Study Guide For Quiz #3

N4260U-03 Spring 2021

Chapters
Chapter 8 - Gathering Evidence for Public Health Practice
Chapter 9 - Planning for Community Change
Chapter 11 - Community Assessment Power Point
1. Gathering Evidence... Know the difference between a retrospective study and a
prospective study.
 Retrospective study - “WEAK STUDY” aka case-control studies – work
backward from the effect to the suspected cause & compare exposures (mothers
who took DES – daughters and sons at risk for health issues)
♦ Analytic study in which participants are enrolled after the health outcome
of interest has occurred
♦ Case‒control studies retrospectively compare subjects (cases) with a
condition (disease) and matched subjects/control without the
condition/disease.
♦ Advantages: Allow for the examination of multiple exposures for a single
outcome, suitable for studying rare diseases and those with long latency
periods, require fewer case subjects, generally quicker, less expensive, and
well suited for outbreak investigation
♦ Disadvantages: Not appropriate for rare exposures, subject to bias because
of the method used to select controls, do not allow direct measure of
incidence

 Prospective study – aka cohort study/studies – are longitudinal studies, which

monitor subjects over time to find associations between risk factors and health
outcomes
♦ Cohort studies, also called longitudinal studies, examine phenomena
prospectively to observe presumed effects over time.
♦ Cohort study: longitudinal- monitors subjects over time to find
associations between risk factors and health outcomes, expensive.
minimize selection bias, look for causal associations (Harvard Nurses’
Health Study 1976-present)
♦ Prospective study: Analytic study in which participants are enrolled before
the health outcome of interest has occurred.
2. Experimental Study-Be able to identify which is the intervention, control group and
treatment group if presented with a scenario.
 Intervention
♦ Preventative trials
♦ Therapeutic trials
♦ Intervention study is the epidemiologic investigation designed to test a
hypothesized relationship by modifying an identified factor in a
population. Studies may be therapeutic (clinical) or preventive.
 Control group
♦ Subjects in an experiment who do not receive the “treatment” and provide
baseline data against which the effects of the treatment can be measured.
 Treatment group
♦ The one receiving the treatment
 (If presented with a scenario)
 The “gold standard” for research design is the randomized, control group design.
Intervention study: Investigation designed to test a hypothesized relationship by
modifying an identified factor in a population. Studies may be therapeutic (clinical) or
preventive.
•Quasi-experimental study: Study with limited control where the subjects cannot be
randomly assigned to an intervention. However, the researcher can still manipulate the
dependent variable.
•Clinical trial: Experimental study in which the investigator specifies the type of
exposure for each study participant and then follows each person’s health status to
determine the effects of the exposure.
•Hypothesis: Statement of the expected outcome between two or more variables in a
specific population
•Null hypothesis: Statement that there is no difference between/among the variables
under study.
•Demographic variables: Characteristics or attributes that are collected to describe the
sample.
•Sample: Selected subset of a population; a sample can be random or nonrandom and
representative or non-representative.
•Independent variable: The treatment or experimental activity that is manipulated by the
researcher to test its effect on the dependent variable.
•Dependent variable: The response, behavior, or outcome presumed to be affected by
the independent variable(s).
 •Controls: Subjects in an experiment who do not receive the “treatment” and provide
baseline data against which the effects of the treatment can be measured.
•p value: In statistical testing, the probability that the obtained results are not due to
chance alone. Generally, the significance level set by the researcher is less than or equal
to 0.05.

