NSG3130/ NSG3130 Exam 1 V2 – Fundamentals & Skills for Nursing Practice II 2025/2026 | Galen | Practice Questions & Verified Answers

NSG3130/ NSG3130 Exam 1 V2 – Fundamentals & Skills for Nursing Practice II 2025/2026 | Galen | Practice Questions & Verified Answers A nurse teaches the importance of folic acid intake to a group of pregnant women. This is considered which level of preventive care? A) Illness behavior B) Primary prevention C) Tertiary prevention D) Secondary prevention B. Primary prevention is considered true prevention. It aims at maintaining physical and emotional health in an already healthy individual. - are described as a person's idea Health beliefs All the following are considered internal variables that influence a client's health beliefs and practices except: A. Perception of functioning B. Emotional factors C. Developmental stage D. Socioeconomic factors D. Socioeconomic factors Clients maintain health or enhance their health by routine exercise and proper nutrition. This is known as: A) Illness B) Health promotion C) Control of external variables D) Wellness education B. Health promotion External variables A client comes into the clinic for a complete physical examination. The nurse obtains a health history and determines the client is at risk for heart disease. Which of the following would lead the nurse to believe this A. Father died of a heart attack at age 40 B. The client is 25 years old C. The client lives near a chemical plant D. The client work as a carpenter A. Father died of a heart attack at age 40 The nurse works in a clinic located in a community with many Hispanics. Which strategy if implemented by the nurse would decrease health care disparities for the Hispanic patients? Teach clinic staff about Hispanic health beliefs. The nurse is caring for a Native American patient who has a traditional belief about health and illness. Which action by the nurse is most appropriate? Ask the patient whether it is important that cultural healers are contacted. The nurse is caring for an Asian patient who is being admitted to the hospital. Which action would be most appropriate for the nurse to take when interviewing this patient? Observe the patient's use of eye contact. A female staff nurse is assessing a male patient of Arab descent who is admitted with complaints of severe headaches. It is most important for the charge nurse to intervene if the nurse takes which action? a. The nurse explains the 0 to 10 intensity pain scale. b. The nurse asks the patient when the headaches started. c. The nurse sits down at the bedside and closes the privacy curtain. d. The nurse calls for a male nurse to bring a hospital gown to the room. c. The nurse sits down at the bedside and closes the privacy curtain. The nurse is caring for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention? Ask permission before touching a patient during the physical assessment. You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP? A. Assisting the patient with oral hygiene B. Observing the patient's response to feedings C. Facilitating expression of grief or anxiety D. Initiating daily weighing A. Assisting the patient with oral hygiene Which task is appropriate for a registered nurse (RN) to delegate to a nursing assistant? A. Explaining to the patient the preoperative preparation before the surgery in the morning B. Administering the ordered antibiotic to the patient before surgery C. Obtaining the patient's signature on the surgical informed consent D. Assisting to the bathroom before leaving for the operating room D. Assisting to the bathroom before leaving for the operation room You are the charge nurse in a surgical unit. You are doing a staff assignment for the 3-to-11 shift, which patient do you assign to the licensed practical nurse (LPN) The patient who had a vaginal hysterectomy 2 days ago and is being discharged tomorrow As the registered nurse, which tasks below should you NOT delegate to the NPN? A. Performing an assessment on a new admission B. Starting blood transfusion C. Develop a plan of care for a patient who is admitted with Guillain-Barré syndrome An RN delegates to the LPN to administer a scheduled tube feeding to a patient. The RN has now transferred full accountability to the LPN for the task getting done, and the RN is no longer accountable for the task. A. True B. False B. False An RN has a critical patient that needs constant monitoring. However, the RN also has other patients in need of care. Which tasks below could the RN delegate to the LPN to help continue the process of patient care? A. Obtaining a routine 12-lead EKG B. Collecting a stool specimen C. Admitting and assessing the new admission D. Updating and evaluating the patient's plan of care. A. Obtaining a routine 12-lead EKG B. Collecting a stool specimen D. Updating and evaluating the patient's plan of care. You are supervising a beginning nursing student who is documenting patient care. Which of the following actions requires you to intervene? The nursing student: A) Documented medication given by another nursing student. B) Included the date and time of all entries in the chart. C) Stood with his back against the wall while documenting on the computer. D) Signed all documentation electronically. A. Documented medication given by another nursing student. A patient asks for a copy of her medical record. The best response by the nurse is to: A) State that only her family may read the record. B) Indicate that she has the right to read her record. C) Tell her that she is not allowed to read her record. D) Explain that only health care workers have access to her record. B. Indicate that she has the right to read her record What is an appropriate way for a nurse to dispose of printed patient information? Place in a secure canister marked for shredding You are giving a hand-off report to another nurse who will be caring for your patient at the end of your shift. Which of the following pieces of information do you include in the report (select all) A. The patient's name, age, and admitting diagnosis B. Allergies to food and medication D. That the patient's pain rating went from 8-2 on a scale of 1 to 10 after receiving 650mg of Tylenol. Which of the following is an example of an external variable that could impact someone's health? Friend Which of the following external variables should be addressed with a patient when providing education during a routine health care visit? Select all that apply. Lack of physical activity Use of tobacco High fat diet A client sets a goal with their nurse to lose 100lbs. The client was told to lose 35lbs on their own first, to be eligible for gastric band surgery, which should help them lose the remainder of the weight. The client is apprehensive, but went ahead and scheduled the surgery for 5 months out, intending to lose the weight in that timeframe. What stage of health behavior change is this client in? Action Contemplation Using the concept of "Maslow's Hierarchy", the nurse knows to address which clients' needs first? Oxygen, Cardiac Function The nurse is drawing a blood specimen on a client and accidentally punctures themself with the contaminated