ATI RN COMMUNITY HEALTH NURSING STUDY GUIDE QUESTIONS AND ANSWERS 2023 LATEST UPDATE

ATI RN COMMUNITY HEALTH NURSING STUDY GUIDE QUESTIONS AND ANSWERS 2023 LATEST UPDATE Systems thinking - correct answers.Studies how an individual, or unit, interacts with other organizations or systems Upstream thinking - correct answers.Is used to focus on interventions that promote health or prevent illness, as opposed to medical treatment models that focus on care after an individual becomes ill Nightingale's Environmental Theory - correct answers.-Highlights the relationship between an individual's environment and health -Depicts health as a continuum -Emphasizes preventive care Health Belief Model - correct answers.-Purpose is to predict health behaviors -Emphasizes change at the individual level -Assumes that the preventive health behaviors are taken primarily for the purpose of avoiding disease Milio's Framework for Prevention - correct answers.-Emphasizes change at the community level -Identifies relationship between health deficits and availability of health-promoting resources Pender's Health Promotion Model - correct answers.-Does not consider health risk as a factor that provokes change -Examines factors that affect individuals actions like: personal factors, feelings, benefits, barriers, attitudes of others, and abilities Determinants of Health - correct answers.Factors that influence that client's health. --> nutrition, stress, education, environment, finances, and social status Health Indicators - correct answers.Describe the health status of a community and serve as targets for the improvement of a community's health --> mortality rates, disease prevalence, levels of physical activity, obesity, tobacco, or other substance use Community - correct answers.-A group of people and institutions that share geographic, civic, and/or social parameters -The "community is the client" in community health nursing Goals of Community Health Nursing - correct answers.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" Public Health Nursing - correct answers.-It is population-focused, and involves a combination of nursing knowledge along with social and public health sciences -GOAL: promote health and preventing disease PHN: Assessment - correct answers.-Using systematic methods to monitor the health of a population -->Monitor health status to identify community health problems -->Diagnose and investigate health problems/hazards in the community PHN: Policy Development - correct answers.Developing laws and practices to promote the health of a population based on scientific evidence PHN: Assurance - correct answers.Making sure adequate health care personnel and services are accessible, especially to those who might not normally have them Population-focused Nursing - correct answers.-Includes assessing to determine needs, intervening to protect and promote health, and preventing disease within a specific population Key Principles of PHN: - correct answers.-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 Ethics - correct answers.Preventing harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity, and providing confidentiality, competency, trustworthiness, and advocacy Advocacy - correct answers.The nurse plays the role of informer, supporter, and mediator for the client Evidence-Based Practice - correct answers.-Involves using the best practices, expert opinion, and client preferences to change the delivery of client care -GOAL: improve client outcomes EBP: Data - correct answers.The nurse should appraise data collected from 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) Quality - correct answers.Quality assurance, improvement, and management are part of improvement of health care Total quality management (TQM) - correct answers.Approach that seeks to improve quality and performance which meets or exceeds expectations Continuous quality improvement (CQI) - correct answers.Approach to quality management that emphasizes the organization and its processes and systems and uses objective data to analyze and improve processes Community Health Education - correct answers.-Nurses regularly provide health education in order to promote, maintain, and restore the health of populations -Nurses must take in account the barriers that make learning difficult like: age, cultural beliefs, poor reading skills, and language barriers -Effective community health education requires planning Learning Theories: Behavioral Theory - correct answers.Use of reinforcement methods to change learners' behavior Learning Theories: Cognitive Theory - correct answers.Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors Learning Theories: Critical Theory - correct answers.Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors Learning Theories: Developmental Theory - correct answers.Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge Learning Theories: Humanistic Theory - correct answers.Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest Learning Theories: Social Learning Theory - correct answers.Links information to beliefs and values to change or shift the learners' expectations Domains of Learning: Cognitive - correct answers.Involves knowledge and the development of intellectual skills Domains of Learning: Affective - correct answers.Involves a change in attitude and development of values Domains of Learning: Psychomotor - correct answers.Involves the performance of a skill Development of a Community Health Education Plan - correct answers.-First, identify population-specific learning needs -Design the educational program -Implement the educational program -Evaluate the achievement of learning objectives Epidemiology - correct answers.The study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection Epidemiology Process - correct answers.A systematic method of targeting a specific health need with the goal of improving health -->Provides a broad understanding of the spread, transmission, and incidence of disease and injury Epidemiological Triangle - correct answers.-Epidemiology involves the study of the relationships among an agent, host, and environment -Their interaction determines the development and cessation of communicable diseases, as they form a web of causality, which increases or decreases the risk for disease --> Agent: the physical, infectious, or chemical factor that causes disease --> Host: the living being that an agent or the environment influences --> Environment: the setting or surrounding that sustains the host Epidemiological Calculations - correct answers.-Incidence rate: Number of new cases in the population at a specific time / population total -Prevalence rate: Number of existing cases in the population at a specific time / population total -Mortality rate: provide information about cause of death --> Crude mortality rate: overall death rates --> Cause-specific rate: death from specific cause --> Infant/age: specific to lifespan -Attack rate: Number of people exposed to a specific agent who develop the disease / total number of people exposed --> Endemic when there is a moderate, ongoing occurrence in a given location --> Epidemic: rate of disease exceeds the usual level of the condition in a population --> Pandemic: condition occurs when an epidemic occurs in multiple countries or continents Health Promotion - correct answers.