3. Some data to consider-Be able to identify 4 leading causes of mortality worldwide and
the 4 common risk factors
 4 leading causes of mortality worldwide
♦ Some data to consider....In 2014 the World Health Organization (WHO)
updated its 2011 report and confirmed that
1. non-communicable diseases (NCDs) are still the leading cause of
mortality worldwide.
2. cardiovascular diseases (17.7 million)
3. cancers (8.8 million)
4. respiratory diseases (3.9 million)
5. diabetes (1.6 million).
These four groups of diseases account for 81% of all NCD deaths and
share four common risk factors:
 1.Physical inactivity
 2.Tobacco use
 3.Poor diets
 4.Harmful use of alcohol

4. Social Justice- Understand the concepts of social justice and market justice
 Social justice
♦ • Social justice refers to an equitable sharing of both the common burdens
and the common benefits or advantages in society.
♦ • The basis of social justice is a value system in which healthcare is a right
and achieving health equity and population health are goals.
♦ • Social justice holds that all individuals are entitled to equal protection
from health hazards in the environment produced by the powerful
♦ Achieving social justice requires addressing the root causes of ill health,
including “poverty, substandard housing, poor education, unhygienic and
polluted environments, and social disintegration...[that] lead to systemic
disadvantage not only in health, but also in nearly every aspect of social,
economic, and political life” (Gostin & Powers, 2006, p. 1054)
  Market justice
♦ In contrast, in the value system of “market justice,” which characterizes
modern American society, health is one of personal individual
responsibility, and healthcare and other social goods are treated as
commodities or economic goods (Beauchamp, 1976; Budetti, 2008; Gostin
& Powers, 2006).

5. Examples of Social and Physical Determinants of Health-Review the difference between

them and be able to pick out which is which
 Social determinants of health
♦ •Availability of resources to meet daily needs, such as educational and job
opportunities, living wages, or healthful foods
♦ •Social norms and attitudes, such as discrimination
♦ •Exposure to crime, violence, and social disorder, such as the presence of
trash
♦ •Social support and social interactions
♦ •Exposure to mass media and emerging technologies, such as the Internet
or cell phones
♦ •Socioeconomic conditions, such as concentrated poverty
♦ •Quality schools
♦ •Transportation options
♦ •Public safety
♦ •Residential segregation
 Physical determinants of health
♦ •Natural environment, such as plants, weather, or climate change
♦ •Built environment, such as buildings or transportation
♦ •Worksites, schools, and recreational settings
♦ •Housing, homes, and neighborhoods
♦ •Exposure to toxic substances and other physical hazards
♦ •Physical barriers, especially for people with disabilities
♦ •Aesthetic elements, such as good lighting, trees, or benches
 (be able to determine which is which)

6. Building a Coalition- Know the Do’s and Don’t's of building a coalition group Be able to
select which steps the nurse should include as her process (what are the do’s)
 Coalition
♦ Group of consumers, health professionals, policy makers and others
working together to improve community health status or to solve a
specific community health problem
 Stakeholder
  An individual , organization, or group that has an interest(stake) in a
specific community health issue or outcome of a community level
intervention
 Key informant
 Person knowledgeable about specific aspects of a problem and the
community’s current and past attempts to address it
 Logic model
 Visual representation of how a program is organized, including activities,
resources, short-term and intermediate outcomes, and program goals
 Sustainability
 Establishing the conditions for the health improvements achieved by an
intervention to continue beyond the period of a formal community health
program to continue or for a program to continue after grant funding ends

 “Do’s” of building a coalition group (know what the nurse should include as her
process)
♦ Consider how each member of the coalition and the organization or group
represented will benefit from the work of the coalition.
♦ Understand group dynamics and member’s motives for serving.
♦ Form a group that is heterogeneous but able to show mutual respect.
 “Don’ts” of building a coalition group
♦ Assign members of the coalition to tasks in a random manner.
♦ Seek out people with similar opinions and roles in the community.