needle. After allowing the site to bleed, which of the following steps should the nurse take? Wash the puncture site with soap and water. The nurse is caring for a client diagnosed with Clostridium difficile (C. diff). To prevent the transmission of C. diff, the nurse should. A. perform hand hygiene with soap and water rather than alcohol based hand sanitizer. B. wear a mask when in the room and for the dient to wear a mask when in public. C. assume that only surfaces that the client has touched are actually contaminated D. sterilize all of the equipment and supplies that leave the client's room A. perform hand hygiene with soap and water rather than alcohol based hand sanitizer. The nurse is caring for a newly admitted patient. The nurse collects the following data and reviews the patient's clinical record. Vital Signs: T 99.8° F, Pulse 110, RR 24 bpm, B/P 128/80, Pain 9 out of 10 on a scale of 0-10 with patient stating pain is in the lower left abdominal quadrant that started 3 days ago. Patient is a 65 year old female that smokes 1 pack of cigarettes a day for 45 years. She drinks alcohol socially on weekends. Her husband died 1 year ago of cancer and she states that she "misses him a lot." Daughter wants her to move in with her, but patient states she wants to remain independent. Patient participates in a sewing group at her church to make pillows for hospitalized children Which level is the priority for this patient according to Maslow's Hierarchy of Needs? A. Self-esteem B. Physiologic C. Love and belonging D. Safety and Security D. Safety and Security Identify which of the following are basic types of health promotion activities. (Select all that apply) A. A billboard promoting abstinence to prevent sexually transmitted infections and unplanned pregnancies B. school of nursing that is holding a blood pressure fair C. A nurse who models healthy lifestyle behaviors D. A wellness assessment program A. A billboard promoting abstinence to prevent sexually transmitted infections and unplanned pregnancies B. A school of nursing that is holding a blood pressure fair Which meal tray should the nurse deliver to a client of Orthodox Judaism faith who follows a kosher diet? Sweet and sour chicken with rice and vegetables, mixed fruit, juice. Which strategy would most help an English-speaking nurse to communicate with a patient for whom English is a second language? Slow down when speaking to articulate more clearly. The ambulatory care nurse is discussing preoperative procedures with a Japanese American client who is scheduled for surgery the following week. During the discussion, the client continually smiles and nods the head. How should the nurse interpret this nonverbal behavior? Reflecting a cultural value A patient prefers to seek acupuncture for pain relief before taking prescribed medication. What response by the nurse is most appropriate? Recognize that alternative forms of treatment can be effective. An Asian American client is experiencing a fever. The nurse plans care so that the client can self treat the disorder using which method? Foods considered to be yin When a nurse is providing care for a client who has been diagnosed with varicella, the nurse should implement which precaution method? airborne When a nurse is providing care for a client who has been diagnosed with epiglottitis, the nurse should implement which precaution method? droplet The nurse is prioritizing a client's problems based on Maslow's hierarchy of needs. The nurse would address which problem first? A. Poor understanding B. Fear of the unknown C. Social isolation D. Lack of sleep D. Lack of sleep When considering different healthcare delivery systems, what category would a patient who is currently in the ICU for sepsis fall into? Secondary A nurse preceptor is explaining the goals of healthy people 2020 with her new graduate nurse. One goal is to reduce health disparities. Which of the following would be a correct interpretation of health disparities? The differences in care received from one person to another based on socioeconomic status, race, age, etc. The process by which individuals from one cultural group merge with, or blend into, a second group is known as: A. Assimilation B. Acculturation C. Social structure D. Social openness A. Assimilation Interpreter: Transforms the message expressed in a spoken or signed source language into its equivalent in a target language. Translator: Converts written material from one language into another. Principles of Delegation: - First Principle: nurses must have knowledge of the nurse practice act in the state where they are licensed, as it defines the RN scope of practice. Other resources of delegation: organization's policy and procedure manual, and the NCSBN website and journal articles. - Second Principle: RNs cannot delegate assessment, planning, evaluation, or accountability for the assigned task. The RN must follow-up with the delegate to make sure the task has been completed. assignment to someone else. If the individual cannot complete the task, then it must be reassigned, or the RN needs to complete it. Task that can be delegated to UAP • Vital signs (UAP) • I&O (including emptying foley catheters, drains and • Transfers and ambulation - stable patients • Postmortem care • Bathing/Feeding • Simple dressing changes • Attending to safety - setting up bed alarms Task that can be delegated to LPN/LVN • Medication Administration (except IV medication unless IV certified) • Complex dressing changes • Other basic nursing skills (NG tube placement; foley catheter insertion) • Enteral feedings (G-tube/NG) • Update care plans • Plus, everything that the UAP can do Which one of the following is an example of the emotional component of wellness? a. The client chooses healthy foods. b. A new father decides to take parenting classes. c. A client expresses frustration with her partner's substance abuse. d. A widow with no family decides to join a bowling league. a. The client chooses healthy foods Which individual appears to have "taken on" the sick role? a. An obese client states, "I deserve to have a heart attack." b. A mother is ill and says, "I won't be able to make your lunch today." c. A man with low back pain misses several physical therapy appointments. d. An older adult states, "My horoscope says I will be well again." b. A mother is ill and says, I won't be able to make your lunch today. Because a client recently diagnosed with diabetes mellitus is confident that blood sugar control can be improved with diet and exercise alone, and recently checked out a video on the management of diabetes at the HMO education center, the client's actions are most representative of which model? a. Health belief model b. Clinical model c. Role performance model d. Agent-host-environment model a. Health belief model A NURSE AND A PRIMARY CARE PROVIDER INFORM A CLIENT THAT CHEMOTHERAPY IS RECOMMENDED FOR THE DIAGNOSIS OF CANCER. WHICH OF THE FOLLOWING NURSING ACTIONS IS MOST REPRESENTATIVE OF THE CONCEPT OF HOLISM? a. OFFER TO COME TO THE CLIENT'S HOME TO PROVIDE NEEDED PHYSICAL CARE. b. CONTACT THE CLIENT'S SPIRITUAL ADVISER. c. INQUIRE HOW THIS WILL AFFECT