1: Responsibilities for Care in Community/ Public Health Nursing

D: The term community health nursing is an umbrella term used for all nurses who work in a
community. This term denotes the setting of practice for the nurse.
A community/public health nurse is best defined as a nurse who
a. Applies concepts and knowledge from nursing and public health.
b. Gives care to families in the community.
c. Has a baccalaureate and previous experience in community health.
d. Is employed outside of an acute care setting.
A:
Public health nurses synthesize all their nursing expertise, as well as knowledge, from
public health, whereas nurses with varied educational backgrounds may be employed in
community settings
The only clear distinction between a community health nurse and a public health nurse is
that
a. The community health nurse gives care in community settings regardless of
personal education, whereas public health nurses have specific educational
preparation.
b. Community health nurse is a title that has historically been used, whereas public
health nurse is the new “in” title for the role.
c. The community health nurse is employed to give care to families and groups,
whereas the public health nurse works in public health departments.
d. Community health nurse is the broader term that includes public health nursing,
school nursing, and home health nursing.
D: Although the nurse should provide care in all the ways described, for recipients to accept
the care, the care must be consistent with their cultural expectations and norms.
When the nurse is caring for a family or a community, it is important that the nurse provide
care that is
a. Similar to that described in the textbook or procedure manual
b. Consistent with agency policies
c. Inexpensive
d. Culturally congruent
C: By definition, an aggregate is a group of persons who have one or more characteristics in
common, particularly a set of persons under statistical study with some co
What is the meaning of the term aggregate as used in community health?
a. A group of persons who reside in a specific geographic area
b. All the persons who live in a specific community
c. A set of persons who have some characteristic in common
d. “The public” in professional terminology
C: While the nurse’s practice should be consistent with employing agency policies, legal
mandates, and professional standards, the nurse must seek a balance between individual
autonomy and other individual rights and the rights of all other community members. It is
a delicate balance.
What is the appropriate approach for the community/public health nurse in balancing
individual privacy and autonomy and the community’s needs for safety and security?
a. Fulfill agency policies first.
b. Implement professional standards of nursing practice.
c. Seek a balance between individuals’ needs and the community’s needs.
d. Remember that group needs outrank individual needs.
B: To provide for the greatest good to the greatest number, it is often necessary to focus on
basic services, such as immunization or prenatal care, because such care has the most
effect on the whole community
While the nurse’s practice should be consistent with employing agency policies, legal
mandates, and professional standards, the nurse must seek a balance between individual
autonomy and other individual rights and the rights of all other community members. It is
a delicate balance.
D:
Although option B fulfills the criteria of egalitarian (equal) justice, it is a short-term
answer to an ongoing problem. Trying to achieve the outcome of the greatest good for the
greatest number of persons is a utilitarian approach to justice, which is more helpful in
dealing with large populations such as clients seen by the community/public health nurse
When faced with an ethical conflict about limited resources and unlimited need, which
action is the most just?
a. Giving care to clients whose needs most closely match the nurse’s abilities
b. Giving care to whichever prospective clients ask for care first
c. Working as hard as possible and not worrying about it
d. Trying to a
D
Which document is helpful in describing competent and appropriate nursing care in the
community?
a. Community Health: Standards of Nursing
b. Healthy People 2020
c. The Joint Commission: The Comprehensive Accreditation Manual
d. Public Health Nursing: Scope and Standards of Practice
Focuses on achieving health goals for persons
living in the United States
What is Healthy People 2020 about?
Used by organizations
pursuing accreditation from this organization
What is the Joint Commission Manual?
D:
How does a community/public health nurse provide indirect care to clients in homes,
clinics, senior citizen centers, schools, prisons, homeless shelters, and other living
environments?a. Being employed in community settings such as outpatient clinics
b. Providing anticipatory guidance and health promotion activities to community
members
c. Providing care in mobile vans to citizens in their own neighborhoods
d. Being involved on a political action committee to create new client services
A: Although both nurses would give excellent care to the individual client, the acute care
nurse would assess the client individually and adapt interventions accordingly. The
community/public health nurse would seek to identify others in the family who might need
intervention or referral as well. The community/public health nurse provides care from a
family-focused model, being concerned not only
How would the actions of the community/public health nurse caring for a recently
discharged client in his home differ from those of the acute care nurse?
a. The community/public health nurse would assess the health and needs of all the
family members.
b. The community/public health nurse would be careful to be nonjudgmental about
the family’s living situation.
c. The community/public health nurse would explain why each nursing intervention
was being performed.
d. The community
C
Referral or directing someone to another source of assistance is an appropriate response
when the nurse cannot fulfill the need.
