COMPREHENSIVE EXAMINATION
REPORT: PUBLIC HEALTH
NURSING —
POPULATION-CENTERED HEALTH
CARE IN THE COMMUNITY (10TH
EDITION)
Prepared for: Academic Review and Advanced Certification Candidates Based on Text: Public
Health Nursing: Population-Centered Health Care in the Community, 10th Edition by Marcia
Stanhope and Jeanette Lancaster Format: Expert Analysis, Theoretical Contextualization, and
Rigorous Examination Items
Part 1: Influencing Factors in Public
Health Nursing and Population Health
Advanced Theoretical Framework: The Evolution of Population Health
The tenth edition of Stanhope and Lancaster’s seminal text establishes a paradigm shift from
the traditional medical model to a robust, population-centered approach. This shift is not merely
semantic but represents a fundamental reorientation of nursing practice towards the upstream
determinants of health. The text posits that the "client" is no longer solely the individual in the
hospital bed, but the aggregate—the community or population whose health status is shaped by
a complex interplay of social, environmental, and economic forces.
Historical Determinants and the Legacy of Leadership
To understand the current trajectory of public health nursing (PHN), one must interrogate its
origins. The discipline did not emerge in a vacuum but was forged in the crucible of the
19th-century industrial revolution and the subsequent sanitation movement. The text places
significant emphasis on the Shattuck Report of 1850, authored by Lemuel Shattuck. This
document is widely regarded as the cornerstone of American public health infrastructure. It was
Shattuck who first articulated the necessity for state and local boards of health, the systematic
collection of vital statistics, and the professionalization of sanitary inspections. Although initially
ignored, these recommendations laid the architectural blueprint for the modern public health
system.
Simultaneously, the nursing profession was evolving through the leadership of Florence
Nightingale and Lillian Wald. Nightingale’s contribution extended far beyond the Crimea; she
effectively professionalized the concept of "district nursing" and utilized statistical evidence to
,demonstrate the link between environmental sanitation and mortality rates. However, it was
Lillian Wald who truly synthesized nursing with social justice. By founding the Henry Street
Settlement in 1893, Wald demonstrated that health could not be separated from the social
conditions of poverty, housing, and labor. She coined the term "public health nurse" to describe
a practitioner who addressed these "root causes" rather than just the symptoms of disease. This
lineage continues through Mary Breckinridge, who in 1925 founded the Frontier Nursing
Service (FNS), proving that nurse-midwives could drastically reduce maternal and infant
mortality even in the most remote, underserved rural environments.
Global and Economic Contexts
The contemporary PHN must also navigate the macro-level forces of globalization and
economics. The transition from the Millennium Development Goals (MDGs) to the
Sustainable Development Goals (SDGs) marks a critical expansion in global health policy.
While the MDGs (2000-2015) targeted specific metrics in developing nations, the SDGs
(2015-2030) are universal, applying to all nations, and integrate the economic and
environmental dimensions of sustainability. Goal 3 specifically targets health, but the other 16
goals address the social determinants (poverty, education, climate) that underpin health
outcomes.
Economically, the US healthcare system’s pivot from retrospective to prospective payment
systems represents a defining constraint on practice. Retrospective payment (fee-for-service)
historically encouraged the overutilization of services by reimbursing costs after they were
incurred. In contrast, prospective payment systems (such as DRGs for Medicare) establish fixed
reimbursement rates based on diagnosis, incentivizing efficiency and cost containment. This
economic pressure fundamentally alters the nurse’s role, prioritizing case management, early
discharge planning, and community-based preventative care to avoid costly hospital
readmissions.
Examination Module 1: Foundations, History, and Economics
Question 1 Topic: Historical Foundations of Public Health Structure Scenario: A public health
policy analyst is reviewing the origins of the state health department system in the United States
to support a proposal for modernized vital statistics collection. The analyst highlights a
mid-19th-century document that is universally credited with proposing the creation of local
boards of health and the standardized tracking of birth and death rates. Question: Which
document is the analyst citing as the primary architect of this infrastructure? A. The Elizabethan
Poor Law of 1601 B. The Shattuck Report of 1850 C. The Sheppard-Towner Act of 1921 D. The
Institute of Medicine’s Report on the Future of Public Health (1988)
Answer: B Detailed Rationale: The correct answer is The Shattuck Report of 1850. Authored
by Lemuel Shattuck for the Massachusetts Sanitary Commission, this report is the seminal
document in American public health history. It provided a comprehensive plan for a sanitary
survey of the state and recommended the establishment of a state board of health and local
boards of health in every town. Crucially, it emphasized the collection and analysis of vital
statistics (births, deaths, and diseases) as the empirical basis for health planning. While the
recommendations were not immediately adopted due to political inertia, they eventually formed
the structural foundation for the public health system in the United States.