OTHER ASPECTS OF THE CLIENT'S LIFE. d. PROVIDE THE CLIENT WITH INFORMATION ABOUT HOW TO JOIN A SUPPORT GROUP. c. Inquire how this will affect other aspects of the client's life WHILE HOSPITALIZED A CLIENT IS VERY WORRIED ABOUT BUSINESS ACTIVITIES. THE CLIENT SPENDS A GREAT DEAL OF TIME ON THE PHONE AND WITH COLLEAGUES INSTEAD OF RESTING. WHICH PRINCIPLE OF NEED THERAPY APPLIES TO THIS CLIENT? a. HIS HIGHER LEVEL NEED CANNOT BE MET UNLESS THE LOWER LEVEL PHYSIOLOGICAL NEED IS MET. b. HIS LOWER LEVEL OF PHYSIOLOGICAL NEEDS ARE BEING DEFERRED WHILE HIGHER NEEDS ARE ADDRESSED. c. THE HIGHER NEED TAKES PRECEDENCE AND THE LOWER NEED NO LONGER MUST BE MET. d. IT IS NECESSARY FOR SOMEONE ELSE TO MEET HIS HIGHER LEVEL NEEDS SO HE CAN FOCUS ON THE LOWER LEVEL NEEDS. b. His lower level of physiological needs are being deferred while higher needs are addressed. A CLIENT WHO IS 46 POUNDS OVERWEIGHT TELLS YOU, "I WAS JUST BORN TO BE FAT. I DON'T HAVE THE WILLPOWER." ALTHOUGH WEIGHT LOSS OCCURRED WHILE ATTENDING TWO PREVIOUS PROGRAMS THAT "GUARANTEED" WEIGHT LOSS, THE WEIGHT RETURNED ALONG WITH EXTRA POUNDS AFTER EACH PROGRAM. ACCORDING TO THE HEALTH PROMOTION MODEL, THE NURSE IS MOST LIKELY TO FOCUS ON WHICH BEHAVIOR-SPECIFIC COGNITION AND AFFECT VARIABLE FOR THIS CLIENT? a. PERCEIVED BARRIERS TO ACTION b. PERCEIVED SELF-EFFICACY c. INTERPERSONAL INFLUENCES d. SITUATIONAL INFLUENCES b. Perceived self-efficacy A CLIENT IS ADMITTED FOR HEART FAILURE. THE NURSE ASSESSES THAT THE CLIENT'S BLOOD PRESSURE IS BELOW NORMAL RANGE AND THE APICAL PULSE IS 110 BEATS/MIN. THE NURSE KNOWS THAT THE INCREASE IN THE CLIENT'S PULSE ILLUSTRATES WHICH ASPECT OF THE CLIENT'S HOMEOSTATIC MECHANISM? a. COMPENSATION b. DECOMPENSATION c. SELF-REGULATION d. EQUILIBRIUM a. Compensation USING MASLOW'S FRAMEWORK, WHICH STATEMENT CHARACTERIZES THE HIGHEST LEVEL OF NEED? a. "NURSE, MY PAIN IS SEVERE...IS IT TIME FOR MY SHOT?" b. "I FELT WELCOMED WHEN I FIRST JOINED THE GROUP AND I LOOK FORWARD TO THE MONTHLY MEETINGS." c. "I'M VERY PROUD OF RECEIVING THE EMPLOYEE OF THE MONTH AWARD." d. "THERE HAVE BEEN HOME BREAK-INS WITH BURGLARY IN OUR NEIGHBORHOOD. WE ARE THINKING OF MOVING." c. I'm very proud of receiving the employee of the month award The major factor contributing to the increased emphasis on the need for proficiency in cultural nursing practice in the United States is which of the following? a. An increasing birth rate b. Limited access to health care services c. Demographic changes d. A decreasing rate of immigration c. demographic changes Which behavior is an initial step in culturally responsive nursing practice? a. Help the client recognize the need to adapt health practices to fit commonly accepted practices. b. Discuss the meaning of the medical regimen with the client. c. Inform the client that lack of adherence to the medical regimen may be detrimental. d. Ask a cultural broker to explain the relevance of the intervention. Discuss the meaning of the medical regimen with the client In initiating care for a client from a different culture than the nurse, which of the following would be an appropriate statement? a. "Since, in your culture, people don't drink ice water, I will bring you hot tea." b. "Do you have any books I could read about people of your culture?" c. "Please let me know if I do anything that is not acceptable in your culture." d. "You will need to set aside your usual customs and practices while you are in the hospital." c. "Please let me know if I do anything that is not acceptable in your culture." Which behavior is most representative of a culturally competent nurse? a. Helps clients of Native American heritage identify ways to relate more to their culture. b. Helps parents of Latino heritage recognize that their children need to speak English. c. Interprets and validates beliefs of a client with African-American heritage. d. Asks a nurse of Japanese heritage to teach others dosage calculations since Asians are good at math. c. Interprets and validates beliefs of a client with African American heritage. WHO Definition of Health a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity WHO Determinants of Heath Social and Economic Environment Physical Environment Persons individual characteristics and behaviours General Determinants of Health Income and Social Status Social Support Education and literacy Employment/Working Conditions Housing Transportation Personal Health Practices Coping Skills Healthy child development Biology Genetic environment Health services Gender What is Public Health? organized community efforts aimed at the prevention of disease and the promotion of health Benefits from Public Health Dramatic increase in life expectancy: Decreased number of deaths from stroke, coronary heart disease, and cancer Declines in death rates of adults and children Population-focused PH approaches could help prevent up to 70% of early deaths in America, compared to only 10% for medical treatment. What does public health do? Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services Levels of Health Care Services Pyramid Tertiary Secondary Primary Clinical Preventive Services Population Based Heath Care Services functions of public health assessment, policy development, assurance Assessment regular collection, analysis, and information sharing about health conditions, risks and resources in a community Policy Development use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies assurance focuses on the availability of necessary health services throughout the community. Body of Knowledge about population : Definition Cause or Etiology Groups at High Risk Treatment Methods Effectiveness of Treatment Methods Body of Knowledge About Population : Sources Community Health Nursing Research Clinical research in nursing and medicine Research in other fields Information About the Community : Definition Demographic Data Health Status of Sub-populations Services given to various populations Measure of effectiveness of services Information About the Community: Sources Demographics such as age sex and socioeconomic and racial distributions Vital Statistics such as mortality and morbidity Annual reports of health care organizations Services provided by health planning agencies Computerized information systems for monitoring high-risk populations. Healthy People 2020 Goals Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Leading Health Indicators Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care Public health interventions Three Key Nursing Modes in the Community Community Based Nursing Community Oriented Nursing Public Health Nursing community-based nursing manage acute and chronic conditions, focus in on "illness care" of individuals and families across the lifespan Provide Wound Care Communicated Orientated Nurse prevents disease and disability: promotes, protects and maintains health Broader focus on "health care" of individuals families and groups in community Conduct cognitive screening/tests at the community senior center Public Health Nurse prevents disease and disability and promotes and protects the community as a whole Looks at the entire group of older adults in the