis?

A) Increased diagnoses in Type II diabetes among W. Philadelphia residents who live in a food desert with limited green spaces

B) Increased vaping/e-cigarette use by 75% among high school students according to the Youth Behavioral Risk Surveillance Survey

C) High risk of falls in older adults due to decreased physical activity and social isolation, according to the City Health Department, who observed a 30% increase between 2007 and 2017

D) Decreased HPV vaccinations among adolescents in Philly HS
High risk of falls in older adults due to decreased physical activity and social isolation, according to the City Health Department, who observed a 30% increase between 2007 and 2017
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children aged 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis can be best described as:
Epidemic
A business executive develops flu-like symptoms after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings. The scenario best illustrates the interaction of:
Host, Agent, and Environment
Each of the following are classified as what level of prevention?
• Cardiac or stroke rehabilitation programs
• Support groups for diabetes management
• Physical therapy for fall injury victims
Tertiary Prevention
A local university is seeing a rise in the number of students seeking counseling services on campus for depression. The counseling center is interested in identifying the risk factors that are associated with depression in their student body. To do so, they surveyed 75 students with depression and 75 students without depression to compare stressors that are going on in their lives. The epidemiological study the counseling center designed is an example of a:
Case-Control Study
Nurse Jackie is worried about the rising number of patients at her clinic that are victims of physical violence in the neighborhood. She is interested in partnering with local community agencies to develop a violence prevention awareness and education program. Nurse Jackie is interested in intervening on what level of determinant?
Midstream
You are told that a screening test has a high positive predictive value. Which of the following is the best interpretation?
A)The test has a high proportion of false positives.
B)The test has a low proportion of false positives.
C)The test has a high proportion of false negatives.
D)The test has a low proportion of false negatives.
The test has a low proportion of false positives.
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children aged 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. What is the age-specific meningitis death rate (per 1,000) for children aged 15 years and younger for this region to date this year?
0.08 per 1,000
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children aged 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. What is the age-adjusted prevalence rate (per 100,000) of meningitis for children aged 15 years and younger thus far in the current year?
46 per 100,000
Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased.Descriptive epidemiology would use the component of time to explain this change in terms of:
a) Cyclical Patterns
B) Event-Related Clusters
C) Point Epidemic
D) Secular Trends
Secular Trends
You have been asked to help evaluate the validity of a newly developed screening tool for Disease X at your clinic. Of the 1,000 patients at your clinic, 200 are actually living with Disease X, but when tested with the new screening tool, five showed up as a false negative. Based on the false negatives, you were able to conclude that the sensitivity of the screening tool was 97.5%. Knowing that your screening tool exhibited 25 false positive test results, what is the tool's positive predictive value?
88.6%
Which of the following is true about primary health care (PHC) as compared with primary care (PC)?
PHC encourages community participation.
PHC focuses on prevention and cure.
PHC is defined more narrowly than PC.
PHC is person-focused.
PHC encourages community participation.
What is the major barrier to achieving the "Health for All in the 21st Century" in the United States?

Global indicators are not applicable to the United States.

Healthy People 2020 is not consistent with the Declaration of Alma-Ata.

Primary Health Care is not the primary delivery method for health care in the United States.

The U.S public health system is not structured to provide PHC.
Primary Health Care is not the primary delivery method for health care in the United States.
The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is which of the following?
Department of Homeland Security

U.S. Department of Health and Human Services

Center for Disease Control and Prevention

National Institutes of Health
U.S. Department of Health and Human Services
What is the major factor driving current discussions about a Medicare shortfall in the middle of the twenty-first century?

Diversity of the U.S. health care workforce
Changes in fertility rates
Percentage of folks 65+ in the U.S. population
Percentage of foreign-born in the U.S. population
Percentage of folks 65+ in the U.S. population
A factor that strongly influences the success of a PHC system is:

participation of the community members in the design, implementation, and evaluation of the initiative.

assurance of access to care for every woman and child from pregnancy through childhood.

each entity's sense of urgency regarding the evaluation of indicators.

