Chapter 7: Community Health Planning, Implementation, and Evaluation

Chapter 7: Community Health Planning, Implementation, and Evaluation 7 of 31 A community health nurse has determined that the number one priority is to help families in which one member has diabetes. Which of the following actions would be most appropriate to maximize services to persons with diabetes? a. Ask friends with diabetes about what services they want improved. b. Duplicate the diabetic organization's services, because not all patients with diabetes have yet received services. c. Meet with the diabetic organization to see how the public health department can augment what it is offering. d. Submit a request for funding so that the public health department can also offer services to patients with diabetes. Ans- c. Meet with the diabetic organization to see how the public health department can augment what it is offering. The nurse should augment existing resources or create a new service rather than duplicate what is already available to the aggregate. It is assumed that if the nurse has concluded that diabetic issues are the number one priority, there is no pressing need to ask specific questions of friends with diabetes. Which of the following best describes what Lillian Wald suggested in regards to providing care to individuals and families? a. Public health nurses should encourage clients to join the Henry Street settlement for mutual growth and support among the families. b. Public health nurses should focus on providing care in the client's home. c. Public health nurses should recognize the larger social and economic forces that the family cannot control. d. Public health nurses should try to understand that educating clients on how to stay healthy is the nurse's primary responsibility. Ans- c. Public health nurses should recognize the larger social and economic forces that the family cannot control. Wald emphasized that one could not understand an individual without understanding the family, and the family is in the grip of larger social and economic forces that they cannot control. It was not suggested by Wald that clients be encouraged to join the Henry Street settlement, focus on providing care in the client's home, or that it was the nurse's responsiblity to keep clients healthy. 2 of 31 Which of the following best describes why it is important for the nurse to be knowledgeable about the community when providing care to individuals? a. As nurses travel to meet with clients, they must know the community to find the client's residence. b. On the basis of information from community assessment, community health nurses can be visible and vocal advocates for health care reform. c. Community health nurses are expected to have information about the community to share with individual clients. d. Individuals and families are strongly influenced by the community and environment around them. Ans- d. Individuals and families are strongly influenced by the community and environment around them. The nurse must be particularly aware of how individuals and families are influenced by the community and environment around them, although it is indeed important to be an advocate for health care reform and to have information regarding resources available for client services in the process of giving care. It is assumed that community health nurses can read maps—or use a global positioning system in their car—to find client addresses. 3 of 31 Which of the following best describes how the Health Planning Model for care of aggregates differs from the customary nursing process applied to the care of an individual? a. The nurse must be aware of age, gender, race, ethnic group, religion, educational background, occupation, and marital status of the aggregate. b. The nurse must first decide on and define the aggregate to receive care. c. The nurse must determine how best to ensure that each participant receives an equal number of services. d. The nurse must choose which health care need should have first priority. Ans- b. The nurse must first decide on and define the aggregate to receive care. The nurse decides which aggregate to focus on and then carefully defines that aggregate. Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but only those services that each participant needs. 4 of 31 A nurse is using a systems framework when caring for individuals, families, and aggregates in the community. Which of the following best describes an aspect that would be more challenging when caring for an aggregate as opposed to caring for an individual? a. Ability to communicate clearly with the client b. Analyzing power and decision making within the system c. Defining the system's structure and functions d. Recognizing the system's goals Ans- b. Analyzing power and decision making within the system Although all aspects can be challenging, it is probably more challenging to recognize the interacting aspects of a large aggregate system in its power distribution, consensus activities, accommodation, and authority within the decision-making process. 5 of 31 A nurse is caring for an aggregate as his or her client. Which of the following tasks would the nurse complete first? a. Determine the setting of the aggregate b. Gain access into the aggregate c. Identify the nurse's own strengths and preferences d. Review the resources available to use in the community Ans- c. Identify the nurse's own strengths and preferences A nurse should also consider personal interests and strengths in selecting an aggregate for intervention. For example, the nurse should consider whether he or she has an interest in teaching health promotion and preventive health or in planning for organizational change, whether his or her communication skills are better suited to large or small groups, and whether he or she has a preference for working with the elderly or with children. Thoughtful consideration of these and other variables will facilitate assessment and planning. After self-reflection, the nurse will need to determine the setting of the aggregate, consider how to gain access, and identify the community resources available. 6 of 31 A nurse decided that a high-risk aggregate most needed education about diabetes. Which of the following would be the best approach when teaching the group? a. Involve participants in small group activities applying the information. b. Organize the information into a visual presentation such as a PowerPoint presentation. c. Share the nurse's expertise directly with the group at a meeting for that purpose. d. Use handouts and pamphlets with pictures consistent with the local cultural groups throughout. Ansa. Involve participants in small group activities applying the information. Most persons do not enjoy lectures, so the nurse must initiate small group involvement and participation. Those with less educational experience are more comfortable in informal learning settings. Visual only presentations, such as power point presentations and handouts are not the best approach to use with adult learners. Sharing of the nurse's expertise is an important part of the teaching process, but will not be effective if the participants are not actively involved in the learning process. 8 of 31 A nurse is determining the needs of a selected aggregate. Eight percent of the aggregate has diabetes. Which of the following best describes the action that should be taken next to determine if this should be a priority? a. Ask the American Diabetes Association if 8% is a worrisome rate. b. Discuss the findings with the head of the public health department. c. Review the literature to determine the national and state diabetic rate. d. Determine what the aggregate's diabetic rate has been in the past. Ans- c. Review the literature to determine the national and state diabetic rate. A rate by itself is meaningless unless compared with previous trends (although the instructor or the head of the local public health department may or may not know that particular piece of information) or with state or national norms. The easiest way to find those norms would be to check the literature to determine the typical incidence in a similar environment or community. The literature review could include research reports and statistics that will help determine whether this finding represents a priority for this aggregate. 10 of 31 Which of the following actions must a nurse take to be successful in addition to the typical assessment, diagnosing, and planning directly related to the intervention project? a. Advocate for community empowerment throughout the process. b. Choose superb people to implement the plan. c. Confirm administrative support throughout the project. d. Continue to assess both barriers and resources throughout the project. Ans- a. Advocate for community empowerment throughout the process. An essential component is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the process. Attention to community involvement and empowerment helps ensure that the outcomes reflect the community's needs and will be accepted. 11 of 31 A nurse found that several professionals resented time spent interacting with and teaching clients. Which of the following describes the most likely underlying motivation for resisting client involvement? a. Believing that people could change their lives if they really wanted to do s