-National health goals are derived from scientific data and trends collected during the prior decade --> Healthy people 2020 Disease Prevention: Primary - correct answers.Prevention of the initial occurrence of disease or injury --> Nutrition education, family planning and sex education, smoking cessation, communicable disease prevention education, safety education, prenatal classes, immunizations, and advocating for access to health care and healthy environments Disease Prevention: Secondary - correct answers.Early detection and treatment of disease with the goal of limiting severity and adverse effects --> community assessment, screenings, surveillance, and control of outbreaks Disease Prevention: Tertiary - correct answers.Maximization of recovery after an injury or illness (rehabilitation) -->PT and OT, support groups, and case management Cultural Care - correct answers.-Culturally and linguistically appropriate services (CLAS) --> STANDARDS: promote development of a healthcare workforce that can respond effectively to the needs of a diverse client population, providing language and information to a client in their preferred language throughout the delivery of care, and promote ongoing improvement and accountability for culturally appropriate care --> It is important to assess cultural beliefs and practices when developing a plan of care --> Nurses should: be familiar with cultures represented in the local community, consider the uniqueness of each client, and consider that there are variations within each culture Acculturation - correct answers.The process of merging with or adopting the traits of a different culture --> Adapting to a new culture requires changes in daily living practices like: language, education, and social experience Cultural Awareness - correct answers.Includes self-awareness of one's own cultural background, biases, and differences Cultural Needs - correct answers.-Cultural needs of a client are just as important as physical and psychosocial needs -The nurse should avoid imposing personal cultural values on the client Cultural Competence - correct answers.Involves respecting personal dignity and preferences, as well as acknowledging cultural differences --> Requires nurses to be responsive to the needs of clients from different cultures --> Guided by four divisions: 1. Cultural Preservation: allowing preservation of the client's traditional values 2. Cultural Accommodation: supporting and facilitating the client's use of cultural practices that are beneficial to the client's health 3. Cultural Repatterning: assisting the client to modify cultural practices that are not beneficial to the client's health 4. Cultural Brokering: advocating, mediating, negotiating, and intervening between the client's culture and health care culture on behalf of the client Cultural Assessment - correct answers.Provides information to the HCP about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors --> Environmental control: indicates the belief in how the environment affects the individual EX: harmony with the environment = more likely to use alternative medicine and spirituality to promote balance in health status --> Time orientation: describes whether an individual places more value on the past, the present, or the future EX: little interest in health promotion behaviors --> Social organization: describes the significance of individual members of a family or the family as a whole EX: single family member that is not the client might be the decision maker in the family; an individual might forgo her own health care needs for the sake of the good of the family --> Health beliefs and practices: whatever an individual believes is the cause of impaired health will affect actions the individual will take to treat or Biological variations in health - correct answers.Linked to genetic ties from biological relatives Using an Interpreter - correct answers.-Use an interpreter when it is difficult for a nurse or client to understand the others language -Interpreters should have knowledge of health-related terminology -The use of family members as interpreters is not advisable because clients might need privacy, family members can lack objectivity, and family members can have difficulty understanding medical terminology -Nurse should consider the clients preferences when selecting the age and gender of an interpreter -Interpreters should not be from the same community as the client Conveying Cultural Sensitivity - correct answers.-Address clients by their last name unless the client gives permission to use other names -Introduce yourself by name and position -Be authentic and honest -Use culturally sensitive language -Find out what the client knows about their health problems and treatment -Incorporate clients' preferences and practices -Do not make assumptions about clients -Encourage clients to ask about anything they are unsure about -Respect clients' values, beliefs, and practices -Show respect for clients' support systems -Provide health teaching materials in the client's primary language Environmental Health - correct answers.Relates to the quality of the air, lans, water, and other surroundings to which people come into contact with --> Nurses identify environmental health risk, participate in research, and use advocacy to improve environmental quality --> Nurses engage in environmentally friendly practices and use of material as well as providing information to the public about environmental health --> Nurse use toxicological information to understand the specific effects that environmental hazards have on populations at risk or following an exposure (Toxicology considers how exposure to chemicals can have negative effects on health) Environmental Risks - correct answers.-Toxins: lead, pesticides, mercury, solvents, asbestos, and radon -Air pollution: carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke -Water pollution: wastes, erosion after mining or timbering, and run-off from chemicals added to the soil -Contamination: food and food products with bacteria, pesticides, radiation, and medication (growth hormones or antibiotics) Environmental Health: Role for Nurses - correct answers.-Facilitate public participation in measures to improve the environment -Perform individual and population risk assessments -Implement risk communication -Conduct epidemiological investigations -Policy development Environmental Health: Assessment - correct answers."I PREPARE" is a method of determining current and past environmental exposures --> I: Investigate potential expostures --> P: Present work: exposures, use of PPE, location of safety data sheets (SDS), hazardous materials brought home on clothing from work, trends --> R: Residence: age of home, heating, recent remodeling, chemical storage, water --> E: Environmental concerns: air, water, soil, industries in neighborhoods, waste site or landfill nearby --> P: Past work: exposures, farm work, military, volunteer, seasonal, length of work --> A: Activities: hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative medicines/healing --> R: Referrals and Resources: Environmental Protection Agency, SDS, OSHA, local health dep --> E: Educate: risk reduction, prevention, follow up National Health Care Goals - correct answers.Reductions: --> toxic air emissions, waterborne disease outbreaks, per capita domestic water use, blood lead levels in kids, pesticide exposures, indoor allergen levels, homes with lead-based paint, exposure to chemicals and pollutants, risks posed by hazardous sites, schools near highways Increases: --> use of alternative modes of transportations for work, number of days beaches are open and safe for swimming, recycling, testing for lead-based paint in houses, monitoring for diseases Environmental Health: Primary Prevention - correct answers.Individual: --> Educate individuals to reduce environmental hazards Community: --> Educate groups, advocate for safe water and air, support programs for waste reduction and recycling, advocate for effective waste management Environmental Health: Secondary Prevention - correct answers.Individual: --> Survey for health conditions related to environment and work, obtain environmental health histories, monitor workers for levels of chemical exposures, screen children 6 months to 5 years for blood lead levels Community: --> Survey for health conditions, assess neighbors, schools, work sites, and the community for environmental hazards Environmental Health: Tertiary Prevention - correct answers.Individual: --> Refer homeowners to lead abatement resources, educate clients who have asthma about environmental triggers Community: --> Become active in consumer and health-related organizations and legislation related to environmental health issues, support cleanup of toxic waste sites and removal of other hazards Global Health - correct answers.