cure orientation of the private sector of health care delivery in the United States.
participation of the community members in the design, implementation, and evaluation of the initiative.
The majority of medical errors are due to lack of education and training.
True
False
false
A nurse is assigned to provide community outreach to a small town that was partially destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family who lost their home and their best friend in the tornado. Which intervention by the nurse is best?
Assessment of the family's home environment to rule out safety issues
Avoidance of discussion of the disaster of 3 years ago
Consideration that the family will have worked through the emotional aftermath by now
Support of the family in preparing a personal disaster response plan
Support of the family in preparing a personal disaster response plan
A nurse is among the first responders to a disaster. What action by the nurse takes priority?
Arranging for shelter for disaster providers
Immediately developing plans for effective triage and client management
Beginning disease surveillance and planning health education
Performing an extensive community assessment
immediately developing plans for effective triage and client management
A nurse takes the time to read and understand the community's disaster plans and participates in mock disaster drills as a leader of the triage team. The nurse obtained disaster management training through the local Red Cross chapter and registered with the state as a disaster management nurse. Which description of the nurse's activities is accurate?
Professional preparedness
Personal preparedness
Community preparedness
Professional preparedness
Why do acts of bioterrorism often have more casualties?
Victims have little to no time to make preparations
They cause the most widespread destruction of all disasters
Those with chronic conditions are more vulnerable
Early warning systems are not effective
Victims have little to no time to make preparations
Which of the following would be considered "manmade" disasters?
avalanche
structural collapse
cyber attack
flood
structural collapse
cyber attack
In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as:
what public-private partnerships do to treat vulnerable populations.
what the government does to ensure that vital programs are in place.
what the U.S. Public Health Service does to prevent disease, promote health, and deliver services.
what society does collectively to ensure the conditions in which people can be healthy.
what society does collectively to ensure the conditions in which people can be healthy.
A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on which functions?
Monitoring pregnant teenagers for symptoms of complications of pregnancy

Offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members

Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders

Preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders
A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is the nurse addressing?
Assessment
Prevention
Assurance
Policy Development
Assurance
How is a "population" best defined?
High risk group
A group of school children and parents
Collection of individuals who share at least one common characteristic
A geographical location within a community
Collection of individuals who share at least one common characteristic
The primary impetus for the school nurse program established by Lilian Wald was to work with children in the schools and make home visits for the purpose of:

providing and obtaining medical treatment for absent students.

enforcing the department of health's rules and regulations.

excluding infectious children from the school environment.

providing shoes and clothing for students.
providing and obtaining medical treatment for absent students.
Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of her times? (Select all that apply.)

Establishment of settlement houses
Community health's focus on teaching and prevention
Lack of public interest in limiting disease
Establishment of the town and country nursing services in large cities
Middle and upper class fear of diseases
Establishment of settlement houses
Community health's focus on teaching and prevention
Middle and upper class fear of diseases
According to Dr. D'Antonio's recorded lecture, where was the best place to receive medical and nursing care up until the 1920s?
Home
Community Clinics
Hospitals
home
According to Dr. D'Antonio's recorded lecture, during the time of Lillian Wald what did the work of nurses contribute to in New York City (NYC)?
Declines in diptheria rate
Declines in tuberculosis rate
Declines in infant mortality rate
Declines in maternal mortality rate
Declines in diptheria rate
Declines in tuberculosis rate
Declines in infant mortality rate
What impact will the baby boomer generation have on the future of health care?
Decrease in demand because they are a healthier group of older adults.

Decrease in demand because they are less likely to use preventive care.

Increase in demand because of increased life expectancy.

Increase in demand because of rates of acute health problems.
Increase in demand because of increased life expectancy.
Coinsurance is best defined as:

The amount of money that an insured member must pay for an insurance policy

The fraction of the medical expenses the insured member has to pay

The specific flat fee you pay for each medical service

The specified amount a member must pay during a policy period before your insurance plan kicks in
The fraction of the medical expenses the insured member has to pay
Health maintenance organizations (HMO) and preferred provider organizations (PPO) can best be defined by what features:

HMOs have higher monthly premiums and PPOs have lower monthly premiums

PPOs have higher monthly premiums and HMOs have lower monthly premiums

HMOs and PPOs have similar costs associated with premiums

HMOs have no monthly premiums while PPOs have higher monthly premiums
PPOs have higher monthly premiums and HMOs have lower monthly premiums
A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as laboratory services and equipment. Which part of Medicare is being described?
Part A
Part B
Part C
Part D
Part B
The following are types of payment rates for hospitals:
Medicare rate
Medicaid rate
Fixed rate
Actual cost
Medicare rate
Medicaid rate
Actual cost
Ten Great Public Health Achievements
1. Vaccination.
2. Motor-vehicle safety.
3. Safer workplaces.
4. Control of infectious diseases.
5. Decline in deaths from coronary heart disease and stroke.
6. Safer and healthier foods.
7. Healthier mothers and babies.
8. Family planning.
9. Fluoridation of drinking water.
10. Recognition of tobacco use as a health hazard.
IOM 1988 mission for public health
"The fulfillment of society's interest in assuring the conditions in which people can be healthy."
IOM 1988, substance of public health
•Organized community efforts aimed at the prevention of disease and promotion of health. It links many disciplines and rests upon the scientific core of epidemiology."
IOM 1988, organizational framtework of public health
Encompasses both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals
prevention
•Policies and actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability.
primary prevention
Efforts to prevent an injury or illness from ever occurring.
secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent.
tertiary prevention
actions taken to contain damage once a disease or disability has progressed beyond its early stages
5 national health goals from the healthy people in 1979
Reduce infant deaths
Reduce child deaths
Reduce adolescent/young adult deaths
Reduce adult deaths
Reduce sick days in older adults
causes of major health issues in healthy people 1979
Careless habits
Pollution
Permitting harmful social conditions to persist that destroy health
healthy people in 2000 is more focused on
prevention
three categories of objectives 2030 healthy people
core objectives, developmental, and research objectives
core objectives
High-priority objectives that have an identified data source, baseline data, a target, and an assurance of at least two additional data points throughout the decade.
developmental objectives
Developmental objectives represent high-priority issues of interest that do not yet have reliable baseline data. Evidence-based interventions have been identified for developmental objectives. Developmental objectives have not been evaluated for meeting core objective selection and data criteria.
research objectives
Research objectives represent areas where, although there is a high health or economic burden, or significant disparities exist between population groups, more research is needed to identify evidence-based interventions to improve health. Research objectives have not been evaluated for meeting core objective selection and data criteria.
3 core functions of public health
assessment, policy development, assurance
core functions of public health: assessment
Refers to systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community.
core functions of public health: policy development
Refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.
core functions of public health:
`Refers to the role of public health in ensuring that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them.
Assurance also refers to making sure that a competent public health and personal health care workforce is available
Assurance also should mean that public health officials should be involved in developing and monitoring the quality of services provided.
10 essential public health services
1. Monitor health status to identify and solve community health problems.
2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships and action to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
8. Assure competent public and personal health care workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
10. Research for new insights and innovative solutions to health problems.
Indicators Used to Develop a Community Health Profile
•Sociodemographic characteristics
•Health status
•Health risk factors
•Health care resource consumption
•Functional status
•Quality of life
population (aggregate)
Collection of ppl who have one or more personal or environmental characteristics in common
Council on Linkages Between Academia and Public Health Practice (Council on Linkages) focused on
improving public health education and training, practice, and research
endemic disease
disease constantly present in a population
epidemic disease
spread to many people at the same time
pandemic disease
an epidemic disease that occurs worldwide
health equity
Everyone in a community has the ability to achieve the highest level of health possible, irrespective of their social circumstances
health disparities
Group-level differences in patterns or distributions (i.e., incidence or prevalence) of health conditions, statuses, and outcomes in a community or population
health inequities
The systematic and unjust distribution of life-enhancing social resources that contribute to the production of health disparities
secular trends
gradual changes in the frequency of disease over long time periods
point epidemic
Concentration in space and time of a disease event, such that a graph of the frequency of cases over time shows a sharp point, usually suggestive of a common exposure.
cyclical pattern
The component of the time series that results in periodic above-trend and below-trend behavior of the time series lasting more than one year.
event-related clusters
Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.
analytic data
Investigates specific factors and their relationship to disease or related factors
Ecological Study Design
Purpose is to evaluate differences in rates of diseases, conditions, or exposures at an aggregate level
Cross-Sectional Study Design
Purpose is to evaluate and characterize the prevalence of risk factors, behaviors, conditions, diseases at one point of data collection
Case-Control Study Design
•Purpose is to identify factors that may contribute to a medical condition by comparing those who have the condition/disease ("cases") with those who do not ("controls")
sensitivity
The ability of a test to correctly detect those who have the disease
specificity
The ability of a test to correctly identify those who do not have the disease
positive predictive value
Proportion of those who receive a positive test result that are actually disease-positive
negative predictive value
Proportion of those who receive a negative test result who are actually disease negative
what is a community assessment
Explore multilevel factors and resources that contribute to or mitigate against the community's priority health concerns
normative
•A need relative to a standard or desired benchmark
perceived/expressed
•A need based on community feedback or observed behavioral patterns
relative
•A need that exists relative to other communities
primary stakeholders
•Patients
•Clients
•Other service consumers
secondary stakeholders
•Service providers
•Administrators
tertiary stakeholders
•Service providers
•Administrators
gatekeeper
•Formal or informal community leaders who serve as a bridge to stakeholders
•May not necessarily work in a health care environment
primary data collection
interactive and non-interactive
primary data collection interactive (individual)
surveys and interviews
primary data collection interactive (group)
focus groups, community forums, group activities
primary data collection non-interactive
windshield survey
what is the golden standard for primary data collection
mixed-methods
purpose of focus groups
Gathering information and opinions from a small group of people (6 - 12 people)
community forums purpose
Bring together the public and stakeholders to provide perspectives on assets and needs
purpose of group activities
Structured method for group brainstorming that encourages contributions from all participants
photo voice purpose
Engaging community members through art to understand perspective on health needs, experiences, and resources
Purpose of windshield survey
Health professionals drive or walk around a community/area and record observations (e.g., written or photography)
seven "a's"
Awareness
Access
Availability
Affordability
Acceptability
Appropriateness
Adequacy
community nursing diagnosis
•Identifies the health problem(s)

