Chapter 01: Community- and Prevention-Oriented Practice to Improve Population Health
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition

MULTIPLE CHOICE

	1.	Which of the following best describes community-based nursing?
a.	A practice in which care is provided for individuals and families	
b.	Providing care with a focus on the group’s needs	
c.	Giving care with a focus on the aggregate’s needs	
d.	A value system in which all clients receive optimal care	

ANS:	A
By definition, community-based nursing is a setting-specific practice in which care is provided for “sick” individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. These nurses may be generalists or specialists in maternal–infant, pediatric, adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems.

	2.	Which of the following best describes community-oriented nursing?
a.	Focusing on the provision of care to individuals and families	
b.	Providing care to manage acute or chronic conditions	
c.	Giving direct care to ill individuals within their family setting	
d.	Having the goal of health promotion and disease prevention	

ANS:	D
By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing.

	3.	Which of the following is the primary focus of public health nursing?
a.	Families and groups	
b.	Illness-oriented care	
c.	Individuals within the family unit	
d.	Health care of communities and populations	

ANS:	D
In public health nursing the primary focus is on the health care of communities and populations rather than on individuals, groups, and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it. Community-based nurses deal primarily with illness-oriented care of individuals and families acorss the life span. The aim is to amanage acute and chronic health conditions in the community, and the focus of practice is on individual or family-centered illness care.

	4.	Which of the following is responsible for the dramatic increase in life expectancy during the 20th century?
a.	Technology increases in the field of medical laboratory research	
b.	Advances in surgical techniques and procedures	
c.	Sanitation and other population-based prevention programs	
d.	Use of antibiotics to fight infections	

ANS:	C
Improvements in control of infectious diseases through immunizations, sanitation, and other population-based prevention programs led to the increase in life expectancy from less than 50 years in 1900 to more than 78 years in 2013. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains in the health of populations that have come largely from public health accomplishments.

	5.	A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse?
a.	Increase the community’s knowledge about hospice care.	
b.	Promote healthy lifestyle behavior choices among the community members.	
c.	Encourage employers to have wellness centers at each industrial site.	
d.	Ensure timely and effective medical intervention and treatment for community members.	

ANS:	B
Public health approaches could help prevent premature deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment. Increasing knowledge of hospice care, encouraging on-site wellness centers, and ensuring timely treatment of medical conditions do not address the focus of improving overall health through health promotion strategies. This is the major method that is suggested to decrease the incidence of premature death.

	6.	Which of the following is a basic assumption of public health efforts?
a.	Health disparities among any groups are morally and legally wrong.	
b.	Health care is the most important priority in government planning and funding.	
c.	The health of individuals cannot be separated from the health of the community.	
d.	The government is responsible for lengthening the life span of Americans.	

ANS:	C
Public health practice focuses on the community as a whole, and the effect of the community’s health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government.

	7.	Which of the following actions would most likely be performed by a public health nurse?
a.	Asking community leaders what interventions should be chosen	
b.	Assessing the community and deciding on appropriate interventions	
c.	Using data from the main health care institutions in the community to determine needed health services	
d.	Working with community groups to create policies to improve the environment	

ANS:	D
Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. The interventions of asking community leaders which interventions should be chosen, asessing the community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the engagement of the community when making decisions about what the community actually wants and needs.

	8.	Which of the following public health nurses most clearly fulfills the responsibilities of this role?
a.	The nurse who met with several groups to discuss community recreation issues	
b.	The nurse who spent the day attending meetings of various health agencies	
c.	The nurse who talked to several people about their particular health concerns	
d.	The nurse who watched the city council meeting on local cable television	

ANS:	B
Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

	9.	Which of the following best defines aggregate?
a.	A large group of persons	
b.	A collection of individuals and families	
c.	A collection of people who share one or more characteristics	
d.	Another name for demographic group	

ANS:	C
An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a community can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children attending a particular school). These members make up a population. The term population may be used interchangeably with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demograhpic group are not accurate definitions of the term aggregate.

	10.	A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask?
a.	“Which groups are at the greatest risk for problems?”	
b.	“Which patients should I see first as I begin my day?”	
c.	“With which physicians will I be most closely collaborating?”	
d.	“With which nursing assistants will I partner the most?”	

ANS:	A
Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals rather than a community-oriented perspective.

	11.	Making sure that essential community-oriented health services are available defines which of the core public health functions?
a.	Policy development	
b.	Assessment	
c.	Assurance	
d.	Scientific knowledge-based care	

ANS:	C
Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment,  policy development. Scientific knowledge-based care is not a core function of public health. Assessment is systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

	12.	When talking to a women’s group at the senior citizens’ center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action?
a.	Ensure that the women did not expect the nurse to solve their problem.	
b.	Demonstrate that the nurse understood the women’s concerns and needs.	
c.	Express empathy, support, and concern.	
d.	Help the women engage in political action.	

ANS:	D
Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond merely understanidng the women’s concern, and instead mobilizes them to take action. This action does not demonstrate the nurse showing empathy rather the nurse is empowering these women.

	13.	The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first?
a.	To increase the group’s self-esteem	
b.	To maintain communication links with the groups	
c.	To make the groups feel good about their contribution	
d.	To work with the groups, not for the groups	

ANS:	D
Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning. The purpose of meeting with community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing maintaining communication links.

	14.	The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases?
a.	The specific moral or ethical principle related to the situation	
b.	The cheapest, most economical approach	
c.	The most rational probable outcome	
d.	The needs of the aggregate rather than a few individuals	

ANS:	D
The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components of a decision that the nurse might consider in determining the needs of the aggregate.

	15.	Which of the following actions best represents public health nursing?
a.	Assessing the effectiveness of the high school health clinic	
b.	Caring for clients in their home following their outpatient surgeries	
c.	Providing care to children and their families at the school clinic	
d.	Administering follow-up care for pediatric clients at an outpatient clinic	

ANS:	A
A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Caring for clients and their families focuses on individuals and families and not on the entire population. Public health focuses on care of populations.

	16.	Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area?
a.	To assess the needs of the homeless who live there	
b.	To demonstrate their courage and commitment	
c.	To distribute some of their own surplus clothes to those who can use them	
d.	To share with various churches and other charities what is needed	

ANS:	A
In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance to this population that may or may not be helpful or welcomed.

MULTIPLE RESPONSE

	1.	Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.)
a.	Economic turmoil and demand for high-technology care	
b.	Emergence of new or drug-resistant infectious diseases	
c.	Emphasis on overall health care needs rather than only on acute care treatment	
d.	Threat of bioterrorism	

ANS:	B, C, D
As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger commitment to population-focused services, rather it has occurred as overall health needs have become the focus of care.

	2.	Which of the following actions demonstrate effective public health nursing practice in the community? (Select all that apply.)
a.	Epidemiologic investigations examine the environment for health hazards.	
b.	New services are organized where particular vulnerable populations live.	
c.	Partnerships are established with community coalitions.	
d.	Staff members at the public health agency continue to increase in number.	

ANS:	A, B, C
Evidence that public health nurses are practicing effectively in the community would include organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Increasing number of staff does not have a relationship to the effectiveness of public health nursing practice.

	3.	Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select all that apply.)
a.	Home care is less expensive.	
b.	It is much more efficient to give care in the home.	
c.	Nurses prefer to give home care with individual attention.	
d.	People prefer to receive care in their homes rather than in hospitals.	

ANS:	A, D
An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.