-Global health initiatives can be used to improve health status worldwide, and promote equity in treatment -Health for all in the 21st century (HFA21) outlines goals to promote productivity though adequate healthcare services around the globe -Examining the years of life lost from early death and disability provides information about the global burden of disease Influences on Global Health - correct answers.Wars and political unrest, natural and manmade disasters, limited resources and structure in lesser-developed nations, international travel (increase spread of disease), sanitation practice, climate change, maternal health, nutrition Goals for Global Health - correct answers.The Millennium Developmental Goals (MDGs) which called for more developed nations to contribute resources to improve conditions in lesser-developed countries, making global health a responsibility of nations around the world. --> Eradicating hunger and extreme poverty, making primary education available worldwide, promoting empowerment of women and gender equality, reducing child mortality, fostering maternal health, reducing malaria, HIV/AIDS, and other communicable diseases, promoting a sustainable environment, developing global partnerships Global Health: Nursing Interventions - correct answers.-Support the development of health care roles in countries that lack health care professionals -Promote the benefits of nursing as a distinct profession in health promotion and disease prevention and reducing health care costs -Promote the rights of nurses -Foster programs that promote environmental sustainability ("go green") -Act as mentors or consultants to address health of individuals and communities in other countries Access to Health Care - correct answers.The goal of a primary health care system is to make health care available in close proximity to people who need it, and to ensure that it be comprehensive with flexible cost to accommodate the income variations of the individuals who use those services --> PHN advocate for improved access to health care services --> PHN can help shift the focus of the health care system from acute treatment of disease to primary prevention measures, in order to decrease costs Barriers to health care - correct answers.Inadequate health care insurance, inability to pay for services, language barriers, cultural barriers, lack of providers in a community, geographic and social isolation, lack of communication tools (cell phone) and transportation, inconvenient hours, attitudes of HCP towards clients of low income socioeconomic status or those with different ethnic backgrounds, eligibility requirements for state/federal assistance programs Organizations and Financing - correct answers.Good health status positively affects the economy by increasing the individual's potential for productivity and wage-earning Microeconomic Theory - correct answers.Examines individual preference and finances, and how those actions affect cost of care and resource distribution Macroeconomic Theory - correct answers.-Focuses on aggregate behaviors, economic growth, and employment - The cost associated with health care is a barrier to care for many become some providers ration health care, and only offer services to individuals with certain coverage types -The U.S government is involved in providing direct health care services, providing information and protection to the public, setting policies, and assisting providers and the public with finances Affordable Care Act - correct answers.- It was created to help make health insurance affordable for all people and decreases the amount of federal spending on health care - It affects the way medicare benefits are implemented and the way private insurance companies supply coverage - IMPORTANT ELEMENTS: --> Extending eligibility for dependents to remain on parent's insurance until age 26 --> Prohibiting health plans from denying benefits for preexisting coverage to children under age 19 --> Banning lifetime limits on benefit coverage --> Covering preventive care services Organizations - correct answers.The health care system in the U.S. is influences by federal and private organizations (insurers, employers), as well as global health organizations --> international, federal, state, and local organizations International: World Health Organization (WHO) - correct answers.- Provides daily information regarding the occurrence of internationally important diseases - Establishes world standards for antibiotics and vaccines - Primarily focuses on the health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care Federal: Veterans Health Administration - correct answers.Finances health services for active and retired military persons and dependents Federal: Department of Health & Human Services - correct answers.- Under the direction of the secretary of state - Funded through federal taxes - Consists of the following: --> Administration for children and families (ACF) --> Administration for community living (ACL) --> Centers for Medicare/Medicaid Services (CMS) --> Agency for Healthcare research and Quality (AHEQ) --> Centers for Disease Control and Prevention (CDC) --> Agency for Toxic Substances and Disease Registry (ATSDR) --> Food and Drug Administration (FDA) --> Health Resources and Service Administration (HRSA) --> Indian Health Service (IHS) --> National Institutes of Health (NIH) --> Substance Abuse and Mental Health Services Administration (SAMHSA) State: State Departments of Health - correct answers.Obtain funding from state legislature and federal public health agencies --> Manages Women, Infant and Children (WIC), which promotes nutrition for women, infants, and children up to age 5 who are of low socioeconomic status --> Oversees Children's Health Insurance Program (CHIP), which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid --> Establishes public health policies --> Provides assistance/support for local health departments --> Responsible for the administration of the Medicaid program --> Reports notifiable diseases to the CDC State: State Boards of Nursing - correct answers.- Development and oversight of the state's nurse practice act - Licensure of RN's and LPN's - Oversight of the state's schools of nursing Local Health Department - correct answers.- Receives funds from the state level to implement community level programs - Primary focus is to offer various services and programs - Responsible for identifying and intervening to meet health needs of the local community - Work closely with local officials, businesses, and stakeholders - Report notifiable diseases to the state department of health - Funded though local taxes with support from federal and state funds Private Funding - correct answers.Health Insurance and Employer Benefits -Managed care: Bases on using a case management approach with a specific group of providers in an attempt to contain the cost of care Private Funding: Health maintenance organizations (HMOs) - correct answers.Comprehensive care is provided to members by a set of designated providers Private Funding: Preferred provider organizations (PPOs) - correct answers.Predetermined rates are set for services delivered to members --> Financial incentives are in place to promote use of PPO providers Private Funding: Medical savings accounts - correct answers.Untaxed money is put in an account for use for medical expenses Self pay - correct answers.Individuals are responsible for payment --> Offer sliding scale payment where the payment is based off on the individuals income Community Health Program Planning - correct answers.