Community Nursing - Exam 1 Questions & Answers correct

Community Nursing - Exam 1 Questions & Answers correct Define public health nursing. What is the goal of public health. The practice of promoting and protecting the health (and preventing disease) of populations using knowledge from nursing, social, and public health sciences Goals: assuring conditions where people can be healthy, providing maximum benefit to the largest # of people What is epidemiology? What is the nurse's role in the community? = study of health-related trends in populations for the purpose of disease prevention, health maintenance and health protection Nursing roles: - assess risk and exposure - recognize patterns - eliminate barriers to care - provide interventions and education to targeted groups Define social determinants of health those conditions into which people are born, live, grow, work and age labelled the causes behind the causes of ill health they are the economic and social conditions that shape the health of individuals, communities and jurisdictions as a whole What is a community assessment and its purpose? = Assessing a community by collecting data on the people (demographics, culture), environment, and social systems to make community health diagnoses and guide public health interventions purpose: analyze assets, strength, resources, needs, and barriers impacting achievement of health Using the steps of the public health approach, identify how each part corresponds to John Snow's epidemiology work with cholera outbreak. 1. Surveillance = found that many poor people were sick with cholera in London 2. Risk Factor ID: outbreaks in certain areas of low SES, mapped out and found these areas with contaminated water wells 3. Intervention Evaluation: stop exposure to contaminated water in the area and on a larger scale 4. Implementation: convinced gov'mt that cholera was d/t contaminated sewage water and fountains with clean water were installed Match each component of the public health approach with the questions they answer. What is the problem? What is the cause? What works? How do you do it? What is the problem? = surveillance What is the cause? = risk factor identification What works? = intervention evaluation How do you do it? = implementation What re the 3 core functions of public health? Explain. Assessment: systematically collect, analyze, and make available info on healthy communities Policy: promote the use of a scientific knowledge base in policy and decision making Assurance: ensure provision of services to those in need What are the 10 public health services? monitor health diagnose and investigate inform, educate, empower mobilize community partnership develop policies enforce laws link to/provide care assure a competent workforce evaluate research Explain how core public health interventions to decrease tobacco usage happen at each level of government. Core functions: assess, policy development, assurance Levels of gov: local, state, federal Identify each stakeholder's role in public health: academia government employers and businesses the media academia education, training, research, public service government agencies city planning, education, health policy employers/business health insurance, wellness initiatives and benefits, healthy workplaces media public discourse, health education and promotion, health communication, social media as catalyst What is the difference between public health and health care. public health = focus on the population health care = focus on the individual patient What are some examples of nongovernmental organizations? professional membership organizations (America public health association) associations r/t a specific health concern (American cx society) organizations of citizens focused on health concerns (Americans for nonsmokers rights) foundations that support health projects and influence policy development (Bill and Melinda gates foundation) Explain the health impact pyramid. As you go up the pyramid, individual effort needed increases. As you go down the pyramid, public health impact increases. Which is the priority of public health nursing: primary, secondary, or tertiary promotion? primary prevention is priority Levels of Prevention Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab, teaching diabetic patients about vascular changes. The disease is already there. What is the Minnesota intervention wheel? describes the scope of practice by what is similar across settings and describes the practice of public health nursing at the individual, community, or systems level -- answers "What do public health nurses do?" as their own practice wedges are different aspects of PHN What are upstream vs downstream interventions? upstream = at community or population level ex: intervening at systems level by changing health policy downstream = at individual level ex: meeting a patient at point of care **the cause of a recurring problem can often be found upstream What is a geopolitical vs. phenomenological community? geopolitical = sharing geographic or political borders (ex: New Yorkers) phenomenological = sharing beliefs, interests, or experiences (ex: MSM, those affected by 9/11) What are some methods for community assessment? - windshield survey and observation - interviewing key informants and stakeholders - studying epidemiological data What is community health planning? systematic organization of a plan to address the health problems identified in the community assessment T/F: Health Promotion focuses on Modifiable Risks & Behaviors TRUE Compare compliance and adherence. Compliance: The consistency and accuracy with which a patient follows the regimen prescribed by a physician or other health care professional **more passive, following list of instructions Adherence: the extent to which the patient continues an agreed-upon mode of treatment under limited supervision when faced with conflicting demands **more active engagement in care Define the following in the context of the health belief model: susceptibility severity benefit barriers cues to action self efficacy ▪ Susceptibility: chances for health problem; likelihood of adverse outcome ▪ Severity: how serious is the health problem and its consequences (family life, financial, social) ▪ Benefit: perceived sense of effectiveness of a behavior to prevent a health threat ▪ Barriers: difficulties to actualize a health behavior (inconvenient, time consuming, expensive, unpleasant, painful, upsetting); may interfere with the motivation to perform the health behavior ▪ Cues to Action: internal or external ▪ Self-efficacy : confidence in one's ability to take action What us the trans-theoretical model? provides a framework for exploring if a client is ready to make changes in behavior **helps you assess if it is time for health promotion interventions Explain the following change strategies in the context of the trans-theoretical model (TTM): pre-contemplation contemplation preparation action maintenance termination Pre-contemplation: Increase awareness of need for change; personalize information about risks and benefits. " I dont smoke that much" Contemplation: Motivate, evoke change; encourage making specific plans. " I could quit but Im under stress so it might not be the best time" Preparation: Assist with developing and implementing concrete action plans; help set gradual goals. "Getting nicotine patches" Action: Assist with feedback, problem solving, social support, and reinforcement " taking action and stopping smoking" Maintenance: Assist with coping, reminders, finding alternatives, avoiding slips/relapses Termination: Provide resources What are the four key principals of motivational interviewing? What are other key qualities of MI? partnership, evocation, acceptance, compassion • A Guiding style of communication • Engage above all else and keep connection going • Evoking ask the person how and when change might come about • Change talk- the more there is the better the outcome • Reflective Listening • Facilitate change process • Give advice skillfully Ambivalence the state of having mixed feelings or contradictory ideas about something or someone A Person may make statements that reflect the internal conflicts they may be experiencing from influencing factors. Resist trying to make it better or use persuasion statements. Encourage change talk through MI techniques OARS Open-ended questions Using Affirmations Forming Reflective statements Summaries What are some of the most vulnerable populations to health literacy problems? • Older adults • Racial and ethnic groups other than White • Recent refugees and immigrants • People with less than a high school diploma or GED • People with incomes at or below the poverty level • Non-native speakers of English • People with compromised health status health literacy is essential to client autonomy and good client outcomes. Any client in need of health services or information needs health literacy skills to: Access services and information. Communicate individual needs and preferences. Internalize the meaning of health information and services available. Grasp the context, options, and resulting consequences in health settings. Make choices that are aligned with their preferences and needs T/F: You should NOT assume all patients may have difficulty comprehending health information and accessing health services FALSE - assume everyone has difficulty understanding health info (because its super complicated!!) and use low-level language What are ways to enhance health literacy (have pts understand health info)? • Be culturally sensitive and provide information in the preferred language. • Assess ability to read before providing written information. People are embarrassed to admit the problem. • Picture based instructions promote better understanding of instructions. • Use a "universal precautions" approach - assume most patients have difficulty understanding health information. • Use clear, concrete communication. What are the 4 steps of teach back? explain, assess, clarify, understanding T/F: Population health is related to government social care spending True Ex: the US spends very little on social programs but spends the most on health costs compared to other countried What is public health management (PMH)? = a model of care that addresses individuals' health needs at all points along the continuum of care through various settings and interventions goal = to maintain or improve the physical and psychological well-being of individuals and address health disparities though cost-effective and tailored health solutions What are some payment reforms that act as drivers for public health management? high health care expenditures low quality care quadruple aim of health improvement value-based care paradigm T/F: Nurse practitioner role to help in chronic care management brings more primary care management expertise to these settings. TRUE What is the "equation" for health care value? quality/cost = value Why is a value-based care model better than traditional models? value-based care puts emphasis on quality of care and health promotion/preventative services Explain fee for service and population based payment models. fee for service = - payments based on volume of services - no link to quality - no incentives for efficiency - prevention and health promotion not emphasized - duplicative services - increased health care costs population based payment = - payment not triggered by service delivery, volume - payment is made to clinicians or health org, making them responsible to organize care for a period of time (ex: 1+ yrs) What is an ACO? Accountable Care Organizations = ACO's are groups of service providers that manage and coordinate care for MEDICARE beneficiaries ACO's are accountable for the cost and the quality of care for a defined population of patients. What is a panel? What is panel management? panel = list of pts a care team is assigned to in the practice panel management = the proactive approach to health care - the team should be concerned with the health of the entire population of its patients, not just those who come for visits What is patient registry database that stores patient health care info list of names of all the pts of a provider of a clinic, w/ medical info about each pt can be searched to give feedback oto a clinic and clinician on performance measures, ID pts overdue to screenings/procedures or that are struggling with certain conditions (ex: DM) Quality measures span 4 domains. What are they? patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk populations Who is the panel manager? clinic team member such as an RN reviews the registry on a. regular basis to make sure patients complete their preventative and chronic care tasks on time, receive lifestyle counseling, and are prescribed and are taking meds T/F: Care coordinators focus on patients who cannot control their complex health needs on their own, and those with worsening chronic conditions TRUE Risk Stratification The process of identifying whether a person is at a high, moderate, or low risk of developing a condition What ar some duties the RN can perform in the primary care setting? - preventative care and chronic illness management - scheduled, independent nurse visits (home visits for procedures, wound care, med rec, education, reassessment, injections) - transitions management (case management) - protocol based care (ex: Coumadin clinics, TB testing, vaccinations) - collaborative PCP/RN visits What are some barriers to the RN's role in the community? - cannot make orders, so require HCP referral anyway - lack of knowledge school focused on acute care - cost to pay RNs - lack of direct RN reimbursements from insurance What are the 4 major contributing factors to the rise of non-communicable diseases (NCDs)? tobacco use, physical inactivity, alcohol, unhealthy diets NCDs are collectively responsible for almost 70% of all deaths worldwide occur in low- and middle-income countries mostly affected What are some barriers to effective chronic disease management? • Ineffective application of acute care models for chronic disease • Rushed practitioners not following evidence based practice • Lack of care coordination & communication • Lack of interdisciplinary health team to address complex needs in chronic disease • Lack of active follow-up to ensure best outcomes • Inadequate use of community resources What is a patient-centered medical home (PCMMH)? = model for achieving primary care excellence so that care is received at the right place, @ the right time, and in the right manner = team-based interdisciplinary care that is patient-centered uses technology for communication between patients and HCPs How can the patient-centered medical home (PCMH) model improve quality outcomes for pts with chronic care needs? - providers in communication, all med records in same place decreases polypharmacy - more communication w/ patient more education, patient is aware of health status, messaging - more comprehensive and coordinated care - accessibility increased - commitment to quality and safety What is care transition and quality transitional care? care transition = transition out of hospital to home/treatment center/rehab/hospice quality transitional care = Facilitate the connection, Assess barriers to self-care and any influences related to SDH, earlier entry into palliative care programs, age-friendly care, involving community resources, home care referrals What are the 4 M's Framework of an age-friendly health system? what Matters (to the patient) Medication Mobility Mentation ex: Mt. Sinai geriatric ER