entire group of older adults in the community and programs to support them evaluate whether they are effective. Standards of Public Health Nursing Practice Assessment, Population diagnosis and priorities, Outcomes Identification, Planning, Implementation PHN 1. Assessment Nurse assesses the health status of populations using data , community resources identification, input from the population and professional judgement. PHN 2. Population Diagnosis and Priorities Analyzes collected assessment data and partners with the people to attach meaning to those data and determine opportunities and needs. PHN.3 Outcomes Identification The public health nurse participates with other community partners to identify expected outcomes in the populations and their health status PHN.4 Planning The public health nurse promotes and supports the development of programs, policies and services that provide intervention that improve the health status of populations PHN. 5 Implementation, Coordination of Care, Health teaching and Health Promotion , Consultation and Regulatory Activities The public health nurse ensures access and availability of programs, policies, resources and services to the population PHN. 6 Evaluation The public health nurse evaluates the health status of the population Characteristics of Public Health Nursing Population Focused Community Oriented Health and Prevention Focused Interventions at the Community Level Concern for the health of all members of the population or community, particularly vulnerable populations Elizabethan Poor Law of 1601 guaranteed assistance for poor, blind, and "lame" individuals First Hospital founded in america Pennsylvania Hospital (1971) Shattuck Report (1850) -first known public health report that reported to MA sanitary commission that linked causes of illness and death to unsanitary health conditions -utilized: birth/death records and demographic data -single finding: INCREASED LIFE EXPECTANCY, 1850 average life span was 25 years, 2000 average span is 75+ Florence Nightingale Established standards for hospitals, nursing education and was instrumental in establishing public health nursing Coined term District Nursing Lillian Wald Founder of Public Health Nursing Established the Henry Street Settlement, in New York's Lower East Side Still in operation today First Community Health Nurse Henry Street Settlement House This settlement was founded by Lillian Wald in NYC. It addressed serious health conditions and concerns of immigrants. Services included visiting nurses, baby clinics, disease prevention, health education, and treated minor illnesses. Jessie Sleet Scales 1st African American public health nurse Lina Rogers First school nurse Ada Mayo Stewart Occupational/industrial traveling nurse- she began working with employees and families free of service, providing obstetrical care, sickness care and post surgical care in workers homes 1909: "Visiting Nurse Quarterly" first continuing nursing program on a university campus 1914 First post training school course in public health nursing 1922 National Organization for Public Health Nursing Created Standards for public health nursing 1923 Public Health Nursing section formed within the APHA 1910s Targeting infectious and parasitic diseases 1918 Influenza Pandemic killed as many as 50 to 100 million people worldwide. 1909 Metropolitan Life Insurance Company Mary Breckinridge () Founder of the Frontier Nursing Service, in Hyden, Kentucky 1st midwifery education program in U.S. Pearl McIver 1931 First nurse employed by U.S. Pubic Health Service Title VI Social Security Act of 1935 Epidemiology the study of the distribution of mental or physical disorders in a population descriptive epidemiology a form of epidemiology that describes a disease according to its person, place, or time Determinants of health events factors, exposures, behaviors, contexts, and characteristics that determine (or influence) the patterns (answers the how and why); may be individual, relational, social, communal, or environmental. analytic epidemiology a form of epidemiology that investigates origins causes and associations between factors or events and health epidemic a disease occurence that clearly exceeds normal or expected frequency in a community or region endemic continuing presence of a disease or infectious agent in a given geographic area Pandemic an epidemic that is geographically widespread 19th Century John Snow and Florence Nightingale John Snow father of epidemiology Cholera Florence Nightingale Environmental conditions during Crimean war how nurses use epidemiology - Nurses look at health and at disease causation, and how both prevent and treat illness - Nurses are involved in the surveillance and monitoring of disease trends Basic Concepts of epidemiology Rates proportions, risk, ratio Measures of morbidity and mortality Measures of incidence Measures of prevalence web of causality Recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase or decrease the risk for disease Epidemiological Triangle agent, host, environment Chain of Causation Prevalence Rate the number of new and old cases of a disease in a population in a given period of time, divided by the total number in that population basic triad of descriptive epidemiology time, place, person Describes the distribution of disease death and other health outcomes in the population according the the above Methods of Epidemiologic Investigative Process Analytic Epidemiology Experimental Epidemiology Framingham Heart Study • FHS is a long term, multigenerational study, designed to identify genetic and environmental factors influencing the development of cardiovascular and other diseases. • Age Greater than or equal to 50 for men and 60 for women • Hypertension • Smoking • Obesity • Family History of premature CHD • Diabetes • Sedentary lifestyle • Abnormal lipid levels experimental studies clinical trials and community trials Establishing Causality Strength of the association Dose Response Relationship Temporally Correct Relationship Causality Biological Plausibility Consistency with other Studies Specificity Surveillance Mechanism that public health agencies use to monitor the health of their communities to provide a factual basis from which agencies can appropriately set priorities, plan programs, and take actions to promote and protect the public's health Immigration Health Issues Recent changes in immigration laws have increased migration to the United States Legal Immigrant not a citizen but allowed to both live and work in the US Refugees admitted outside the usual quota restricitions based on fear of persecution do to thei race religion nationality, social group or political views. Non-immigrants admitted for limited duration Unauthorized immigrants People who enter a country without proper documents. Factors to consider for providing health care for immigrants Financial constraints (uninsured) Language barriers Differences in social, religious and cultural backgrounds between the immigrant and the health care provider Providers lack knowledge about immigrant groups Traditional healing or folk health care practices the may be unfamiliar to US health