- Role of PHN: collaborative leadership role - Community health program planning should reflect the priorities set as a result of analysis of community assessment data - Priorities are established based on: --> The extent of the problem (percent of the community affected) --> The relevance of the problem to the public (degree of risk) --> The estimated effect of intervention (improvement of health outcome, adverse effects) Ecological Model - correct answers.- An Ecological Model for population health can be used as a guide to examine the determinants of health for a population, and for targeting interventions to multiple factors that affect health - It includes: --> Individual traits (age, gender, biological factors) --> Social, family, and community relationships --> Occupational an home environment --> Overall conditions created by local, state, national, and worldwide forces and trends Community Assessment: Individual, Family, Aggregates - correct answers.- Community assessment is a comprehensive approach that emphasizes the community as a client, with the goal of providing benefit to the people of the area as a whole, rather than to individuals - Assessment and diagnosis are the foundation - It is necessary to expand the ADPIE efforts from the individual to the community or aggregate level Factors to consider when determining health of a community - correct answers.- Status: Epidemiological data, client satisfaction, mental health, crime rates - Structure: Presence of health care facilities, service types and patterns of use, demographics - Process: Relationships, communication, commitment to and participation in health Community Assessment Components - correct answers.- People: demographic, biological factors, social factors, cultural factors, - Place or Environment: physical factors, environmental factors - Social Systems: health systems, education systems, religious systems, legal systems, welfare systems, transportation systems, political systems Data Collection - correct answers.- A critical community health nursing function - Identify the health needs of the local community - It is essential to combine several methods of data collection to have the best outcome Data Collection: Informant Interviews - correct answers.Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants - STRENGTHS: --> Minimal cost, offers insight into beliefs and attitudes, no reading/writing of participants - LIMITATIONS: --> Built-in bias, meeting time and place Data Collection: Community Forum - correct answers.Open public meeting - STRENGTHS: --> Opportunity for community input, minimal cost - LIMITATIONS: --> Difficulty finding time/place, potential to drift from the issue, participation Data Collection: Secondary Data - correct answers.Use of existing data to assess problems; Websites with .edu, .org, and .gov are reliable - STRENGTHS: --> Database of prior concerns/needs, ability to trend health issues over time - LIMITATIONS: --> Data might not represent correctly, time consuming Data Collection: Participant Observation - correct answers.Observation of formal or informal community activities - STRENGTHS: --> Identification of power structures, indication of community priorities, environmental profile - LIMITATIONS: --> Bias, time consuming, inability to ask participant questions Data Collection: Focus Groups - correct answers.Directed talk with a representative sample - STRENGTHS: --> Participants being potential supporters, provides insight into community support, reading/writing of participants not required - LIMITATIONS: --> Discussion of irrelevant issues, getting participants, ensuring the sample is truly represented, time consuming Data Collection: Surveys - correct answers.Specific questions asked in a written format - STRENGTHS: --> Data collected on client population and problems, random sampling, available written or online, contact with people isn't required - LIMITATIONS: --> Low response rate, expensive, time consuming, collection of superficial data, requires reading/writing of participants Data Collection: Windshield Survey - correct answers.Descriptive approach that assesses several community components by driving through a community - STRENGTHS: --> Provides a descriptive overview of a community - LIMITATIONS: --> Need for a driver, time consuming, results based only on visualization and not input from the community - Survey components: people, place, housing and social systems Analysis of Community Assessment Data - correct answers.- Steps in analysis of community assessment data: --> Gather collected data into a database --> Assessing completeness of data --> Identifying and generating missing data --> Synthesizing data and identifying themes --> Identifying community needs and problems --> Identifying community strengths and resources - Problem analysis is completed for each identified problem Community Health Diagnosis - correct answers.- Problems identifies by community assessments - Incorporate information from the community assessment, general nursing knowledge, and epidemiological concepts - Often written as: --> Risk of... among... related to Community Health Program Planning, Development, and Management - correct answers.An individual's ability to understand basic health information and make decisions, or health literacy, can affect the ability or desire to take action - PLANNING: --> Brainstorming - ASSESSMENT: --> Collect data about the community/members - Diagnosis: Identify and prioritize health needs of the community - PLANNING: --> Develop interventions to meet identified outcomes - IMPLEMENTATION: --> Cary out the plan - EVALUATION: --> Examine the success of the interventions Home Health - correct answers.- Nurses provide health care services to clients where they reside, which includes traditional homes, assisted living, and nursing homes - The nurse should always take measures to ensure her own safety - The nurse is a guest in the clients home and should respect the values of the client and household members - Care in the home setting is used to target specific at-risk individuals and groups - Nurses must work as an interprofessional team in order to provide holistic care -Nurse functions as educator, provider of skilled nursing interventions, and coordinator of care - Many clients leave the hospital in just a few days and are still very ill - Clients/family members need skilled services and education about the disease process, prescribed medications, and future implications of their illness - Skilled services include: --> Wound care, skilled assessment, lab draws, medication education, parenteral nutrition, central line care, catheter insertion and maintenance Omaha System Model - correct answers.