7. Questions to Help Identify Stakeholders- Stakeholders-Who stands to gain or lose if the

community problem is addressed
 Who gains or loses if the issue is addressed???
1.Which groups or population aggregates are affected by this community health
problem?
2.Who are the “opinion leaders” in the community?
3.Who stands to “gain” or “lose” if this community health problem is addressed? How
can they be engaged in finding solutions?
4.Whose help will be needed to address this community health problem?
5.Who needs to be “on board” or “invested” for this intervention to be successful and
for the changes to be sustained after the intervention
8. Five Useful Methods for Collecting Data- understand that informant interviews use key
informants
1. Informant Interviews (key informants)
2. Participant Observations (ie attend meeting and watch)
3. Windshield Surveys (personal observation)
4. Analysis of Data existing data and national sources: Census state and local data
5. Surveys
9. Smart Objectives- know what SMART stands for and be able to pick out objectives that
are smart and not smart
 •SMART is an acronym for program objectives that are specific, measurable,
achievable, relevant, and time-bound.
 Writing SMART Program Objectives
♦ •Specific: What behaviors, knowledge, skill, change in health status
indicators or outcome will result from the program?
♦ •Measurable: How will the outcome be measured and how will one know
if the objective is achieved? Are the data available?
♦ •Achievable: Is it realistic to reach the desired outcome with the resources
and time available to the program?
♦ •Relevant: Is the objective related to the program’s goals and activities?
♦ •Time-bound: When will the objective be achieved?
♦ •Not SMART: The program will reduce teen pregnancy.
♦ •SMART: The number of births to girls aged 19 and younger in
Springfield will be reduced by 20% from 40 births in 2010 to 32 or fewer
in 2015.
♦ •Not SMART: Fewer teens will start smoking.
♦ •SMART: The proportion of high school sophomores in the state of
Georgia who report having ever smoked a cigarette on the Youth
Behavioral Risk Factor Survey in 2020 will be no more than 7%.
♦ •Not SMART: The number of older minority residents of River City
receiving a flu shot will double.

♦ Be able to pick out smart objectives and not smart objectives

10. Basics of Social Marketing- know what they are if you are given a list
 Be able to identify the basics of social marketing
♦ Take a look at these sentences. What do the bold words have in common?
1. •Fasten your seat belt
 2. .•Eat more fruit.
3. •Pull over to use your cell phone.
4. •Don’t litter.
5. •Get a mammogram
6. .•Talk to your doctor
These words describe problems to be addressed by changing behavior.
•Research may help to describe what your audience is currently
doing or thinking, which can help shape realistic goals for behavior
change. Social marketing is about identifying the specific target audience
segment(s), describing the benefits you will offer, and the creating
interventions that will influence or support the desired behavior change.
•Social marketing planning requires us to understand and
incorporate the “The Four Ps of Marketing,” into our program planning.
Social marketing is critical because it looks at the “Four Ps” and the
provision of health services from the viewpoint of the consumer.
 1. Know your Audience.
 Understand that you are not the target audience.
 2. It is about Action.
 The process of heightening awareness, shifting attitudes and strengthening
knowledge is valuable if, and only if it leads to action.
 3. There must be an Exchange.
 If you want someone to give up, or modify, an old behavior or accept a new one,
you must offer that person something very appealing in return.
 4. Competition always exists.
 Your audience can choose to do something else.
 5. Keep “The Five Ps of Marketing” and policy in mind.
 Product Price Place Promotion Policy
 6.It is important to understand that change happens on the “installment plan”.
Change does not happen all at once.

11. Ethical Priniciples- What are they? Be able to identify what one is being described.
 Autonomy
♦ • Empowering students to understand the information they are given and
to utilize all resources to make their own choices regarding health and life-
style choices by providing them with accurate and honest information
 Beneficence
♦ • Providing and focusing on topics that are relevant to students at this
college
 Non-maleficence
 ♦ • Providing students with information and resources in a safe environment
with materials that we are properly educated on when we discuss them
 Justice
♦ • Providing all students with confidentiality, access to the same
materials/resources with consideration for age, education, and interest
♦ • Providing equal opportunity to for them to ask questions
12. Community Assessment- Approach for Broad Range of People Know that using multiple
methods of perspectives is the best approach for an accurate assessment of a broad range
of people
 1.Use a questionnaire written on a fifth grade reading level
 2.Interview a subpopulation of each group represented
 3.Analyze census data
 4. Use multiple methods of perspectives
13. Windshield surveys Subjective- know that windshield surveys are subjective data (not
objective, cognitive analysis, or valid data)
 •Assessments made by community health nurses are often informal. They use the
windshield survey to learn about the neighborhoods in which their clients live.
Many community health providers use this method, but it has its limitations.
 • It is a subjective process which nurses may use to understand the community by
viewing surroundings. It is a descriptive way of understanding what appears to be
the physical expression of the community as it is viewed on foot or through the
windshield of a car.
 •There is recent criticism that community assessments have often emphasized
what was missing in communities to address health and safety, rather than looking
at the strengths and resources the community may have to address these issues
♦ • Community location (boundaries, urban/rural)
♦ • Size density• Housing (type/condition, adequacy, multiple families)
♦ • Signs of decay (older area? disrepair? obvious sanitation issues?)
♦ • Safety hazards present in the environment• (sidewalks, motor vehicles,
safe routes to school, crime)
♦ • Street people (who is walking around?)
♦ • Transportation (availability of public?)
♦ • Stores (groceries, fast food, restaurants, clothing, gas? vacancies?)
♦ • Open space/ recreation
♦ • Sewage and waste disposal (any obvious issues?)