care providers Be culturally competent Four principles of cultural competence -care is designed for the specific client -care is based on the uniqueness of the person's culture and includes cultural norms and values -care includes self-employment strategies to facilitate client decision making in regard to health behavior -care is provided with sensitivity and is based on the cultural uniqueness of clients Two principles for developing cultural competence Maintain a Broad Objective and open attitude toward individuals and their cultures Avoid seeing all individuals as alike Stages in developing cultural competence Culturally Incompetent Culturally Sensitive Culturally Competent Three dimensions of each stage Cognitive (thinking) Affective (feeling) Pyschomotor (doing) Concepts of Cultural Competence Cultural Awareness Cultural Knowledge Cultural Skill Cultural Encounter Cultural Desire Dimensions of Cultural Competence Cultural preservation Cultural accommodation Cultural repatterning Cultural brokering Inhibitors to Developing Cultural Competence/Awareness Stereotyping Prejudice Racism Ethnocentrism Cultural Blindness Cultural Imposition Cultural Conflict Cultural Shock cultural nursing assessment Systematic way to identify the beliefs, values, meanings, and behaviors of people while considering their history, life experiences, and the social and physical environments in which they live. Two Phases of an In-Depth Cultural Assessment Data Collecting Phase Organizing Phase Organizing Factors of Culture Communication Space Social Organization Time Perception Environmental Control Biological Variations Culture and Nutrition Five Principles of a Culturally Competent Organizational Model Valuing Diversity Conducting Cultural Assessment Understanding the Dynamics of Difference Institutionalizing cultural knowledge Adapting to diversity Community Health Assessment Process Assessment Diagnosis Plan Implementation Evaluation Three Dimensions of Community people, place, function goals and means of community oriented practice Nurse and community seek healthful change together Three characteristics of community health Status - Involves physical, emotional and social components Structure- Services and Resources in a community Process - Effective community functioning or problem solving Assessing the Community Health Data collection and interpretation Data gathering Data generation Composite database analysis Community Reconnaissance Assessment Issues Identifying the Community Problems Planning the community health Implementing for community Evaluating the intervention for community health Three sources of information about a community Other nurse, social workers or health care providers who are familiar Community members Your own observations Community Assessment Methods Informant Interviews Participant Observation Windshield Surveys Secondary Analysis of Existing Data Surveys Windshield Survey Motorized equivalent of simple observation Observe many Dimensions of Community Life Key Informant Interviews Formal/Informal Role Imprortant dimensions of community Strengths & Weaknesses Issues/Concerns Suggestions/Solutions Community Health Diagnosis Risk of _________________ (problem/dx) among _________________ (group/target pop.) is related to _______________ (community factors) and ___________________ (contributing factors) Infectious Disease are the number one cause of death worldwide Fomite any nonliving object or substance capable of carrying infectious organisms ie clothing and vedding Incubation Period the period between exposure to an infection and the appearance of the first symptoms prodrome Phase of early manifestations of the infection until overt clinical syndrome Fever Most common sign of a communicable disease in infants and children Special Vulnerability of Infants and Children Immune System not fully mature and disease protection through immunization is incomplete Poor hygiene Nurse role in prevention standard precautions Hand Hygeine Promote/Provide Immunizations Separate Ill and Well Patients in the Clinic Eliminate Habitat or reservoir of host Kill pathogen Educate Caregivers susceptibility likely to be affected by something Immunity Natural, Acquired, Passive, Herd, Active Factors Influencing the spread of disease Resistance Natural Immunity Acquired Immunity Active Immunization Passive Immunity Herd Immunity Infectiousness Resistance Hosts ability to withstand infection Natural Immunity species-determined innate resistance to an infectious agent. acquired immunity resistance acquired by a host as a result of previous natural exposure to an infectious agent Active immunization immunization of an individual by administration of an antigen passive immunity immunization through transfer of specific from an immunized individual to an unimmunized individual (mother to infant) herd immunity immunity in most of a population Modes of transmission vertical and horizontal vertical transmission from parent to child horizontal transmission person to person direct transmission Transmission of blood or body fluids through touching (including shaking hands), kissing, coughing, sneezing, and talking. indirect transmission Transmission of blood or body fluids through contact with an intermediate contaminated object such as a razor, extractor, nipper, or an environmental surface. Vector Borne Disease Lyme disease Malaria West Nile Rabies primary prevention Efforts to prevent an injury or illness from ever occurring. secondary prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent. tertiary prevention actions taken to contain damage once a disease or disability has progressed beyond its early stages Three points of action Removal elimination or containment of the cause of infection Disruption and blockage of the chain of disease transmission Protection of the susceptible population from infection and disease Control of disease The reduction of incidence or prevalence of a given disease to locally acceptable level as a result of deliberate efforts Elimination of disease Controlling a disease within a specified geographical area and reducing the prevalence and incidence to near zero Eradication of disease termination of all cases of a disease and its transmission globally Epidemiology of HIV Affects minorities more Heterosexuals account for 27% of new cases 12 mill in the US 38 mill worldwide Hepatitis A Virus (HAV) a virus that is transmitted through the oral-fecal route and causes a form of acute hepatitis Hepatitis B virus Spread through blood and body fluids. Can survive at room temperature for at least one week Hepatitis C (HCV) The most widespread chronic blood-borne illness in the US. No Vaccine available. Leading cause of chronic liver disease. Category A Bio terrorism Agents High Infectivity and High Death Rate Anthrax Plague Ebola Smallpox Category B bioterrorism Moderate Infectivity and low death rate EColi Category C bio terroism Potential for high infectivity and high death rate Hantavirus FDA Has to look if food is a threat to community health Vaccine preventable diseases measles, rubella, pertussis, influenza, HPV, Dipth, Polio Tetanus Hep A&B What is tuberculosis? an