- Nurses caring for individuals, families, and communities under home health and hospice care often used this to implement the nursing process - Used in many electronic health record systems - STEPS: --> Collecting and assessing data --> Stating the problem --> Identifying an admission problem rating using a problem classification scheme --> Planning and intervening --> Re-rating problems during the span of care delivery and at discharge --> Evaluating the end problem outcome Home Health: Living Environment - correct answers.The nurse must evaluate the living environment for safety, paying close attention to nonsecure rugs, electrical outlets, and extension cords; the use of oxygen; low lighting; the need for safety devices in the bathroom; and other potential environmental hazards --> Older adults are at a higher risk for falls Home Health: Client Education - correct answers.-Nurses provide follow-up care after an acute hospital stay - They must educate the client/family regarding complications or adverse reactions --> Can include when to contact the agency, ER, or provider --> Information and resources for clients/families can provide support in dealing with illness - Providing education encourages clients to be independent and involved in their own care Hospice - correct answers.- Focuses on enhancing the quality of life through the provision of palliative care, supporting the client/family through the dying process, and providing bereavement support to the family following the client's death - It is a comprehensive care delivery system for clients who are terminally ill - Further medical care aimed towards cure is stopped and the focus becomes relief of pain and suffering, as well as enhancing quality of life - Controlling manifestations of the medical problem and dying process is a priority - Clients can receive hospice care in the home, hospice centers, hospitals, and at long-term care - The nurse provides care for the client and their entire family that includes, skilled direct services and indirect care coordination - Postmortem bereavement services are offered for the family - Helping the family transition from an expectation of recovery to acceptance of death is an important aspect of providing hospice care - The nurse can continue to work with th Occupational Health - correct answers.- All work environments have associated risks - Health care in the workplace seeks to both promote health and prevent occupational illness and injury through improvement and maintenance of health - It is essential for the nurse to develop partnerships with workplace administration, industrial hygienists, safety specialist, occupational medicine physicians, HR departments, union representatives, and health insurance agencies - The nurse works to promote a healthy work environment to foster the health and safety of workers - It entails making independent nursing judgments when providing care to the workforce aggregate Occupational Health: Susceptibility - correct answers.- Risk for work-related illness and injury - Factors affecting susceptibility to illness & injury: --> Host factors: worker characteristics, such as job inexperience, age, and pregnancy --> Agent factors: Biological agents (virus, bacteria, fungi); Chemical agents (smoke); Mechanical agents (musculoskeletal strains); Physical agents (temperature extremes); Psychological agents (threats to well being) --> Environmental factors: Physical factors (heat, odor, ventilation); Social factors (sanitation, overcrowding); Psychological factors (addictions, stress) Occupational Health: Responsibilities - correct answers.- Primary prevention: Teaching good nutrition and knowledge of health hazards, and providing information on immunizations, and use of PPE - Secondary prevention: Identifying workplace hazards, early detection through health surveillance and screening, prompt treatment, counseling and referral, and prevention of further limitations - Tertiary prevention: Restoration of health through rehabilitation strategies and limited-duty programs Occupational Health: Exposure to Hazards - correct answers.- An occupational health history provides framework for a nurse to begin to assess a worker for possible exposure to health hazards - GOAL: Identify agents and host factors that place the worker at risk, identify ways to eliminate or minimize exposure, and prevent potential health problems Occupational Health: Site Walk-through - correct answers.- A work site walk-through or survey is apart of a workplace assessment - The nurse should focus on: --> Observation of work processes and materials --> Job requirements --> Actual and potential hazards --> Employee work practices (hygiene, disposal) --> incidence/prevalence of work-related illness/injuries --> Control strategies to eliminate exposures Occupational Health: Control Strategies - correct answers.Designed to reduce future exposures based upon results from investigations into work-related illness/injury Occupational Health: Protection - correct answers.From Violence: --> Be aware of jobs that are repetitive, boring, or draining because they could cause an individual to become aggressive and violent --> Refer patients to employee-assistance programs that provide confidential counseling and referrals to other professional services if needed From Work-Related Injuries: --> Related to falls, environmental hazards, and burns --> Nurses can research and trend analysis to improve working conditions by eliminating or minimizing hazards and potential problems Occupational Safety and Health Act of 1970 (OSHA) - correct answers.- Develops and enforces workplace health regulations to protect the safety and health of workers - Provides education to employers about workplace health and safety National Institute for Occupational Safety and Health (NIOSH) - correct answers.- A part of the CDC that focuses on identification of workplace hazards and research for prevention of workrelated injury and illness - Provides education to safety and health professionals about workplace safety National Advisory Committee on Occupational Safety and Health (NACOSH) - correct answers.- Made up of 12 members representing labor, occupational health and safety professionals, and the general public - The committee's purpose is to advise the secretaries of labor and health and human resources on policies and programs that affect occupational safety and health Workers' Compensation Acts - correct answers.State level legislation that regulates financial compensation to workers suffering from injuries or illness resulting from the workplace Faith Community - correct answers.- The nurse works with individuals, families, and faith communities who share common faith traditions - Members represent the entire lifespan and all family types - Nurses provide interventions to individuals and groups in homes, congregational meeting places, acute or long term care facilities or through school - The practice is governed by each states nurse practice act and standards of practice - Interventions are based on spiritual, physical, emotional, and social dimensions - Nurses must be aware of faith and belief practices of the congregants served - Caring and spirituality are central among faith-based organizations - Circle Model of Spiritual Care: --> C: Caring --> I: Intuition --> R: Respect for religious beliefs and practices --> C: Caution --> L: Listening --> E: Emotional support Faith Community: Missionary Nurse - correct answers.Missionary nursing seeks to promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe Faith Community: Parish Nurse - correct answers.- Promote the health and wellness of populations of faith communities --> Population includes church members and individuals and groups in the geographical community - Nurses work closely with pastoral care staff, professional health care members, and lay volunteers to provide a holistic approach to healing (body, mind, and spirit) - Functions of the Parish Nurse: --> Personal health counseling, health education, liaison between faith community and local resources, facilitating support groups, and spiritual support School - correct answers.School nursing encompasses many roles: --> Case manager, community outreach, consultant, counselor, direct caregiver, health educator, and researcher School: Primary Prevention - correct answers.