When a community/public health nurse cannot meet a need of the client, it is most
appropriate for the nurse to
a. Encourage the client to pay someone to meet that need.
b. Inform the client that insurance will not pay for the care.
c. Refer the client to a person or agency that may be able to provide assistance.
d. Suggest that the client discuss the need with the physician.
B
Nurses usually encourage clients to initiate contact as one way of maintaining
responsibility for their own care without encouraging dependency. Nurses work with
clients with a specific difficulty or barrier, such as language, in a way that empowers them
to follow up on the referral.
What is the nurse’s most appropriate action when it becomes apparent that another agency
is needed to help a family best meet their health needs?
a. Call the other agency to set up care for the family.
b. Give the family information to initiate contact with the other agency.
c. Report the need to the community/public health nurse’s supervisor for action.
d. Write a letter to the appropriate agency suggesting that it contact the family.
C
Because the young man has presumably been taught the advantages of abstinence or
protection for engaging in sex, and yet continues to return for further testing, it is clear that
information alone has not changed his behavior. Therefore, the nurse should interview the
client about his values and help him perceive how reducing his risks may help him achieve
his goals.
A young man has repeatedly visited the sexually transmitted disease (STD) clinic for
human immunodeficiency virus (HIV) testing. What should the nurse do in addition to
completing the testing?
a. Determine whether the young man is heterosexual or homosexual.
b. Emphasize repeatedly the importance of abstinence.
c. Discuss his perceived barriers to practicing safe sexual behaviors.
d. Teach the importance of using protection for engaging in sexual acts.
D
Well-being requires learning to create meaning and a sense of belonging in life while
recognizing that control (i.e., preventing the death) is not always possible.
A nurse includes well-being in her definition of health. What will the focus be when the
nurse provides care to a family confronting the imminent death of a family member?
a. Sharing the nurse’s knowledge of the physiology behind the client’s symptoms
and the appropriate interventions for comfort
b. Administering pain medication so that the client can be kept comfortable
c. Reinforcing the need for the whole family to adapt to the impending death
d. Discussing the perceived meaning of life with the family
A
Many states require treatment for patients whose diseases are contagious to persons around
them. The other choices are unfortunate, but patients have the right to choose their lifestyle
behaviors, and nurses are not police officers.
A community/public health nurse may ignore an individual’s wishes in which of the
following circumstances?
a. Caring for a client with tuberculosis who refuses treatment
b. Educating a client who adds salt to food while following a cardiac diet
c. Discovering that a client drinks wine before dinner every night
d. Finding evidence that the client may be smoking marijuana
C
Case management is defined as the development and coordination of a plan of care for a
selected client.
How might case management be defined?
a. An incident that necessitates intervention
b. A synonym for cost containment
c. Developing and coordinating a plan of care for a client
d. Advocating for groups of clients who have a specific illness
A
Nurses must establish and maintain relationships with professionals in other agencies and
create partnerships to address community problems. Through networking with other
community groups, nurses may be able to improve the health of special interest groups and
improve case management services. The purpose of community health planning meetings
is not to receive advice from others. However, the increased networking may help nurses
solve problems that they may be encountering.
Why is it necessary for public health nurses to attend community health planning
meetings?
a. To network with other community groups
b. To protect the health of special interest groups
c. To coordinate case management efforts
d. To seek advice from others in the community
C
Community/public health nurses obtain membership in decision-making groups as another
way to increase their influence and contribute to health planning
Why would a nurse choose to be an active member of several professional associations?
a. To be able to spend time with friends and colleagues
b. To be part to the organization’s annual convention/conference
c. To be part of the decision-making and political action activities
d. To be able to have professional development opportunities
B
The World Health Organization (WHO) points out that values underlying health for a
community include equity, empowerment, and cooperation. As a balance to some of the
values of efficiency, materialism, and hierarchic power structures, nurses are speaking for
connectedness and caring.
