Which type of plan should the nurse employ to assess the strengths and weakness of the organization?

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1. Social Science
2. Psychology
3. Community Psychology

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A community/public health nurse employed by the local health department is told by the director to engage in health planning. Which of the following actions will the nurse perform?
a. Collecting and analyzing data
b. Serving vulnerable populations
c. Planning for health care needs of individuals
d. Applying the nursing process to community-based care

A
Community health planning is a continuous social process by which data about clients are collected and analyzed for the purpose of developing a plan to generate new ideas, meet identified client needs, solve health problems, and guide changes in health care delivery.

The director of a public health agency suggested that the community/public health nurse select the target population for a new program. Of the following populations, which would be considered the target population?
a. Persons for whom the nurse is most comfortable caring
b. Persons for whom some change in health or lifestyle behaviors is desired
c. Persons eligible for care according to federal guidelines
d. Persons that can afford to pay for their care

B
Although clients may be chosen as recipients of care for any of the reasons listed, the target population is typically persons for whom change in health-related behaviors is desired whom the community/public health nurse desires change, whether in lifestyle behaviors or health outcomes.

What was the significance of the National Health Planning and Resources Development Act of 1974?
a. It created the program that yielded the first evidence that managed care reduced costs.
b. It funded nationwide health planning to improve health care and reduce costs.
c. It provided additional federal money to the states to spend on health care.
d. It allowed states to take responsibility for planning health care services.

B
Before this Act was signed into law, planning was primarily at the state level. The Act provides federal funding to coordinate resources to meet documented needs.

What was the result of the prospective payment system legislation?
a. Hospital stays were shortened, which placed a greater responsibility on family care.
b. Payments to the hospitals and physicians that fulfilled the new rules were higher.
c. Nursing staffing was increased to meet the needs of more acutely ill patients.
d. Diagnoses were more accurate and complete before clients were admitted to acute care.

A
The prospective payment system changed the patterns of hospital billing and thereby altered patterns of inpatient hospital stays. Hospital stays were shortened, and more health service delivery responsibilities were the responsibility of community agencies and family members.

According to the American Nurses Association (ANA) and the American Public Health Association (APHA), the community/public health nurse is responsible primarily for whom?
a. The community as a whole
b. The employer who is paying the nurse's salary
c. The individual for whom the nurse is caring
d. The governmental unit that is responsible for its citizens

A
Both the ANA and the APHA state that the nurse's primary responsibility is to the community or population as a whole and that nurses must acknowledge the need for comprehensive health program planning to implement this responsibility.

Whether a nurse's plan of care for a community is acceptable is probably determined by which aspect of the plan?
a. It was created in coordination with community members.
b. It was financially feasible.
c. It was politically correct and feasible.
d. It was something in which the nurse really believes.

A
Stressed throughout Chapter 16 is the importance and need for the community to be involved in the planning. If the community is not involved from the beginning, the program may not be effective. The program is more likely to be successful if the community is involved.

Which of the following actions is a nurse most likely to perform in an approach to community health planning with the community empowerment model?
a. Motivating bankers and financial advisers to help the community in its development
b. Obtaining the best experts available to help the community develop
c. Using a grassroots approach and democratic decision making
d. Writing grants to obtain money for the community and health care programs

C
Although a nurse might well perform all of these actions, the definition of community development is to create progress for the community by actively involving community members. This grassroots approach entails the use of a democratic decision-making process, encourages self-help, relies on voluntary cooperation, and helps develop leadership within the group.

Which of the following facts is a drawback of the community empowerment model?
a. Bankers and other money people are very busy and often uninterested.
b. Grants, although beautifully written, may not get funded.
c. It is hard to persuade experts to volunteer their time.
d. It is the slowest approach and takes the longest to obtain results.

D
Although the community empowerment model may have the longest-lasting effects, it does take considerable time and effort to implement, because democratic decision making is a slow process.

How might the social planning model best be defined?
a. A process of experts engaging in rational, deliberate problem solving
b. A process of group meetings that take place until everyone reaches consensus
c. A process of collaboration to write grants to fund health care programs
d. A process of using democratic decision making through a grassroots approach

A
A social planning model is in existence when experts take responsibility for solving problems, sometimes with little community involvement. The community empowerment model uses democratic decision making through a grassroots approach.