● Distractor Analysis: The Elizabethan Poor Law (Option A) established early welfare
systems in England but was not a public health blueprint. The Sheppard-Towner Act
, (Option C) was significant for maternal-child health funding but came much later. The IOM
Report (Option D) critiqued the "disarray" of the system in the late 20th century but did not
establish the original infrastructure.
Question 2 Topic: Pioneers of Public Health Nursing Scenario: A nursing student is writing a
thesis on the integration of social services and nursing care. The thesis focuses on the leader
who founded the Henry Street Settlement and explicitly linked the health of immigrant
populations to their socioeconomic conditions, effectively launching the specialty of public health
nursing. Question: Which historical figure is the focus of this thesis? A. Florence Nightingale B.
Clara Barton C. Lillian Wald D. Mary Breckinridge
Answer: C Detailed Rationale: The correct answer is Lillian Wald. Wald, along with Mary
Brewster, established the Henry Street Settlement in New York City in 1893. Her unique
contribution was the realization that nursing care in the home could not be effective without
addressing the underlying social determinants of health, such as overcrowding, poor sanitation,
and labor exploitation. She coined the term "public health nurse" to describe this expanded role,
which included advocacy, political activism, and community organization alongside clinical care.
The Henry Street Settlement became a model for the settlement house movement and visiting
nurse associations worldwide.
● Distractor Analysis: Florence Nightingale (Option A) focused on hospital sanitation and
district nursing education but is not associated with the Henry Street Settlement. Mary
Breckinridge (Option D) founded the Frontier Nursing Service for rural health. Clara
Barton (Option B) founded the American Red Cross.
Question 3 Topic: Global Health Goals (MDGs vs. SDGs) Scenario: A non-governmental
organization (NGO) is updating its strategic plan to align with the United Nations' current
development framework. The program director explains that unlike the previous goals which
focused solely on developing nations, the new goals are universal and include a broader focus
on environmental sustainability and inequality. Question: Which set of goals is the NGO
aligning with? A. The Millennium Development Goals (MDGs) B. The Sustainable Development
Goals (SDGs) C. The Alma-Ata Declaration D. The Healthy People 2030 Initiatives
Answer: B Detailed Rationale: The correct answer is The Sustainable Development Goals
(SDGs). Adopted in 2015 to guide global development through 2030, the SDGs represented a
major expansion from the earlier MDGs. While the MDGs (Option A) consisted of 8 goals
primarily targeting poverty and disease in developing nations, the SDGs consist of 17
interconnected goals that apply to all countries, including developed ones. The SDGs explicitly
link health (Goal 3) with other sectors such as education, economic growth, climate action, and
peace/justice, reflecting a holistic "Planetary Health" perspective.
● Distractor Analysis: The Alma-Ata Declaration (Option C) affirmed primary health care as
a human right in 1978. Healthy People 2030 (Option D) is a U.S.-specific national
framework, not a UN global directive.
Question 4 Topic: Health Economics (Micro vs. Macro) Scenario: A public health nurse is
lobbying the state legislature to increase the cigarette tax. The nurse argues that increasing the
cost will reduce the demand for cigarettes among teenagers, a specific consumer behavior.
Simultaneously, the nurse argues that this will reduce the long-term state healthcare burden,
improving the state's overall economic stability. Question: The argument regarding the
teenager's consumer behavior is an application of which economic branch? A. Macroeconomics
B. Microeconomics C. Gross Domestic Product (GDP) Analysis D. Keynesian Economics
Answer: B Detailed Rationale: The correct answer is Microeconomics. Microeconomics
focuses on the behavior of individual decision-making units, such as consumers (teenagers)
and firms (tobacco companies), and how prices affect supply and demand in specific markets.