What underlying values should be a part of a healthy community?
a. Responsibility and respect
b. Connectedness and caring
c. Stability and safety
d. Marketability and security
C
Certification is a voluntary process that validates an individual registered nurse’s
qualifications in a specified area of nursing. A community health nurse who completes
educational preparation in community health or public health at the graduate level may
choose to seek certification in this specialty area. After passing the certification exam, the
credentials APHN, BC may be used.
What is the significance of the credentials APHN, BC?
a. A special professional development program for community/public health nurses
b. A special title given to nurses who join the American Nurses Association
c. A voluntary process that demonstrates knowledge, education, and experience
d. A title given to a nurse who has a special master’s degree
B
Because cost containment in health care continues to be a national goal, it is important for
community/public health nurses to continue to document the cost of nursing care and the
savings that nursing care can provide (Deal, 1994). Home care expanded because nurses
demonstrated that quality care can be provided for some clients in the home at a lower cost
than in the hospital.
Which action by home health nurses is crucial because of current national health care
goals?
a. Administer medications and treatments correctly and safely.
b. Document the savings and benefits of home care services.
c. Guide a group to an appropriate resource to best meet their needs.
d. Teach an ill person’s family how to promote self-care.
C
Beliefs of the nursing profession in general are to care for the sick and dying, promote the
health of individuals and families, and provide holistic care to clients. One difference
between community/public health nurses and other nurses is that they pay special attention
to vulnerable and at-risk populations, especially elderly persons; infants; and disabled, ill,
and poor persons.
Which nursing activity is unique to community/public health nurses?
a. Care for the sick and dying
b. Commitment to promote health of individuals and families
c. Focus on vulnerable groups in the community
d. Provide holistic care to clients in the presence of their families
C
The ethical principle of justice is defined as treating all people fairly. One way that
community/public health nurses would exhibit justice is by providing nursing services to
all, regardless of their ability to pay. Community/public health nurses can give care only
within the limitations of third-party payer requirements. A difficulty for community/public
health nurses is coping with the disparities in our current health care system.
Which ethical principle might be difficult for the community/public health nurse to
implement?
a. Nonmaleficence
b. Beneficence
c. Justice
d. Respect for autonomy
A, C, E
All nurses care for the ill, support human growth and development, and promote
self-responsibility or self-care. Community/public health nurses promote equitable
distribution of health care, a healthful physical environment, and a basic standard of living
that supports the health and well-being of all persons
Which commitments are unique to community/public health nursing? (Select all that
apply.)
a. Advocacy for equitable distribution of health care
b. Care of ill, disabled, and suffering persons
c. Political action for a healthful physical environment
d. Promotion of self-responsibility or self-care in relation to health
e. Focus on a standard of living that supports health for all
f. Support for human growth and development throughout the life span
A, B, F
Discussing the vision empowers nurses and helps them remember why they became
nurses. It also allows other persons to become involved and to recognize new possibilities.
Expressing the vision provides an opportunity for other persons to become partners in
working for potential outcomes: not only the broader vision but also in relation to specific
projects. Nurses do not force or coerce other persons, and they often work with members
of other professions on issues related to health.
What is the value of nurses’ discussions of their vision for the health of the community?
(Select all that apply.)
a. Other persons are assisted in seeking possibilities that they may not have
considered.
b. Other persons are encouraged to become partners in a specific project.
c. Other persons are forced to think about health issues and nurses’ power.
d. Other persons are coerced to become partners in the nurse’s dream.
e. Attention is drawn away from issues pushed by other professions.
f. The vision becomes a source of energy and motivation for everyone involved in
the discussion.
C, D
The predominant intervention strategies used with families are primary care, health
teaching (including anticipatory guidance), referral, and collaborating and coordinating
care. Screening can be performed by various nurses, as can care of individuals. Nurses
probably cannot resolve conflict, although they may help family members cope with
conflict. Collecting data for research can be done only with a client’s permission.