How might the social action approach be summarized?
a. A process of experts engaging in rational, deliberate problem solving
b. A process of group meetings that take place until everyone reaches consensus
c. A process in which groups seek redistribution of power or basic change in organizational policies
d. A process in which groups work together to write several grants to get money for health care programs

C
The social action approach is a process in which direct, often confrontational action is undertaken to redistribute power, resources, or decision making in the community, to effect a change in the basic policies of formal organizations, or both.

A community/public health nurse is using the social action model to facilitate change in the community. Which of the following aspects of this model may make the nurse feel uncomfortable?
a. Admitting that the nurse may not know the best approach
b. Cooperating with a large number of community agencies
c. Confronting power brokers directly
d. Sharing decision making with other people

C
This approach requires direct confrontation to obtain redistribution of power, resources, or decision making, which may be uncomfortable for anyone.

Lewin's change theory is being applied as the community is addressing improvements in public safety. Which of the following would be one of the first steps in creating change?
a. Determining whether anyone else agrees
b. Having a careful plan as to what change is desirable
c. Making community members aware of the need for change
d. Assessing community needs to determine whether change is possible

C
The first step is to ensure that the need for change is recognized or felt by people in a position to help create the change. Disequilibria exist or are created, which disrupts the status quo. The stimulus for the perceived need may be within the client or come from an outside force.

People in the community are feeling insecure and vulnerable because the neighborhood is considering closing one of the local elementary schools. Which of the following actions should a nurse take?
a. Ask the formal leader of the group to speak out against the closure.
b. Ask the informal leader to offer a rationale for the closure.
c. Offer help and support for those involved.
d. Offer to write legislators opposing the decision.

C
The nurse must recognize that change is threatening and anxiety provoking, and so individuals will need help and support while they experience the proposed change. Asking other people to take a leadership role to speak out against the closure would not be appropriate. Writing to legislators may be effective, but it is not the best action when trying to work with people who are feeling vulnerable and insecure.

A nurse would like to facilitate a change within the community. Which of the following actions is the nurse likely to take, in view of Lewin's theory of change?
a. Freezing the change by constant persuasion, reinforcement, and use of focus groups
b. Increasing driving forces, decreasing restraining forces, or doing both
c. Stabilizing change by decree, rules and procedures, or legislation
d. Unfreezing the change by using the three techniques described by Lewin

B
Lewin described forces that facilitate change (driving forces) or impede change (restraining forces). Driving forces must exceed restraining forces in order for change to occur. Therefore, the nurse may increase driving forces, decrease restraining forces, or attempt to do both.

What is the purpose of Planned Approach to Community Health (PATCH)?
a. To enable assessment by different health institutions in order to maximize resources
b. To encourage assessment of high-risk groups so that efforts can be focused
c. To engage entire geopolitical communities in assessing their health needs
d. To suggest that states cooperate with federal departments to ensure continuity

C
PATCH is an attempt to engage entire geopolitical communities in a comprehensive assessment of their health needs, rather than focusing solely on groups at high risk or those served by a specific health institution. It depends on the participation of citizens, the cooperation of several organizations within the community, and the vertical integration of local, state, and federal government resources.

A nurse is initiating program planning. Which of the following actions will the nurse perform first?
a. An accurate and thorough assessment of the community
b. A confirmation of the formal and informal leaders of the community
c. A determination of the budget available for obtaining relevant data
d. An analysis of the employer's perspective on potential program needs

A
Although all of the actions may need to be performed when a program is planned, programs cannot be planned before a comprehensive accurate and thorough assessment.

Which of the following actions should the nurse perform when analyzing collected assessment data?
a. Categorizing the data and identifying the implications
b. Creating graphs, charts, and maps to display the data
c. Determining the aggregates at high risk for specific problems
d. Identifying target populations by demographic characteristics

A
All of the actions would be performed very early in the process, but the data must first be categorized to identify the inferences that are descriptive of actual or potential health problems.

A nurse is reviewing the collected data and discovers some information is not available. Which of the following conclusions will the nurse make?
a. There is a data gap.
b. There is insufficient information to draw appropriate conclusions.
c. Further effort by the team is required.
d. Further analysis needs to be performed.