REPORT: PUBLIC HEALTH
NURSING —
POPULATION-CENTERED HEALTH
CARE IN THE COMMUNITY (10TH
EDITION)
Prepared for: Academic Review and Advanced Certification Candidates Based on Text: Public
Health Nursing: Population-Centered Health Care in the Community, 10th Edition by Marcia
Stanhope and Jeanette Lancaster Format: Expert Analysis, Theoretical Contextualization, and
Rigorous Examination Items
Part 1: Influencing Factors in Public
Health Nursing and Population Health
Advanced Theoretical Framework: The Evolution of Population Health
The tenth edition of Stanhope and Lancaster’s seminal text establishes a paradigm shift from
the traditional medical model to a robust, population-centered approach. This shift is not merely
semantic but represents a fundamental reorientation of nursing practice towards the upstream
determinants of health. The text posits that the "client" is no longer solely the individual in the
hospital bed, but the aggregate—the community or population whose health status is shaped by
a complex interplay of social, environmental, and economic forces.
Historical Determinants and the Legacy of Leadership
To understand the current trajectory of public health nursing (PHN), one must interrogate its
origins. The discipline did not emerge in a vacuum but was forged in the crucible of the
19th-century industrial revolution and the subsequent sanitation movement. The text places
significant emphasis on the Shattuck Report of 1850, authored by Lemuel Shattuck. This
document is widely regarded as the cornerstone of American public health infrastructure. It was
Shattuck who first articulated the necessity for state and local boards of health, the systematic
collection of vital statistics, and the professionalization of sanitary inspections. Although initially
ignored, these recommendations laid the architectural blueprint for the modern public health
system.
Simultaneously, the nursing profession was evolving through the leadership of Florence
Nightingale and Lillian Wald. Nightingale’s contribution extended far beyond the Crimea; she
effectively professionalized the concept of "district nursing" and utilized statistical evidence to
,demonstrate the link between environmental sanitation and mortality rates. However, it was
Lillian Wald who truly synthesized nursing with social justice. By founding the Henry Street
Settlement in 1893, Wald demonstrated that health could not be separated from the social
conditions of poverty, housing, and labor. She coined the term "public health nurse" to describe
a practitioner who addressed these "root causes" rather than just the symptoms of disease. This
lineage continues through Mary Breckinridge, who in 1925 founded the Frontier Nursing
Service (FNS), proving that nurse-midwives could drastically reduce maternal and infant
mortality even in the most remote, underserved rural environments.
Global and Economic Contexts
The contemporary PHN must also navigate the macro-level forces of globalization and
economics. The transition from the Millennium Development Goals (MDGs) to the
Sustainable Development Goals (SDGs) marks a critical expansion in global health policy.
While the MDGs (2000-2015) targeted specific metrics in developing nations, the SDGs
(2015-2030) are universal, applying to all nations, and integrate the economic and
environmental dimensions of sustainability. Goal 3 specifically targets health, but the other 16
goals address the social determinants (poverty, education, climate) that underpin health
outcomes.
Economically, the US healthcare system’s pivot from retrospective to prospective payment
systems represents a defining constraint on practice. Retrospective payment (fee-for-service)
historically encouraged the overutilization of services by reimbursing costs after they were
incurred. In contrast, prospective payment systems (such as DRGs for Medicare) establish fixed
reimbursement rates based on diagnosis, incentivizing efficiency and cost containment. This
economic pressure fundamentally alters the nurse’s role, prioritizing case management, early
discharge planning, and community-based preventative care to avoid costly hospital
readmissions.
Examination Module 1: Foundations, History, and Economics
Question 1 Topic: Historical Foundations of Public Health Structure Scenario: A public health
policy analyst is reviewing the origins of the state health department system in the United States
to support a proposal for modernized vital statistics collection. The analyst highlights a
mid-19th-century document that is universally credited with proposing the creation of local
boards of health and the standardized tracking of birth and death rates. Question: Which
document is the analyst citing as the primary architect of this infrastructure? A. The Elizabethan
Poor Law of 1601 B. The Shattuck Report of 1850 C. The Sheppard-Towner Act of 1921 D. The
Institute of Medicine’s Report on the Future of Public Health (1988)
Answer: B Detailed Rationale: The correct answer is The Shattuck Report of 1850. Authored
by Lemuel Shattuck for the Massachusetts Sanitary Commission, this report is the seminal
document in American public health history. It provided a comprehensive plan for a sanitary
survey of the state and recommended the establishment of a state board of health and local
boards of health in every town. Crucially, it emphasized the collection and analysis of vital
statistics (births, deaths, and diseases) as the empirical basis for health planning. While the
recommendations were not immediately adopted due to political inertia, they eventually formed
the structural foundation for the public health system in the United States.