Which interventions are most commonly used by community/public health nurses caring
for families? (Select all that apply.)
a. Administering screening tools to all family members
b. Applying the nursing process to the care of individuals
c. Collaborating and coordinating referrals as needed
d. Providing health teaching, including anticipatory guidance
e. Participating in collecting data on clients for clinical research
f. Resolving conflict among family members
A, C, D
The immediate short-term need can be met by asking community resources such as
churches to donate supplies. The young women themselves can be empowered by forming
a group to share resources and pass them on to others when equipment (e.g., cribs) is no
longer needed. However, in the long term, the community itself must recognize the
problem and decide what actions might be appropriate. In a similar manner, in the long
term, younger students need education on how to avoid the risks of early pregnancy
The nurse was caring for several single teenage mothers who desperately needed supplies
such as diapers and cribs, but no resource in the community provided these specific items.
Which of the following actions would be most helpful? (Select all that apply.)
a. Asking churches and other community charities to donate such supplies
b. Asking the local hospital to not bill the mothers for labor and delivery costs
c. Empowering the mothers by helping them form a self-help group to share
resources
d. Engaging the community in recognizing the problem and implementing changes
e. Holding fundraisers to give cash to the mothers to purchase such supplies
f. Teaching a sex education course in all the schools for prepubescent students
B, D, E, F
Performing tasks such as applying the nursing process or providing the best care possible
is not maintaining competence. Competency is maintained by ongoing professional
development such as attending educational programs, becoming involved in peer review,
reading and integrating relevant research findings, and continually evaluating one’s
personal practice.
What would a new baccalaureate-prepared community/public health nurse be expected to
do to improve personal competency and quality of care? (Select all that apply.)
a. Apply the nursing process to a large aggregate.
b. Be actively involved in peer review.
c. Provide the best possible care to individuals and families.
d. Participate in relevant continuing education programs.
e. Integrate relevant research findings for evidence-based practice.
f. Systematically evaluate personal professional practice performance.
B, C, F
While all the options would be excellent interventions, finding a source of medical care or
referring a single mother to a public assistance program, even recognizing the right to
autonomy, does not change the environment. Improving the environment by having only
healthy choices available, establishing waste recycling, and helping get drunk drivers off
the road makes the world safer for everyone.
Which nursing actions would help ensure a healthful environment? (Select all that apply.)
a. Help an elderly couple obtain access to a health clinic that will accept Medicare.
b. Help parents fight to get soda and candy vending machines out of the school.
c. Help the high school student government establish a waste recycling program.
d. Refer a single mother to a public assistance program.
e. Recognize that individuals have a right to smoke if they so desire.
f. Support members of Mothers Against Drunk Driving who testify to Congress
Public Health Nursing
Requires specific educational preparation for nurses to work in a community
Community Health Nursing
Denotes a setting for the practice
Community/Public Health Nursing Practice
Nursing care that is population-focused and community oriented. Care aimed at improving the health of one or more populations & is usually provided in settings outside of hospitals & nursing homes. Must have formal education specific to public health nursing that complements basic nursing education.
Health Goals of Community/Public Health Nurse
1. epidemiology, statistics, & research
2. orientation to health care systems
3. identification of high-risk populations
4. application of public health concepts to the care of groups of culturally diverse persons
5. interventions with high-risk populations
6. orientation to regulations affecting public health nursing practice
Community-Based Nursing
Nurse that works outside of hospitals & nursing homes, but doesn’t have any formal education in public health nursing. Provides care directed at individuals/families, rather than populations.
Population-Focused Care
Assessment, planning & evaluation that occurs at the population level
Public Health Nurse
A nurse who has received formal public health nursing preparation
Visions
Broad statements describing what we desire something to be like; derive from the ability of human beings to imagine what does not currently exist
Commitments
Agreements we make with ourselves that pledge our energies for or toward realizing our visions
Public Health Commitments
1. Ensuring equitable distribution of health care
2. Ensuring a basic standard of living that supports the health & well-being of all persons
3. Ensuring a healthful physical environment
Clients
The explicit naming of families, groups, and aggregates or populations is a major focus; nurses empower individuals, families & groups to participate in creating healthful communities
A balance of individuality & unity
What is the ideal for a healthful community?