A
A lack of information is called a data gap. The nurse may devise a strategy to collect additional data or draw the conclusion that the data gap itself may be informative.

Which of the following data would be more typical of an acute care diagnosis than a community/public health nursing diagnosis?
a. A child in the school system admitted for insulin overdose
b. Health promotion needs for the neighborhood school
c. Mortality and morbidity rates for the city
d. Services unavailable in the county

A
A diagnosis referring to a need could be based on any of the selections, but community/public health focuses on aggregates, not individuals, and so the child being admitted would have what is more typical of an acute care nursing diagnosis.

A nurse is preparing to write a community diagnosis. Which of the following actions must the nurse take?
a. Choosing a diagnosis from the 12 functional health patterns
b. Choosing from an agency-approved list of NANDA International diagnoses
c. Describe a situation and suggest an etiologic component focused on an aggregate
d. Use appropriate NANDA International wellness-focused diagnoses

C
Any of the options might be chosen; however, to write a community/public health diagnosis, the nurse must maintain the focus on aggregates in a specific environment or community. A diagnosis is a statement that synthesizes assessment data, as well as a label that describes a situation and implies an etiologic component.

What do most community/public health nursing diagnoses include?
a. The afflicted individual or family, risk factors, and the desired outcome
b. The aggregate at high risk and the nurse's decision as to appropriate care
c. The target population, the health response desired, and host or environmental factors
d. The NANDA International terminology with associated evidence and outcomes

C
Community/public health nurses focus not on individuals but on aggregates, and they rarely use NANDA International diagnoses, which focus primarily on acute problems of individuals.

Which of the following actions must the nurse take when confirming the diagnosis before final decisions are made?
a. Ensuring that it is a diagnosis used in the Omaha diagnosis system
b. Checking to see whether the diagnosis is reimbursable
c. Prioritizing the diagnosis within the agency's mission
d. Validating the diagnosis/conclusion with the community or client

D
Although the nurse might engage in any of these actions, the most important action is to validate the conclusions with the involved aggregate.

Which of the following is the most effective way of prioritizing nursing diagnoses?
a. Ensuring that the diagnoses are reimbursable by third-party payers
b. Determining the degree of community concern about the problem
c. Comparing the diagnoses with the agency's mission statement
d. Discussing conclusions with another community/public health nurse

B
Although the nurse might engage in any of these actions, the most effective way to prioritize nursing diagnoses is to choose the diagnosis most important to the involved aggregate.

A nurse decided to set up a planning group. All of the following groups of people expressed interest in being involved in the planning along with the nursing staff. If the nurse must eliminate one group to keep the size of the group manageable, which of the following groups should the nurse eliminate?
a. A convenience selection of local citizens
b. Formal and informal leaders of the community
c. Those who are probably going to be against the intervention
d. The aggregate for which the intervention is going to be implemented

A
It is crucial that the target group, caregivers, and formal and informal leaders be involved. It is also helpful to have broad segments of the community to provide a widespread base of support. However, if size must be limited, the involvement of community members who are not leaders (in a position to promote acceptance), who will not be implementing the program, or who will not be affected by the program may be eliminated. The opposition must not be eliminated from the committee.

Which of the following groups should be included in any planning group to ensure that weaknesses are addressed and counterarguments are known?
a. Administrators from the local hospital or hospitals
b. Administrators of the health care agency
c. Leaders in the community
d. Those initially expected to resist the proposal

D
People who are against the proposal are the most helpful in knowing what arguments will be used and what weaknesses are apparent in the proposal. It is always possible that they may become involved and become supporters.

Which of the following aspects of a solution to a problem allows the nurse to identify it as the best choice?
a. It must be financially reimbursable.
b. It must have the support of the clinical agency.
c. It must represent the values, beliefs, and perceptions of the involved aggregate.
d. It must have the most advantages and the fewest disadvantages.

C
Although all these suggestions are extremely important, the most crucial is that the solution fit the community's perspective, beliefs, and values. The community must be motivated to address the issue.

Which of the following situations will cause difficulties when a nurse tries to persuade a community to accept a particular intervention?
a. The solution is oriented to the future, not the present.
b. Powerful groups in the community may not be committed to this intervention.
c. The intervention is inconsistent with cultural, ethnic, or religious beliefs.
d. The intervention may need more tax dollars than have currently been funded.