14. Community as a System... Does a difference in one area impact other areas? Be able to
identify subsystems
 The different parts of the community interact with each other. In order to make a
difference in one area you need to understand how other areas impact it. If you
make a difference in one area, it will impact other areas.
15. SWOT Analysis- What is internal and external? What Are mean by strengths,
weaknesses, opportunities, and threats? If given an example, know which one it is.
 Internal (strengths, weaknesses)
 External (opportunities, threats)
16. To run meetings efficiently- know what is involved and be able to select the appropriate
ways to do this
 •Know the purpose of the meeting (to make a decision, generate ideas,
communicate something, or to plan)
 .•Show respect for the time and expertise of coalition members.
 •Begin and end on time.
 •Send an agenda and background materials in advance.
 •Get the right people to attend. Know who your resources are and the role that
they play.
 •Invite only key stakeholders.
 •Stay on topic.
 •Communicate results.
 •Learn how to resolve conflicts and reach consensus.
17. Actions that help provide holistic and effective care in a community Know what actions
(collaborating with other healthcare workers and clients) the nurse should prioritize to
provide the most holistic and effective care for the community
 A community health nurse may be working in a community recently devastated
by a disaster like a hurricane or a tornado. Many of the survivors are being cared
for in their homes. Care might be needed for those who are ill, recovering, or in
hospice.
 ***The nurse need to collaborate with other health care workers and the clients.
Why??
♦ Note limitations of the following without the above:
1. What about referral of the clients to an outreach center?
2. What about a consult with hospice nurse or social worker?
3. What about providing care according to the healthcare provider’s
orders?
18. The environment- What does it mean to be an obesogenic environment? Know what
kinds of things might make it that way? Ie lots of junk food, people around you who eat
poorly and too much, buffet style eating, etc.
 Obesogenic environment—defined as an environment promoting or contributing
to obesity
 Salutogenic environments are ones “...that reduce vulnerability to illness and
promote enhanced levels of well-being”
19. Internal and External locus of control- review behaviors for each
 Internal locus of control
♦ Some people understand that there are consequences for their
actions/behaviors.
 Example: If I do this, then my health could improve.
Vs
 External locus of control
o Some people believe that things are in the control of God, work or
authority figures. Therefore, they believe that their actions/behaviors will
not change what will happen.
Examples: Somebody in control wants me to do it. Work requires things
that are out of my control which is why I have problems. It is God’s will
or it is hereditary so I cannot control it.
20. I would invite you to consider the following- know that routines tend to decrease anxiety
and change tends to increase anxiety
 Routines tend to decrease anxiety.
 Change tends to increase anxiety.

 For those who have difficulty with transition or have had difficulties in the past, it
may be more difficult to approach change.