- Assess the knowledge base regarding health issues --> Teach health promotion (hand hygiene, healthy food choices, disease prevention, immunizations) - Assess the immunization status of ALL children --> Maintain current records School: Secondary Prevention - correct answers.- Assess children who become ill or injured at school --> Provide care to kids who have headaches, stomach pain, diarrhea, parent separation anxiety, minor injuries (cuts and bruises) - Assess all children, faculty, and staff during emergencies --> Provide emergency care such as first aid, create emergency plans, and maintain inventory of emergency supply equipment - Perform screening for early detection of disease and initiate referrals as appropriate --> Vision and hearing, height and weight, and oral health - Assess children to detect child abuse or neglect --> The school nurse is required by law to officially report all suspected cases of child abuse/neglect - Assess children for evidence of mental illness, suicide, and violence --> Identify children at risk - Respond to school crisis and disasters --> Develop a crisis plan, act as a first responder, and participate in drills School: Tertiary Prevention - correct answers.- Assess children who have disabilities --> long-term outcomes - Assess children who have long-term health needs at school - Provide nursing care for children who have chronic disorders, including asthma, diabetes, and cystic fibrosis --> Administer medications - Provide ongoing care for adolescent parents or adolescents who are pregnant --> Assist in pregnancy identification, provide parenting education, and teach safe sex practices Components of Coordinated School Health Programs - correct answers.- Health education, physical education, health services, nutrition services, counseling, psychological, and social services, promotion of a healthy and safe school environment, health promotion for staff, facilitation of family/community involvement Forensics - correct answers.- Forensic nurses care for perpetrators of injury as well as victims of sexual assault, substance use related injuries, human trafficking, physical abuse, gang violence, disaster, and accidental injuries - Nurses combine nursing knowledge with knowledge of the criminal justice system - Nurses work in clinics, ED, law enforcement agencies, mental health facilities, and correctional facilities - Safety is the primary principle of forensic nursing --> Other principles include respect, beneficence, nonmaleficence, caring, justice, truth, and intuition - Requires an advanced education and certification - Sexual assault nurse examiner (SANE) collects detailed medical, physical, and emotional data from clients following a sexual assault, manages samples, and provides support to clients --> A SANE often testifies in legal proceedings related to findings of client assessment Forensics: Primary Prevention - correct answers.Develop and implement injury prevention programs (SIDS, sexual assault) Forensics: Secondary Prevention - correct answers.- Examine victims of crime for indicators of intentional injury - Provide direct care to both the client and perpetrator following a sexual assault - Collect and preserve evidence from possible crimes, using written and picture documentation Forensics: Tertiary Prevention - correct answers.- Provide treatment to incarcerated individuals - Connect clients with community resources after injury (mental health counseling, physical rehab) Aggregates of the Community - correct answers.- This includes individuals from: --> infancy to death --> Families --> Groups within the community Children (Birth to 12 Years) and Adolescents - correct answers.HEALTH CONCERNS/LEAD CAUSE OF DEATH: - Children: --> Perinatal conditions/congenital abnormalities --> SIDS --> MVA/other unintentional injuries - Adolescents: --> MVA/other unintentional injuries --> Homicide --> Suicide SCREENING/PREVENTIVE SERVICES: - Children: --> Ht/Wt --> Vision/hearing --> Hemoglobinopathy, phenylalanine level, T4 --> Immunization status --> Lead exposure --> Cholesterol and triglyceride levels --> Dental health - Adolescents: --> Ht/Wt --> Dental health --> Rubella serology/immunization history --> Substance use disorders --> MSE screenings --> Vision and hearing --> Cholesterol and triglyceride levels NATIONAL HEALTH GOALS: - Children: --> Reductions in dental caries, obesity, and exposure to second hand smoke --> Increases in newborn blood spot screenings and follow up testing, access to a medical home, schools that require health education, childhood immunizations, use of seat belts, and activity - Adolescents: --> Reductions in violent crimes, Women - correct answers.HEALTH CONCERNS/LEAD CAUSE OF DEATH: - Reproductive health, heart disease, diabetes, and malignant neoplasm (breast, cervical, ovarian) SCREENING/PREVENTIVE SERVICES: - Ht/Wt, BP, cholesterol, dental health, pap smear test, mammogram/clinical breast exam, fecal occult blood test/sigmoidoscopy (50+), vaccine history, immunization status, diabetes, HIV, and skin cancer NATIONAL HEALTH GOALS: -Reductions in: --> Diseases involving bone (osteoporosis) --> Death from cancer (breast, ovarian, cervical) --> Sexual violence - Increases in: --> Planned pregnancy --> Early and adequate prenatal care --> Ability to identify early signs of CVA/heart attack --> Abstinence from drugs, alcohol, and tobacco COMMUNITY EDUCATION: - Nutrition, STI prevention, substance use disorders, breast self-exam, skin protection, HIV protection, and injury prevention Men - correct answers.HEALTH CONCERNS/LEAD CAUSE OF DEATH: - Heart disease, malignant neoplasm (prostate, testicular, skin, colorectal), unintentional injuries, lung disease, and liver disease SCREENING/PREVENTIVE SERVICES: - Ht/Wt, BP, dental health, digital rectal exam, fecal occult blood test/sigmoidoscopy (50+), immunization status, diabetes, HIV, skin cancer, and cholesterol levels NATIONAL HEALTH GOALS: -Reductions in: --> Death from cancer specific to men --> Incidence of HIV/AIDS --> Fatal and nonfatal injuries -Increases in: --> Participation in aerobic and muscle-strengthening activities --> Ability to identify warning indicators of a heart attack or stroke COMMUNITY EDUCATION: - Nutrition, self-testicular exam, skin protection, substance abuse disorders, HIV prevention, and injury prevention Older Adults - correct answers.HEALTH CONCERNS/LEAD CAUSE OF DEATH: - Heart disease, malignant neoplasm, cerebrovascular disease, COPD, pneumonia and flu, and substance abuse disorders SCREENING/PREVENTIVE SERVICES: - BP, Ht/Wt, dental health, fecal occult blood test/sigmoidoscopy, mammogram/clinical selfbreast exam, pap smear, vision and hearing, substance abuse, immunization status, functional assessment, medication history, osteoporosis, diabetes, and skin cancer NATIONAL HEALTH GOALS: - Reductions in: --> Musculoskeletal concerns --> Mental health concerns --> Hospitalizations --> Substance use --> Sensory concerns --> Hip fractures --> Fall-related deaths - Increases in: --> Screenings for colorectal cancer --> Participation in health promotion --> Public reporting of elderly abuse/neglect --> Maintain an active lifestyle --> Self-management of disease/chronic disorders COMMUNITY EDUCATION: - Substance use disorders, nutrition, exercise, dental health, sexual behavior, injury prevention (car, falls, viole Families - correct answers.