Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Nies: Community/Public Health Nursing, 7th Edition,100% CORRECT

Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which statement best summarizes Lillian Wald’s achievements? a. She suggested new nursing specialties. b. She demonstrated how to improve health in communities. c. She gave expert clinical nursing care to her clients. d. She was appointed a national nursing leader. ANS: B Lillian Wald improved health in a community by using diplomacy and neighborhood power. She was elected president of a national nursing organization and created new nursing specialties such as school nursing. However, she is primarily known for her creation of Henry Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably improved health in many communities. DIF: Cognitive Level: Understand (Comprehension) 2. Which statement best describes “thinking upstream”? a. Modifying economic, political, and environmental factors b. Preparing for nursing career long-term goals by planning now c. Seeking causes of water and air pollution “upstream” from cities d. Trying to understand howNorRwhyIsoGmeoBn.e Cgot Mill ANS: A U S N T O Upstream thinking actions focus on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world. DIF: Cognitive Level: Understand (Comprehension) 3. Which statement best describes a weakness of early nursing theories? a. Many nurses did not know or understand the theoretical basis of nursing practice. b. Most nursing theories focused on microscopic individual concerns. c. The theories did not reflect the actual world of nursing practice. d. The theories had global applicability to nursing practice. ANS: B Most nursing theories have an extremely narrow focus on individual nurse–patient care situations. This microscopic focus ignores the broader global social macroscopic perspective. DIF: Cognitive Level: Understand (Comprehension) 4. Which best describes the primary purpose of nursing theory? a. To improve nursing practice b. To demonstrate that nursing is a profession c. To organize nursing knowledge d. To serve as a basis for ongoing nursing research ANS: A Although nursing theory does serve as a basis for ongoing research, does help demonstrate that nursing is a profession, and may help nurses organize their knowledge; its primary purpose is to improve nursing practice. DIF: Cognitive Level: Understand (Comprehension) 5. A client did not attend the clinic for required follow-up care after his extensive surgery. Using the Health Belief Model, which would be the most appropriate conclusion for the nurse to make? a. The client is noncompliant. b. The client is suffering from self-neglect. c. The health care system is not meeting the client’s perceived needs. d. The health care system is not accessible for the client. e. The nurse has not motivated the client appropriately. ANS: C Although it is easy to blame the patient for being noncompliant or neglecting himself or herself, or to blame the nurse for not “educating” the patient appropriately, it is equally plausible that the health care system is not meeting the client’s perceived needs. Clients can have many reasons for not keeping an appointment, such as family emergencies, lack of funds, or lack of transportation. Sociocultural and ethnic barriers can also be factors. This is part of the Health Belief Model where the premise is that the world of the perceiver determines the action. DIF: Cognitive Level: Apply (Application) 6. Which assumption makes OrNemU’Rs SthIeoNryGdTifBCltOtoMuse? a. That nurses will always be caring for families and groups b. That clients are able to control their environment c. That clients recognize the need for nursing intervention d. That teaching clients self-care is the primary goal of nursing practice ANS: B Orem’s theory emphasizes self-care not the need for nursing intervention. It assumes that the client can control his or her environment, whereas most persons cannot control work, school, or neighborhood environments. Orem’s theory is focused on individual self-care. The primary focus of nursing practice is on self-care needs and activities. DIF: Cognitive Level: Understand (Comprehension) 7. Which statement best describes the major assumption of the Health Belief Model (HBM)? a. People will act if action is both easy and convenient. b. People will act if exposed to fear messages stressing their vulnerability. c. The major determinant of preventive health behavior is avoiding disease. d. The major determinant of preventive behavior is providing proper health education. ANS: C The HBM is based on the assumption that the primary reason people act is disease avoidance. Such avoidance means they perceive themselves as susceptible to a serious disease, there is some cue to action, and there are more benefits than barriers to acting. DIF: Cognitive Level: Understand (Comprehension) 8. Which assumption of the Health Belief Model (HBM) is problematic? a. People have both free will and access to health resources. b. People listen to the advice given by health care professionals. c. People are influenced by health messages given over media channels. d. People make what they perceive as rational decisions in a given situation. ANS: A The HBM assumes that people have access to health resources, but such resources are not always available to certain groups. Economic, political, and environmental constraints interfere with free choice. The HBM may effectively promote behavior change by altering the patient’s perspectives, but it does not acknowledge the health professional’s responsibility to reduce health care barriers. The HBM places the burden of action exclusively on the client. DIF: Cognitive