Chapter 12 - Care Management Power Point

1. Key terms/Assisted Living- What is the definition and be able to apply it to a elderly
woman’s needs scenario
 An elderly woman had a hip fracture after a fall in her home. She is able to bathe
herself and cook meals on occasion but is realizing that she needs to change her
living arrangements.
▫ She would like nursing care available onsite, communal dining, and
recreation options. An assisted living facility is the best fit for her needs.
Why?
▫ What makes the following choices not good options?
▫ • Independent living in a senior living facility
▫ • Nursing home
▫ • Apartment located near a hospital
2. 22. Care Management vs Case Management-know the difference between the 2
 Care management -
▫ -coordination of a plan or process to bring health services together as a
common whole in a cost-effective way
▫ -evaluation of healthcare interventions, including need and
appropriateness of care, and the actions taken to attain effective and
efficient outcomes (sometimes referred to as utilization review)
  Case management -
▫ -development and coordination of care for a selected client and family-
collaborative process of assessment, planning, facilitation and advocacy
for options and services to meet an individual’s health needs through
communication and available resources to promote quality cost-effective
outcomes

3. Example of Care Management-If given an example of Care Management- be able to

identify that it is care management as opposed to other things
A community care nurse at a healthcare agency assists in coordinating a plan for
providing health services in the most cost-effective way possible to a large
number of members living in the region.
Why is this not:
Case management?
Home healthcare?
Interdisciplinary collaboration?
4. Types of Agencies
 •Private/Voluntary like VNA (Board of Directors-not for profit but they do profit
and it is invested back into the agency)
 •Hospital-Based Agencies like BJC Home Health
 •Proprietary Agencies
 For Profit
▫ •Official Agencies
▫ Public monies- Health Departments
5. Financing and Regulation of Home Care
 –Necessity
 –Homebound (key stipulation is that leaving home is the taxing effort required to
leave home, reimbursement requires severity level of illness to qualify)
 –Plan of care (agency-generated written document that is guided by a lengthy
assessment)
 –Skilled needs
 –Intermittent care needs

 $$$ Medicaid, Medicare, Tricare & VA (military) Private Insurance

 Regulations- state and federal government criteria/eligibility

 6. Criteria for Medicare for Home Health Services- Know the criteria
 Criteria that an individual must meet to receive Medicare for home health services
are:
▫ •Home bound
▫ • Specific plan of care
▫ • Skilled healthcare needs
▫ • Intermittent care needs (not continuous 24-hour necessity for care)

▫ Medicare will pay for skilled needs if the above criteria is met but the
nurse needs to seek renewal every 60 days to continue care
7. Medicare Renewal- What is the timing that is required?
 The client wants to know how long Medicare will pay for skilled needs.
 This care must seek a renewal if skilled needs continue to exist every 60 days.

8. Comparison of Skilled and Nonskilled nursing care- be able to say which is which if
given a list
Skilled Nursing Care Nonskilled Nursing Care
Assessment of lungs and weight of a client Changing a dry dressing
diagnosed with congestive heart failure
Teaching a newly diagnosed diabetic client Teaching the client’s significant other/spouse
how to fill insulin syringes or use an insulin how to pay healthcare bills
pen
Managment of care given to a client Managing care of a home health aide after all
postcerebrovascular accident by speech healthcare skilled needs have been stabilized
therapy, physical therapy, and home health
aide services
Changing a complicated wet-to-dry dressing Pouring medication in plastic labeled
on a client’s abdomen container
Monitoring the fluctuating blood pressure of Visiting the client to decrease lonelieness
an elderly man who has just started taking
antihypertensive medication

9. Parish/Faith-based nursing/What does Faith Community Nursing look like?- What are the
key roles? What would a nurse be doing? Be able to pick out what she should and should
not be doing.
 Health educator
 Personal health counselor
 Referral agent
  Coordinator of volunteers
 Developer of supportive groups
 Integrator of faith and health
 Health advocate

 What does Faith Community Nursing look like?