- Nurses must engage in community ADPIE activities that are focused on family issues - Home visits provide nurses with the opportunity to observe the home environment and to identify barriers and supports to health-risk reduction APPROACHES: - Family as a component of society --> Monitors how families interact with other institutions in an community - Family as a system --> Studies how interactions among a family affect the whole family function - Family as a client --> Examines the family unit functioning first, then the individual needs next - Family as context --> Focuses on an individual first, and then the family next CRISIS AND TRANSITIONS - Family crisis --> Occurs when a family is not able to cope with an event --> The family's resources are inadequate for the demands of the situation - Transitions --> Include birth or adoption of a child, death of a family member, child moving out, marriage of a child, major illness, divorce, and loss of main family income --> These Vulnerable Populations - correct answers.- Violence - Substance abuse disorders - Mental health issues/illnesses - Poverty and Homelessness - Rural residency - Migrant employment - Veteran status - Disability Factors that can threaten health - correct answers.- Low income - Difficulty assessing health care - Poor self-esteem - Young/old - Chronic stress - Environmental factors National Health Goals - correct answers.- Increase in the number of people who have a routine PCP and health insurance - Reduction in the number or people who are unable to access or have a delay in accessing health care services and prescribed medications and those who have disabilities that report physical barriers to accessing health and wellness programs in the community Violence: Homicide - correct answers.- Often related to substance abuse - Most homicides are committed by someone known to the victim and occur during an argument - Abuse often precedes homicide within families - Increasing rate among adolescents more than in older aged groups Violence: Assault - correct answers.- Males are more likely than females to be assaulted - Youths are at a significantly increased risk Violence: Rape - correct answers.- Rape is often unreported - Most incidents of rape are: spousal (marital) or acquaintance (date) rape - Females are more likely than males to be raped - The risk is increased in cities, between 8p and 2a, on the weekends, and in the summer months Violence: Suicide - correct answers.- Rates of suicide are highest among individuals 45 to 64 years of age - Females are more likely to attempt; however, males are more likely to complete suicide - Caucasians are more likely than other ethnic groups to commit suicide - Risk factors: --> Depression, mental health disorders, substance abuse use, firearm access, and intimate partner violence Violence: Abuse - correct answers.- Physical violence: occurs when pain or harm results towards an: --> Infant or child --> Intimate partner --> Older adult - Sexual violence: occurs when sexual contact takes place without consent - Emotional violence: includes behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member - Neglect: includes the failure to provide physical care, emotional care, education, or health/dental care Violence: Economic maltreatment - correct answers.- Failure to provide for the needs of a vulnerable person when adequate funds are available - Unpaid bills when another person is managing finances - Theft of or misuse of money or property Individual Assessment for Violence - correct answers.- Risk factors: --> History of abuse, low self-esteem, fear and distrust of others, poor self-control, inadequate social skills, minimal social support/isolation, immature motivation for marriage or childbearing, and weak coping skills - Recognizing potential child abuse/neglect: --> Unexplained injury, unusual fear of the nurse and others, injuries/wounds not mentioned in hx, fractures (new and old) in various stages of healing all over the body, subdural hematomas, malnourishment or dehydration, general poor hygiene or inappropriate dress for weather conditions, parent considers child to be "bad" - Recognizing potential older adult abuse: --> Unexplained or repeated physical injuries, physical neglect and unmet basic needs, rejection of assistance by caregiver, financial mismanagement, withdrawal and passivity, depression Community Assessment for Violence - correct answers.- Social and community risk factors: --> work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources (playgrounds, parks, theaters) Strategies to Reduce Societal Violence - correct answers.- Primary Prevention: --> Teach alternative methods of conflict resolution, anger management, and coping skills --> Organize parenting classes --> Educate clients about community services that are available to provide protection from violence - Secondary Prevention: --> Identify and screen those at risk for abuse --> Assess and evaluate any unexplained bruises or injuries --> Screen all pregnant women for potential abuse - Tertiary Prevention: --> Establish parameters for long-term follow-up care and supervision --> Make resources in the community available to survivors of violence --> Work with parents with children in foster care Caring for Clients who Experience Violence - correct answers.- Build trust and confidence - Focus on the client rather than the situation - Assess for immediate danger - Provide emergency care as needed - Work with the client to develop a plan for safety - Make needed referrals for community services and legal options - Complete mandatory reporting if abuse has occurred Substance Use Disorders - correct answers.- Involve the maladaptive use of substances resulting in threats to an individuals health or social and economic functioning - It has significant effects on family dynamics, and often leads to codependency - It negatively affects family life, public safety, and the economy - Recovery occurs over years and usually involves relapses - A strong support system is very important Substance Use Disorders: Dependence - correct answers.- Dependence is a pattern of pathological, compulsive use of substances and involves physiological and psychological dependence - Cardinal indicators include: --> Manifestations of tolerance and withdrawal --> Denial, defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing, and "go with the flow" attitude Substance Use Disorders: Health problems - correct answers.- Alcohol, tobacco, and other substances use disorders can cause many health problems including: --> Low birth rates, congenital abnormalities, accidents, homicides, suicides, chronic disease, and violence Alcohol Use - correct answers.- Most commonly used substance in the U.S. - It is socially acceptable and easily accessible - It is a depressant; it dulls the senses to outside stimulation and sedates the inhibitory centers in the brain - People who frequently and consistently drink develop a tolerance, an increased requirement for alcohol to achieve the desired effect Effects of Alcohol - correct answers.- The direct effect is determined by the blood alcohol level in the body - The body processes alcohol dependence on several factors: --> Size and weight of the drinker --> Gender (affects metabolism) --> Carbonation (increases absorption) --> Time elapsed during alcohol consumption --> Food in the stomach --> The drinkers emotional state --> Type of alcohol - Excess alcohol that is not metabolized circulates in the blood and affects the central nervous system and the brain Alcohol Withdrawal - correct answers.- Following prolonged use, manifestations of alcohol withdrawal appears within 4-12 hours - Its important to determine the time of the clients last drink in order to accurately monitor for manifestations of withdrawal - Manifestations: --> Irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, and elevated BP Tobacco Use - correct answers.