Level: Understand (Comprehension) 9. A nurse is using Milio’s framework for prevention to improve the health of clients. Which would the nurse most likely implement? a. Create appropriate national health policies. b. Develop health programs that make healthy choices the easiest choices. c. Promote nationwide educational programs with information on making healthy choices. N R I G B.C M d. Stress that clients are respoUnsibSle fNor tTheir owOn health. ANS: A The range of available choices is critical in shaping a society’s overall health status. Policy decisions in governmental and private organizations shape these choices. Hence, national-level policy making is the best way to impact the health of most Americans rather than continue to concentrate on imparting information in an effort to change individual behaviors. Milo challenged the notion that the main determinant for unhealthful behavior choice is lack of knowledge. DIF: Cognitive Level: Apply (Application) 10. A nurse is using Milio’s approach when caring for a client. Which advantage will the nurse experience? a. It will allow for care interventions outside the hospital system. b. It will demonstrate the effectiveness of using a variety of community resources. c. It will encourage the assessment of the personal and societal resources of the client. d. It facilitates open communication between the client and the nurse. ANS: C As the model focuses on sociopolitical and environmental constraints to a client’s free choice, it also encourages assessment of such constraints, as well as suggesting alternative avenues to helping the patient obtain needed care. Milio encourages the practice of nursing from a broad understanding of health and illness. DIF: Cognitive Level: Apply (Application) 11. Which health-related variable is examined by the critical theoretical perspective? a. Cultural beliefs b. Effect of history and tradition c. Ethnic and racial differences d. Social inequalities ANS: D Critical theoretical perspective examines social inequalities within the broader political, economic, and social systems of society that keep people from reaching their full potential. Cultural beliefs, the effect of history and tradition, and ethnic and racial differences are not examined by the critical theoretical perspective. DIF: Cognitive Level: Understand (Comprehension) 12. A nurse is using the critical theoretical perspective in daily nursing practice. Which activity would the nurse most likely complete? a. Criticize health insurance programs as a barrier to health care. b. Expose social values underlying the health care system. c. Promote individual freedom and decision-making. d. Exert control over the cliNent’Rs enIviroGnmBen.t.C M ANS: B U S N T O Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society. Society must change for health and medical care to improve. Inequities of health care are connected to historically located social arrangements and cultural values of society. DIF: Cognitive Level: Apply (Application) 13. A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the community. Which strategy would the nurse most likely implement? a. Address the root causes of health problems. b. Choose one of the 28 focal areas for emphasis in funding and media attention. c. Concentrate on the goals of improving the quality of life. d. Continue funding expansion of the health care system. e. Expand efforts to put all medical records on electronic media. ANS: A The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health (social determinants of health). Based on Healthy People 2020, advances are needed in these areas in order to improve health. DIF: Cognitive Level: Apply (Application) 14. Which is most closely associated with morbidity and mortality outcomes? a. Number of physicians per capita b. Insurance status c. Crime rate d. Personality traits ANS: B Tremendous disparities for access exist between insured and uninsured people in the United States. Access to care is associated with economic, social, and political factors, and depending on individual and population needs, it can be a primary determinant of health status and survival. Structural variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status. DIF: Cognitive Level: Understand (Comprehension) 15. A nurse has accepted a new position in a public health department. Which characteristic is crucial to the nurse’s success? a. Advanced educational preparation b. Being knowledgeable about the community’s needs c. Listening and showing respect d. Caring and empathetic personality ANS: C Rather than nursing to the community, the nurse must work with the community to be successful. Listening, being patient, providing accurate information, and respecting the experiences of community members are essential for success. DIF: Cognitive Level: Apply N(AUpRplSicaItiNonG) TB.COM 16. A nurse is using a macroscopic approach when providing care. Which would the nurse most likely demonstrate? a. Emphasizing behaviors that will help in healing b. Examining the family’s responses to illness c. Explaining how these actions will help in healing d. Providing testimony to legislators concerning proposed legislation ANS: D All the choices focus on individual client care (microscopic) except for the nurse who is politically involved as demonstrated by providing testimony relevant to proposed legislation (macroscopic). DIF: Cognitive Level: Apply (Application) 17. A nurse is using Milio’s framework to promote healthy eating choices among members of the community. Which intervention would the nurse most likely implement? a. Provide community education about healthy food choices. b. Promote legislation to increase taxation on unhealthy