A nurse graduate is seeking a position of a faith community nurse. She
will be:
▫ • Teaching a class to faith community members on managing high
blood pressure
▫ • Providing counsel on preventing upper respiratory illness to
member
▫ • Referring a faith community member to a nutritionist for dietary
counsel
Why is she not doing the following?
▫ -Assisting an obstetrician in the birth of a faith community
member's child
▫ - Administering vaccinations at a local health clinic
 They do not provide direct nursing care like assisting with births or giving
vaccinations.
 Parish nursing- an approach to holistic care for patients and families in the
community
 Faith community nursing-
▫ Home visiting
▫ Negotiated with faith leader in a community parish, congregation, or
synagogue
▫ Not reimbursed by insurance, but serve as ways to coordinate care to
families
10. Assessing for Risk of Falls- What are the most common rooms for Falls?
 Living room – 31%
 Bedroom – 30%
 Kitchen – 19%
 Bathroom – 13%
 Hallway – 10%

11. Intrinsic and Extrinsic Factors Related to Falls in the Home- Know the difference
between intrinsic and extrinsic issues, What are modifiable issues in the elderly in regard
to falls?
  Intrinsic
▫ Age
▫ previous hx falls
▫ cognitive impairment
▫ muscle weakness
▫ decreased lower body strength
▫ Female
▫ taking 4 or more meds per day
▫ taking psychotropic meds
▫ vision impairment
▫ peripheral neuropathy
▫ Parkinson’s Dx
▫ history of a stroke
▫ arthritis
 Extrinsic
 poor lighting
 changes in floor surface or slippery surface
 high-gloss floors
 lack of handrails on stairs
 inappropriate chair height
 Clutter
 throw rugs
 electrical cords
 loose carpeting
 poor sidewalk and pavement conditions
 snow and ice
 PETS

12. Health Care Reform- What are avoidable hospital re-admissions typically caused by?
 •by insufficient post hospitalization care
 •failure to adhere to recommended medication or therapy regimens
 •lack of physical support for the discharged patient
Chapter 13 - Family Assessment Power Point
1. Ecomaps and Genograms- know definition of each
a. Ecomap
i. a diagram used to identify the direction and intensity of family relationships
between members and/or community institutions of importance to the family.
b. Genogram
i. a diagram of family relationships between blood relatives that can span two or
more generations. Life events such as marriages, divorces, births, and deaths
 are included in the diagram; it is used to identify relationships as well as possible
patterns of disease.
2. Theoretical Perspectives of Family- understand basic concepts of Family Systems
Theory/Family Structural-Functional Theory/ Family Development Theory
3. Homeless Families- Know % of homeless population who are children and how
homelessness impacts children
Precipitating factors
Lost job or work hours
Eviction
Overcrowding
Catastrophic illness
Unanticipated major bills
Interpersonal violence
Natural disaster

4. Calgary Family Assessment Model-Structural Know definitions of Genograms and

Ecomaps
5. Calgary Family Assessment Model –Functional- Know ADSs and IADLs – if given
examples be able to know which one it is
 6. Maternal Care Visits by Nurses- Know actions improve the outcomes of home health
visits and which actions would not improve outcomes
Nurses can have a positive effect on the families. Actions that should improve the outcomes of these
visits include:
•Remain friendly and approachable
•Encourage mother to lead the visit
•Remain flexible and let the families' needs dictate the visit
Why would the following actions not improve outcomes?
•Dictate what the mother should be doing
•Ensure each visit follows the prescribed standards

7. Improving Pregnancy Outcomes-That is the main benefit for the Nurse –Family
Partnership program
a. The public health nurse works closely with the school nurse to locate at-risk
pregnant adolescents to include them in the Nurse–Family Partnership Program.
The nurse points out that the main benefit from being included in the program
is Improved pregnancy outcomes.

b. It does not necessarily:

 •make an expectant mom better prepared for the next pregnancy

•monitor intra-family conflict which can occur

•improve relationship with father of infant

8. Caregiver Burden/Caretaker Son- What are the signs and symptoms of caregiver burden?
Review the cases of the 77-year-old woman and the caretaker son.

a.
b.

c.
 d.
9. Resources for Families of Older Adults- What is available to assist a family in the care of
elderly clients and what is not
a. Resources are available to assist a family with the care of an elderly client
include:
• Adult day care program

• Grocery delivery services

• Caregiver support group

• Companions

b. Would they be eligible for a support animal?

10. Caregiver Advice Record and Enable Act- What is it? What are hospitals required to do?