● Distractor Analysis: The Elizabethan Poor Law (Option A) established early welfare
systems in England but was not a public health blueprint. The Sheppard-Towner Act
, (Option C) was significant for maternal-child health funding but came much later. The IOM
Report (Option D) critiqued the "disarray" of the system in the late 20th century but did not
establish the original infrastructure.
Question 2 Topic: Pioneers of Public Health Nursing Scenario: A nursing student is writing a
thesis on the integration of social services and nursing care. The thesis focuses on the leader
who founded the Henry Street Settlement and explicitly linked the health of immigrant
populations to their socioeconomic conditions, effectively launching the specialty of public health
nursing. Question: Which historical figure is the focus of this thesis? A. Florence Nightingale B.
Clara Barton C. Lillian Wald D. Mary Breckinridge
Answer: C Detailed Rationale: The correct answer is Lillian Wald. Wald, along with Mary
Brewster, established the Henry Street Settlement in New York City in 1893. Her unique
contribution was the realization that nursing care in the home could not be effective without
addressing the underlying social determinants of health, such as overcrowding, poor sanitation,
and labor exploitation. She coined the term "public health nurse" to describe this expanded role,
which included advocacy, political activism, and community organization alongside clinical care.
The Henry Street Settlement became a model for the settlement house movement and visiting
nurse associations worldwide.
● Distractor Analysis: Florence Nightingale (Option A) focused on hospital sanitation and
district nursing education but is not associated with the Henry Street Settlement. Mary
Breckinridge (Option D) founded the Frontier Nursing Service for rural health. Clara
Barton (Option B) founded the American Red Cross.
Question 3 Topic: Global Health Goals (MDGs vs. SDGs) Scenario: A non-governmental
organization (NGO) is updating its strategic plan to align with the United Nations' current
development framework. The program director explains that unlike the previous goals which
focused solely on developing nations, the new goals are universal and include a broader focus
on environmental sustainability and inequality. Question: Which set of goals is the NGO
aligning with? A. The Millennium Development Goals (MDGs) B. The Sustainable Development
Goals (SDGs) C. The Alma-Ata Declaration D. The Healthy People 2030 Initiatives
Answer: B Detailed Rationale: The correct answer is The Sustainable Development Goals
(SDGs). Adopted in 2015 to guide global development through 2030, the SDGs represented a
major expansion from the earlier MDGs. While the MDGs (Option A) consisted of 8 goals
primarily targeting poverty and disease in developing nations, the SDGs consist of 17
interconnected goals that apply to all countries, including developed ones. The SDGs explicitly
link health (Goal 3) with other sectors such as education, economic growth, climate action, and
peace/justice, reflecting a holistic "Planetary Health" perspective.
● Distractor Analysis: The Alma-Ata Declaration (Option C) affirmed primary health care as
a human right in 1978. Healthy People 2030 (Option D) is a U.S.-specific national
framework, not a UN global directive.
Question 4 Topic: Health Economics (Micro vs. Macro) Scenario: A public health nurse is
lobbying the state legislature to increase the cigarette tax. The nurse argues that increasing the
cost will reduce the demand for cigarettes among teenagers, a specific consumer behavior.
Simultaneously, the nurse argues that this will reduce the long-term state healthcare burden,
improving the state's overall economic stability. Question: The argument regarding the
teenager's consumer behavior is an application of which economic branch? A. Macroeconomics
B. Microeconomics C. Gross Domestic Product (GDP) Analysis D. Keynesian Economics
Answer: B Detailed Rationale: The correct answer is Microeconomics. Microeconomics
focuses on the behavior of individual decision-making units, such as consumers (teenagers)
and firms (tobacco companies), and how prices affect supply and demand in specific markets.