C
Although any of these situations could cause a community to reject a proposed intervention, any intervention that is inconsistent with beliefs and values will be immediately rejected.

The intervention that a nurse and a planning group proposed was not accepted, primarily because of poor timing and lack of funds. Which of the following is helpful for the nurse to remember?
a. At least an effort was made to intervene.
b. The situation will probably not get worse.
c. The communities can function without the proposed program.
d. There are always other options that might meet the same goals.

D
A problem can almost always be solved in more than one way.

What is the primary reason why every step of an intervention is planned before the intervention is implemented?
a. It is required by the nursing process procedure.
b. It is the way in which agencies expect to see performance by the nurse.
c. It saves time, and the implementation process goes more smoothly.
d. It allows the nurse to remember what was going to be done.

C
Planning the intervention saves time and helps the implementation process go more smoothly.

What is the primary usefulness of a Gantt chart?
a. It creates a deadline for each step.
b. It describes potential program problems.
c. It identifies the process needed to achieve a certain result.
d. It outlines the steps of the assessment process.

C
A Gantt chart identifies the process needed to achieve a result. Once the final outcome is identified, the major steps necessary to obtain the result are projected backward from results to actions; their timing and sequence are then considered.

What is the primary usefulness of a Program Evaluation and Review Technique (PERT) chart?
a. It creates a flowchart of activities in sequence with time estimates.
b. It identifies potential program problems and possible solutions.
c. It identifies the process needed to achieve a certain result.
d. It outlines the steps of the assessment process.

A
A PERT chart identifies the program activities, resources to accomplish these activities, and the sequence of those activities. Included is a flowchart designed to estimate the time required to complete specific events necessary, with estimates ranked according to optimistic, most likely, and pessimistic outcomes.

The nurse is planning to present an educational program. Which of the following is important for the nurse to remember?
a. Having many handouts so that the audience can remember what was said
b. Ordering a microphone so that everyone in the room can hear easily
c. Using pictures and posters of professionals demonstrating the needed behaviors
d. Using many different methods of presentation with multimedia art

D
As members of a media society, most audiences expect a smooth, professional presentation with the use of many different media. Handouts alone may be unsuccessful, because not all Americans are literate. Reading levels must always be considered. Demonstrations by professionals may be unsuccessful unless their ethnic and cultural backgrounds are similar to those of the audience. Lecture is considered the least effective way of conveying information.

A health screening was held, and the nurse reported the number and names of persons with positive test results to the agency director. What, however, is even more important than reporting this information?
a. Being sure that each client had identification so that no false names could be used
b. Keeping legal documentation of both negative and positive results
c. Telling the person with positive test results where they might go for treatment
d. Using the cheapest screening approach possible

C
There is no purpose in determining who receives positive test results unless there is some plan for treatment of those persons. Referral and treatment resources must be included as part of the intervention. The nurse must provide information about how and where to go for help

Which of the following is the most common type of intervention used to improve the health of a community?
a. Providing direct care to individuals at high risk for health problems and for their families
b. Offering health education and screening programs
c. Using media campaigns to raise awareness of the health needs
d. Teaching fellow staff professionals about community needs and beliefs

B
Several major types of community health intervention programs exist, primarily health-education programs, screening programs, establishing services, policy setting and implementation, increasing community self-help and competence, and increasing power among disenfranchised individuals.

Why should nursing, as a profession, be involved in program planning? (Select all that apply.)
a. As a result of time spent in direct contact with clients in the community, nurses possess useful information.
b. Nurses have enough political power to create barriers if they are not included in the planning process.
c. Nurses, who constitute one third of all health care providers, implement the majority of planned programs.
d. Nurses make up a large portion of health care consumers.
e. Politically, it is wise to include all professions in planning groups.
f. Nurses provide the most expertise of the health care professions.

A, C, D
Nurses should be included in program planning because nurses make up more than one third of all health care workers and implement the majority of health care programs. With experience in seeing what works and what does not, nurses can help planning groups avoid problems. Nurses spend a greater amount of time in direct contact with clients. This exposure to the community enables nurses to obtain useful information. In addition, nurses also account for a large portion of health care consumers.

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