•Describes factors, stressors, and conditions that are related to the health problem

•Provides supporting evidence
data definition
•Pieces of observable information intended to measure, enumerate, inform, or describe health attributes, experiences, and other phenomena
health information systems
•Mechanism for collecting, processing, analyzing, and sharing information required for health systems to organize, develop, scale-up (i.e., improve), and operate health services
U.S. Census Bureau
To serve as the nation's leading provider of quality data about its people and economy
American Community Survey
•Help local officials, community leaders, and businesses understand changes taking place within their communities
behavioral risk factor surveillance system
•To collect data about U.S. residents regarding their risk behaviors, chronic health conditions, and use of preventive services
youth risk behavior surveillance system
•To monitor the prevalence, co-occurrence, and secular trends of health behaviors that contribute to the leading causes of death, disability, and social problems among youth in the United States
national health and nutrition examination survey
•Determine the prevalence of major diseases and their associated risk factors

•Assess nutritional status and its association with health promotion and disease prevention

•Develop public health policy and national standards, direct and design health programs, and expand community health knowledge
the policy surveillance program
•Facilitate and increase use of policy surveillance and legal mapping tools to inform public health initiatives
what were the best source of medical and nursing care until the 1920s
homes
the germ theory of disease 1884
idea that infectious diseases are caused by microorganisms
public health care
•promotes integration of all health care systems within a community to come together to improve the health of the community
Several of the most destructive health conditions can be prevented through
•changes in lifestyle, health screenings, and/or immunizations
•Health care costs in US are highest in world and make up
the greatest % of the GDP
Over the last century, leading causes of death shifted from
Infectious disease (ID) => Chronic and degenerative diseases
Complementary therapies
method of treatment used in conjuction with biomedical therapies
Alternative therapies
method of treatment used in place of biomedical therapies
•Insurance status determines
1.Amount of health care people can afford
2.Kind of health care people can afford
3.Where they can receive care
•Errors with serious consequences most likely to occur in:
1.Intensive care units (ICU)
2.Operating rooms (OR)
Emergency departments (ED)
Majority of medical errors not d/t
•provider negligence, lack of education, or lack of training
Department of Health and Human Services (DHHS)
Agency most heavily involved with health and welfare of U.S. citizens
•Charge: Regulating health care and overseeing health status of Americans
Agency for Healthcare Research and Quality (AHRQ)
•Lead federal agency charged with improving quality, safety, efficiency, and effectiveness of health care for all Americans
Agency for Toxic Substances and Diseases Registry
•protects communities from harmful health effects related to exposure to natural and man-made hazardous substances
Centers for Disease Control and Prevention (CDC)
•To protect America from health, safety, and security threats, both foreign and in US
Centers for Medicare and Medicaid Services (CMS)
One of the most powerful agencies in DHHS
•Administers Medicare
•Works in partnership with state governments to administer Medicaid, Children's Health Insurance Program (SCHIP), and health insurance portability standards
•Also performs quality-focused health care or health-related activities
•Maintains oversight of surveying and certifying of nursing homes and continuing care providers
Food and Drug Administration (FDA)
•Protecting the public health by assuring that foods (except for meat from livestock, poultry and some egg products which are regulated by DOA) are safe, wholesome, sanitary and properly labeled; ensuring that human and veterinary drugs, and vaccines and other biological products and medical devices intended for human use are safe and effective
Indian Health Services (IHS)
•Responsible for providing federal health services to American Indians and Alaska Natives
Administration for Community Living (ACL)
•Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.
Department of Homeland Security
•Mission: Ensure a homeland that is safe, secure, and resilient against terrorism and other hazards
Office of Global Health Affairs (OGA)
•Provides leadership and expertise in global health diplomacy to contribute to a safer, healthier world
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