- Smoking is the most important preventable cause of death in the U.S - Nicotine is a stimulant that temporarily creates a feeling of alertness and energy - Tolerance to nicotine develops very quickly - Cigarette smoking results in deep inhalation of smoke, which poses the greatest health risk for cancer, CV disease, and respiratory disease - Cigars, pipes, and smokeless tobacco increase the risk for cancers of the lips, mouth, and throat - Passive (secondhand smoke) poses considerable health risks such as respiratory disease, and lung cancer to nonsmokers Other Substances - correct answers.- Marijuana: --> Has a low level of toxicity --> It is considered the most commonly used illegal substance in the U.S. --> Users can develop dependence with long-term use, but withdrawal manifestations are minimal - Other Stimulants: --> Caffeine, amphetamines, methamphetamines, and cocaine - Other Depressants: --> Barbiturates, benzodiazepines, chloral hydrate, and GHB - Opiates: --> Morphine, heroin, codeine, and fentanyl - Hallucinogens: --> Produce anxiety, paranoia, impaired judgment, and hallucinations --> LSD, PCP, and MDMA (ecstasy) Substance Use Disorders: Individual Assessment - correct answers.- Establish rapport - Pose questions in a matter-of-fact tone - Be nonjudgmental - Use therapeutic communication - Seek information about specific substances used, methods of use, the quantity, and the frequency - Elicit information about consequences experienced (overdoses, blackouts, legal issues) - Determine if the individual perceives a substance abuse problem - Hx of previous rehab experiences - Gather family hx of substance abuse and social exposure to other substance users Substance Use Disorders: Physical Assessment Findings - correct answers.- Vital Signs: --> Varies depending on substance being used - Appearance: --> Individual can appear disheveled with an unsteady gait - Eyes: --> Pupils can appear dilated or pinpoint, red, and with poor eye contact - Skin: --> Can be diaphoretic, cool, and/or clammy. Needle track marks or spider angiomas can be visible - Nose: --> Can be runny, congested, red, and/or cauliflower-shaped - Tremors: --> Fine or coarse tremors can be present Strategies to Reduce Substance Use Disorders - correct answers.- Primary Prevention --> Increase public awareness, particularly among young people, regarding the hazards and risks of dependence associated with substance use (school education programs) --> Encourage development of life skills --> Assist in the formation of parental action and awareness such as Mothers Against Drunk Driving (MADD) - Secondary Prevention: --> Identify at-risk individuals and assist them to reduce sources of stress --> Screen individuals for substance use disorders - Tertiary Prevention: --> Assist the client to develop a plan to aviod high-risk situations and to enhance coping and lifestyle changes --> Refer the client to community groups such as NA and AA --> Monitor pharmacological management --> Provide emotional support to recovering substance users and their families, including positive reinforcement Mental Health - correct answers.National Alliance for the Mentally Ill (NAMI) is an advocacy group that works to reduce stigma and provide services for clients who have mental health disorders and their families Characteristics of Mental Health Disorders - correct answers.- Occurs across the lifespan - High risk of substance abuse disorders - High suicide risk Mental Health: Specific Disorders - correct answers.- Affective Disorders (Bipolar, major depressive disorder) - Anxiety Disorders (OCD, panic, phobias, and PTSD) - Schizophrenia - Dementia - Conduct disorders - Personality disorders Factors Affecting Mental Health - correct answers.- Individual coping abilities - Stressful life events (exposure to violence, disasters) - Social events (divorce, death, separation) - Chronic health problems - Stigma associated with seeking mental health services Strategies for Improving Mental Health - correct answers.- Primary Prevention --> Provide education to populations --> Teach stress-reduction techniques --> Implement parenting classes --> Organize bereavement support groups --> Promote protective factors and risk factor reduction - Secondary Prevention: --> Screen to detect mental health disorders --> Work directly with at-risk individuals, groups, and families --> Conduct crisis intervention - Tertiary Prevention: --> Perform medication monitoring --> Provide mental health interventions --> Make referrals to various groups of professionals --> Identify behavioral, environmental, and biological triggers --> Assist the client in planning a regular lifestyle and minimizing sources of stress Poverty and Homelessness - correct answers.- The federal poverty level is used to help determine which individuals can receive financial assistance (medicaid, welfare) - Individuals living in poverty are unable to pay for food, transportation, shelter, clothes, and medical care - Community regions that are characterized by poor housing, low employment rates, and increased rates of death and disease can be described as neighborhood poverty - Extreme poverty leads to inadequate housing and homelessness - Homeless individuals are those who do not have a regular nighttime residence, and can include individuals who temporarily reside in a shelter, institution, or on the street Characteristics of Individuals Experiencing Poverty - correct answers.- Insufficient insurance coverage - High-risk work and living environments - Poor nutrition - Increased stress - Less likely to engage in preventive activities or seek treatment for health problems - Increased rate of chronic illness and accompanying physical limitations - Increased morbidity and mortality rates Homelessness Population Characteristics - correct answers.- Adults who are unemployed, earn low wages, or are migrant workers - Female heads of households - Families with children - People who have mental illnesses - Veterans - People who have substance use disorders - Unaccompanied youth - Adolescent runaways - Intimate partner abuse survivors - People who have HIV/AIDS - Older adults who have no support system Health Issues of Homeless Populations - correct answers.- Upper respiratory disorders - HIV/AIDS - TB - Mental health disorders - Malnutrition - Dental caries Strategies for Preventing Homelessness and Assisting Individuals who are Homeless - correct answers.- Prevent individuals and families from being homeless by assisting them in . eliminating factors that can contribute to homelessness --> Refer those who have mental illness to therapy and counseling --> Enhance parenting skills that will assist in preventing teens to runaway - Alleviate existing homelessness by making referrals for financial assistance, food supplements, and health services --> Locating a community shelter and assist them to meet long-term shelter needs --> Work with government officials to develop shelter programs - Prevent recurrence of poverty, homelessness, and health problems that result in conditions of poverty and homelessness --> Advocate and provide efforts towards political activity to provide needed services for people who have mental disorders and are homeless --> Make referrals to employee assistance and educational programs to allow clients who are homeless to eliminate risk factors Rural Residency - correct answers.- Typically have less than 20,000 residents - Low population densities are linked to decreased access to care, decreased health status, and decreased health-seeking behaviors - PHN often face challenges of limited resources and isolation from other