infectious bacterial disease characterized by the growth of nodules (tubercles) in the tissues, especially the lungs. Tuberculosis bacteria Mycobacterium tuberculosis How is TB spread? airborne LTBI Latent TB Infection. An asymptomatic stage of the infection in which the immune system contains the infection and is generally not contagious. Health Absence of disease or illness, wellbeing, multidimensional Health (WHO definition) A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity WHO determinants of health Social and economic environment, physical environment, people's individual characteristics and behaviors "The context of people's lives that determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of their determinants of health." Determines of health Factors that influence the client's health -Income and social status -Social support -Education and literacy -Employment/working conditions -Housing -Transportation -Personal health practices, nutrition -Coping skills -Healthy child development -Biology -Genetic endowment -Health services -Gender Public health Lins disciplines, builds on the science of epidemiology, and focuses on the community; organized efforts designed to fulfill society's interests in ensuring conditions in which people can be healthy Roles of public health Prevents epidemics and the spread of disease, protects against environmental hazards, prevents injuries, promotes and encourages healthy behaviors, responds to disasters and assists communities in recovery, ensures the quality and accessibility of health services Benefits of public health Dramatic increase in life expectancy, decreased number of deaths from stroke, coronary heart disease, and cancer, declines in death rates of adult and children, population-focused public health approaches could help prevent up to 70% of early deaths in America, compared to only 10% for medical treatment Levels of health care services pyramid From bottom to top: population-based heath care services, clinic preventive services, primary health care, secondary health care, tertiary health care All tiers of the pyramid need to be adequately financed Primary health care Both primary care and public health services that are designed to meet the basic needs of people in communities at an affordable cost Secondary health care Services designed to detect and treat disease in the early acute stage Tertiary health care Service designed to limit the progression of disease or disability Core public health functions Assessment, policy development, assurance Assessment Regular collection, analysis and information sharing about health conditions, risks, and resources in a community Policy development Use of information gathered during assessment to develop local and state health policies and to direct resources towards those policies Assurance Focuses on the availability of necessary health serves throughout the community, it includes maintaining the ability of both public health agencies and private providers to manage day-to day operations and the capacity to respond to critical situations and emergencies Assessment services of public health -Monitor health status to identify community health problems -Diagnose and investigate health problems and health hazards in the community -Research for new insights and innovative solutions to health problems Policy development services of public health -Inform, educate, and empower people about health issues -Mobilize community partnerships to identify and solve health problems -Develop policies and plans that support individual and community health efforts -Research for new insights and innovative solutions to health problems Assurance services of public health otherwise unavailable -Ensure a competent health and personal health care workforce -Calculate effectiveness, accessibility, and quality of personal and population Healthy People 2020 Benchmarks developed to make the US population healthy, the main goal being to create a society in which all people live long, healthy lives Overarching goals of Healthy People 2020 Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Promote quality of life, healthy development, and healthy behaviors across all life stages Leading Health Indicators of Healthy People 2020 -Access to health services -Clinical preventive services -Environmental quality -Injury and violence -Maternal, infant, and child health -Mental health -Nutrition, physical activity and obesity CT department of public health Healthy CT 2020 is our state's translation of the national Healthy People 2020 initiative, it provides a framework for health promotion and disease prevention in the current decade, with overarching themes of health equity and social determinants of health Public health nursing intervention wheel a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health, providing a practice foundation. Public health interventions purple section -Surveillance -Disease and other health event investigation -Outreach -Screening -Case finding Surveillance Describes and monitors health events through ongoing and systematic collection, analysis and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions Disease and other health event investigation Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures Outreach Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it and how services can be obtained Screening Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations Case finding Locates individuals and families with identified risk factors and connects them with resources Public health interventions green section -Referral and follow-up -Case management -Delegated functions Referral and follow-up Assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources to prevent or resolve problems or concerns Case management Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services Delegated function Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law Public health interventions blue section -Health teaching -Counseling -Consultation Health teaching Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities Counseling Establishes an interpersonal relationship intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual Consultation Seeks information and generates optional solutions to perceived problems or issues through interactive problem solving with a community, system, and family or individual Public health interventions red section -Collaboration -Coalition building -Community organizing Collaboration Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health Coalition building Promotes and develops alliances among organizations or constituencies for a common purpose Community organizing Helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set Public health interventions yellow section -Advocacy -Social marketing -Policy development and enforcement Advocacy Plead someone's cause or act on someone's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf Social marketing Utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest Policy development and enforcement places health issues on decision-maker's agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies, policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies Principles guiding public health and community nursing Ethics, advocacy, evidence-based practice, quality, professional collaboration and communication Ethics in public health Public health code of ethics guides ethical practice for public health, American Nurses Association's (ANA) public health nursing: scope and standards of practices, public health nurses have a moral mandate to establish ethical standards when advocating for health care policy Application of ethical principles -Balance individuals rights vs rights of community groups -Respect for autonomy: client's right to self-determination -Nonmaleficence: no harm is done -Beneficence:: maximize possible benefit and minimize possible harms contributions of members Population (or aggregate) A collection of individuals who share one or more personal or environmental characteristics Subpopulations Subsets of the population who share similar characteristics Population-focused practice Services are implemented for or with a defined population or subpopulation as opposed to diagnoses, interventions, and treatment carried out at the individual level Characterizing public health nursing -In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention -In other forms of nursing, the client is more likely to see out and request assistance -The public health nurse: meets with community groups, works "with" groups, not "for", helps them act for themselves to solve problems Public health nurses focus on: -What are the major health problems in this community? -Which population groups are at greatest rip? -How are risks distributed geographically? -What services are available? What services need to be provided but are unavailable? Essential services of public health (how to participate as a public health nurse) -Monitor health status to identify community health problems -Diagnose and investigate health problems and hazards in the community -Inform, educate, and empower people about health issues -Primarily works with community groups to create policies and improve the environment -Enforce laws and regulations that protect health and ensure safety -Link people to needed personal health services and ensure the provision of heath care that is otherwise unavailable -Ensure a competent public health and personal health care workforce -Evaluate the effectiveness, accessibility, and quality of personal and population-based health services -Research for new insights and innovative solutions to health problems Nursing roles in the community -Public health nurse -Community based nurse -Community oriented nurse Public health nurse Focus of care: community as a whole Primary goal: prevent disease and disability and protect the community as a whole Activities: conduct research assessment, policy development, and assurance Community based nurse Focus of care: individuals and nurses Primary goal: management of acute or chronic illness Activities: direct one-on-one illness care Community oriented nurse Focus of care: aggregates, communities, populations, at risk, underserved Primary goal: health promotion and disease prevention Activities: indirect (program management), can include direct care of at risk individuals and populations Example of public health nursing Looking at entire group of older adults in the community and programs to support them and evaluate whether these programs are effective Example of community-based nursing Providing wound care at a client's home Example of community-oriented nursing Conducting cognitive screening/tests at the community senior center Levels of prevention Primary, secondary, tertiary Primary prevention Prevention of problems before they occur such as provide immunizations and nutrition education Secondary prevention Early detection and intervention to limit severity and adverse effects such as screening Tertiary prevention Correction and prevention of deterioration of disease Level of prevention: group Interacting people with a common purpose or purposes -Primary: birthing classes for pregnancy teen moms, HIV and other STI education for middle and high school students -Secondary: vision screening of first grade class, mammography van for screening of women in low-income neighborhood, hearing tests at senior center -Tertiary: group counseling for grade-school children with asthma, swim therapy for physically disabled elders at a senior center, AA and other self-help groups, mental health services for military veteran Level of prevention: community Aggregate of people sharing space over time within a social system; population groups or aggregates with power relations and common needs or purposes -Primary: fluoride water supplementation, environmental sanitation, removal of environmental hazards -Secondary: organized screening programs for communities such as health fairs, VDRL screening for marriage license applicants in a city, lead screening for children by school district services, community mental health services for chronically mentally ill, home care services for chronically ill American Nurses Association (ANA) The national professional membership association of nurses that works for the improvement of health standards and the availability of healthcare services, fosters high professional standards for the nursing profession, and advances the economic and general welfare of nurses -By working together, nurses can make a great impact on public health as a whole (immunizations, infection prevention, environmental health, opioid crisis response) Challenges of future of public health -Current trend to move more care into community settings and to reduce the number of hospital days for "sick" clients because community care is less expensive and more appealing to people who prefer to remain at home rather than be treated in a hospital -This trend is expected to grow and continue to change Healthy Nurse, Healthy Nation An initiative to connect and engage nurses, employers, and organizations around improving health in five areas: physical activity nutrition, rest, quality of life, and safety Early public health Ability to preserve health and treat illness has depended on the civilizations's knowledge of science, use and availability of technologies, and degree of social organization (ex. ancient Babylonians, Egyptians, Elizabethan Poor Law (1601), and Industrial Revolution) Public health during America's Colonial Period and New Republic Family/friend system of care, Pennsylvania Hospital, first hospital founded in America (1751), Shattuck Report (1850) What was the first hospital founded in America? Pennsylvania Hospital in 1751 Shattuck Report Addressed public health issues in Massachusetts and recommendations for solving the problems (36 out of 50 are accepted principles of PH) Florence Nightingale () Founder of modern nursing, worked during Crimean War (), lead 38 nurses to hospitals for British sick and wounded soldiers in Scutari in Asia Minor, working against challenges such as poor sanitation, lice, rats, etc. improved soldier health using population based approach, improved environmental and nursing care, epidemiology: document decreased