food choices. c. Lobby for health insurance providers to pay for participation in health promotion programs. d. Encourage community members to be responsible for making healthy choices. ANS: B One of the propositions of Milio’s framework is that alteration in patterns of behavior resulting from decision-making of a significant number of people in a population can result in social change. Some behaviors, such as tobacco use, have become difficult to maintain in many settings or situations in response to organizational and public policy mandates. Increasing taxation on unhealthy food choices may make it more difficult for community members to make these unhealthy choices. DIF: Cognitive Level: Apply (Application) MULTIPLE RESPONSE 1. A nurse has a broad, aggregate focus when providing care to clients. Which best describes how this approach will help improve client outcomes? (Select all that apply.) a. Ensures that collaborative efforts of many professionals will be used b. Confirms the individual’s responsibility for resolving the health problem c. Empowers decision-making based on both individual and community goals, needs, and priorities d. Enables the nurse to ask for assistance from other community professionals e. Encourages allocation of time for population-focused preventive efforts f. Upholds professional nursing standards of care ANS: C, E Having a broader focus will help both nurse and patient make appropriate decisions. Unfortunately, it cannot ensure that others will help. Ideally, it will help both parties recognize that health problems are not just an individual’s responsibility but often a result of environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate time for population-focused hNeUalRthSpIroNmGoTtioBn.eCffoOrMts will also help the nurse’s individual clients over the long term. DIF: Cognitive Level: Apply (Application) 2. A community health nurse is using the Health Belief Model (HBM) as a basis for providing client care. Which best describes the problems associated with using the HBM? (Select all that apply.) a. It ignores the need to reduce health system barriers to action. b. It is extremely difficult to change the client’s belief system. c. It is the nurse’s responsibility to persuade clients to engage in the appropriate behavior. d. Clients do not have the knowledge to correctly analyze the seriousness of the disease or their susceptibility to it. e. Clients expect health professionals to take preventive actions for them. f. The choice and the burden for acting are entirely with the client. ANS: A, F A major problem with this model is that the burden for taking action is totally with the client. The model requires health professionals to assume responsibility for modifying the client’s perceptions so they recognize the need to act. Although the line between persuading and educating is a fine one, nurses are responsible for education. Persuasion may border on coercion. Further, the model assumes that all responsibility is personal, ignoring barriers in the health care system, which may make it difficult for an individual to take appropriate action. DIF: Cognitive Level: Apply (Application) 3. A nurse is using the critical theoretical perspective in practice. Which best describes how the nurse would respond when a client suggests that the physician prescribe a widely advertised medication for tension and anxiety? (Select all that apply.) a. Can you tell me what is going on in your life right now? b. Do you know anyone else who is suffering such tension and anxiety? c. How does your family feel about you having so much tension and anxiety? d. Would you consider using the generic equivalent of this medication? e. What led you to believe this medication would be of help to you? f. What have you tried in the past to relieve tension and anxiety? ANS: A, F The best answer is to ask what is going on in the client’s life at that moment because situational stresses often occur to everyone. Next, asking what previously has been effective in relieving the symptoms may suggest more appropriate actions than medication. Although generics would be less expensive than brand-name medication, medication should not be the first approach to resolving a symptom before even examining why the symptom is occurring. DIF: Cognitive Level: AnalyzNe U(ARnSalyIsNis)GTB.COM 4. According to the critical theoretical perspective, which should be held responsible for many of the illnesses of Americans today? (Select all that apply.) a. Advertisers who market sugar- and fat-saturated food products b. Alcoholic beverage manufacturers, marketers, and sellers c. Manufacturers of products that increase morbidity and mortality d. Corporations who modify their emission rates e. Restaurants that attempt to keep meal costs low f. Tobacco manufacturers who sponsor sports events ANS: A, B, C, F McKinlay (1979) further delineated the activities of the “manufacturers of illness—those individuals, interest groups, and organizations which, in addition to producing material goods and services, also produce, as an inevitable byproduct, widespread morbidity and mortality” (pp. 9, 10). The manufacturers of illness embed desired behaviors in the dominant cultural norm and thus foster the habituation of high-risk behavior in the population. The manufacturers of illness include everyday examples such as the tobacco industry, the alcohol industry, and multiple corporations that produce environmental carcinogens. The existing U.S. Health Care System, in a misguided attempt to help, devotes its efforts to changing the products of the illness manufacturers and neglects the processes that create the products. DIF: Cognitive Level: Analyze (Analysis)