mortality rate from 415 per 1000 at beginning of war to 11.5 per 10000 at end, member of American Statistical Association and frequently used health data to influence individual's health, established standards for hospitals, nursing education, and was instrumental in establishing public health nursing, coined term District Nursing Florence Nightingale and Origins of Trained Nursing Organized nursing practice and nursing education in hospitals (1858), district nursing association founded (1859) by William Rathbone, first nursing schools opened in 1870, visiting nurse associations founded in 1885, Instructive District Nursing in 1886 Who organized nursing practice and nursing education in hospitals in 1858? Florence Nightingale Who founded the District Nursing Association in 1859? William Rathbone Lillian Wald () First community health nurse, founder of public health nursing and coined the term public health nurse, established Henry Street Settlement House in 1863 with colleague Mary Brewster, set standards for public health nursing, nursing education, and school nursing, provided service for society, engaged in autonomous practice, focused on human dignity and cultural caref Who established the Henry Street Settlement House? Lillian Wald with colleague Mary Brewster Who was the founder of public health nursing? Lillian Wald Origins of trained nursing American Red Cross and its Rural Nursing Service initiated home nursing care in areas outside larger cities, care to sick, instruction on hygiene/sanitation, occupational health nursing established, Ada Maya Stewart (1895) first occupational health nurse who coined the term industrial nursing, school nursing established, Lina Rogers became first school nurse, Jessie Sleet (Scales) () was the first African American public health nurse Ada Maya Stewart One of the first industrial nurses, coined the term "industrial nursing", an important figure in occupational health nursing Lina Rogers First school nurse Jessie Sleet Scales First African American public health nurse Continued growth in public health nursing 1909: "Visiting Nurse Quarterly" and first continuing nursing program on a university campus 1922: National Organization for Public Health Nursing (NOPHN); provided standards for PH nursing education American Public Health Association (APHA): 1923 the Public Health Nursing Section was formed within APHA Pubic health nursing during the early 20th century -World War I (nurses needed: home or abroad?) -1918 influenza pandemic (500-100 million deaths worldwide; 670,000 in US) -Limited funding obstacle to public health nursing -1909: Metropolitan Life Insurance Company -1921: Maternity and Infancy Act (also called the Sheppard-Towner Act) Mary Breckinridge () Founder of the Frontier Nursing Services (FNS) in 1925 in rural Kentucky, introduced first nurse-midwives into US, established medical, surgical, and dental clinics, nursing and midwifery services to 10,000 people over 700 square miles, six outposts: traveled on horseback Economic depression and the effect on public health 1930s Depression -Agencies and communities unable to meet the huge needs and numbers of the poor -Decreased funding for nursing services -Federal Emergency Relief Administration (FERA) -Civil Works Administration (CWA) -1931: first nurse employed by US Public Health Service; Pearl McIver -Social Security Act of 1935 (Title VI) -Bolton Act of 1943, established the Cast Nurse Corps (one of the most significant nursing legislations, money towards nursing education for nursing, nursing schools, increased number of schools) From World War II until the 1970s in public health -Americans living longer -New nursing organizations: National League of Nursing (NLN), National League for Nursing Education (1st collegiate PH nursing program), American Nurses Association (ANA) -1950: Public health nursing required in most BSN programs -1952: nursing education programs began in junior and community colleges Public health from the 1970s to the present -1970s: hospice movement, development of birthing centers, daycare for elderly and disabled persons, drug-abuse treatment programs, and rehabilitation services in long-term care -1979: Healthy People initiative -1980s: rising health care costs -1985: National Center for Nursing Research (NCNR) established -1993: NCNR becomes National Institute of Nursing Research nurse-managed centers, nursing shortage) -Affordable Care Act of 2010 (the future of ACA is uncertain) Looking forward to the future in public health -Nurses seek to learn from the past and to avoid known pitfalls, even as they see successful strategies to meet the complex needs of today's vulnerable populations -As plans for the future are made and as unmet public health challenges are acknowledged, the vision of what nurses in community health can accomplish serves as a sustaining force Historical and current perspectives on infectious disease and control -1900: communicable disease were the leading causes of death in the US -By 2000, improved nutrition and sanitation, vaccines, and antibiotics had put an end to the epidemics that once ravaged entire populations -As people live longer, chronic diseases replace infectious diseases as the leading causes of death -Infectious diseases are still the number-one cause of death worldwide -New killers are emerging, and old familiar diseases are taking on different more virulent characteristics (Measles) Emerging and re-emerging infectious diseases -Influenza, H1N1 -Health care associated infections: staph aureus, MRSA -WHO top emerging diseases: Lassa fever, Middel East respiratory syndrome coronavirus (MERS-CoV), Severe acute respiratory syndrome (SARS), Nipah virus disease, Rift Valley fever, Chikungunya, severe ever with thrombocytopenia syndrome, Zika fever Current flu statistics Leading causes of communicable disease deaths -Acute respiratory infections -HIV/AIDS -Diarrheal disease -Tuberculosis -Malaria _Measles People on the move: Worldwide concerns about infectious disease, concern has increased with the growth of migration, as people move from one place to another they ring their diseases, levels of immunity and resistance to diseases, and the viruses or bacteria they may harbor that ave not emerged as diseases in them Epidemiological triangle Agent, host, environment Changes in one of the elements can influence the occurrence of disease by increasing/decreasing risk: components influence health of a community Agent Causes the disease -Infections: virus, bacterial, fungi -Chemical: pesticides, chemicals -Physical: radiation, temperature, noise Host Living being that the agent or environment influences -Age, gender, genetics -Ethnicity -Acquired characteristics (immunological status) -Lifestyle (diet, exercise, occupation) Environment Physical and social setting that sustains the host -Geography -Water and food supply -Presence of reservoirs and vectors -Access to heath care -High risk working conditions -Poverty How to stop the epidemiological triangle Breaking the barrier between any of the three components can contribute to stopping the disease Vertical transmission Passing the infection from parent to offspring v