Empowerment
The process of assisting others to uncover their own inherent abilities, strengths, vigor, wholeness & spirit; depends on the presence of hope;
Concepts
Labels or names that we give to our perceptions of living beings, objects, or events.
Theories
A set of concepts, definitions & hypotheses that help us describe, explain, or predict the interrelationships among concepts
Open System
A set of interacting elements that must exchange energy, matter, or information with the external environment to exist
General Systems Theory
Used in the community/ public health setting to assess and analyze various clients & their relationships with dynamic environments
Boundary
Separates the system from its environment & regulates the flow of energy, matter, and information between the system & its environment
Environment
Everything outside the boundary of the system
Outcomes
The created products, energy, and information that emerge from the system into the environment
External Influences
The matter, energy, and information that come from the environment into the system
Feedback
Information channeled back into the system from its environment that describes the condition of the system
Subsystems
Parts of a system that have their own goals & functions and exist in relationship with other parts.
Structural Subsystems
Subsystems that relate to organization.
Functional Subsystems
Subsystems that are more abstract & relate to specific purposes
Suprasystem
The next larger system in a hierarchy
Equifinality
The same end point can be reached from a variety of starting points & through various paths
Self-Care
The production of actions directed to self or to the environment in order to regulate one’s functioning in the interest’s of one’s life, integrated functioning, and well-being
Population
People residing in an area, and a group/set of persons under statistical study.
Group
A set or collection of persons, not a system of individuals who engage in face-to-face interactions
Risk
A statistical concept based on probability
Aggregate-Focused Care
Aimed at addressing the health of a population whose members share similar characteristics but have limited face-to-face interactions (ex. pregnant teenagers)
Prevention
A complex concept that also evolved from an attempt to control diseases among the public
Epidemiology
The science that helps describe the natural history of specific diseases, their causes, and their treatments
Presymptomatic period, symptomatic period, resolution
What are the three parts of the natural history of a disease?
Primary Prevention
The promotion of health & the prevention of the occurrence of diseases
Secondary Prevention
The detection (screening) and treatment of a disease as early as possible during its natural history
Tertiary Prevention
Preventing disability, complications, and death from disease; includes rehabilitation.
Justice
An ethical concept concerned with treating human beings fairly
Distributive Justice
The ethical concept concerned with the fair provision of opportunities, goods, and services to populations of people
Egalitarian System
Each person has equal access to equal health services
Utilitarian Justice
Resources are distributes so as to provide the greatest good for the greatest number with the least amount of harm
Social Justice
The principle that all persons are entitled to have their basic human needs met, regardless of differences in economic status, class, gender, race, ethnicity, citizenship, religion, age, sexual orientation, disability or health.
Direct Community Care
The application of the nursing process to individuals, families, and groups & involves face-to-face relationships; includes management & coordination of care
Indirect Community Care
Does not involve interpersonal relationships with all persons who benefit from care; includes promotion of self-help & appropriate use of health resources by community members, development of new services.
Intervention Model
Defines the scope of public health nursing practice by type of intervention and level of practice (systems, community, individual/family), rather than by the more traditional “site” of service; describes the scope of practice by what is similar across settings and describes the work of public health nursing at the community and systems practice levels as well as the conventional individual/family level.
Referral
The process of directing someone to another source of assistance
Advocacy
The action of speaking or writing on behalf of someone else & using persuasion in support of another
Teaching
The process of imparting cognitive knowledge, skills, & values
Anticipatory Guidance
Education that occurs before the client is expected to need to act on the information
Monitoring
the verification of the state or condition of health
Evaluation
The determination of the significance or value of this information
Surveillance
Monitoring the health of populations & communities
Coordination
Bringing together the parts or agents of a plan or process into a common whole
Case Management
The development& coordination of a plan of care for a selected client, usually an individual or a family.
Caseload Management
The coordination of care for a number of clients for whom the community/public health nurse is accountable.
1. Assessment of the community 2. assurance that services are provided 3. health policy development
What are the three core public health functions of government?
Factual knowledge, knowledge that emerges from experiential acquaintance with others, self-knowledge, ethical knowledge
What are the four patterns of knowing?
Novice Community/ Public Health Nurses
Expected to apply the nursing process with limited supervision & to adapt care to preferences/needs of individuals, families, groups, aggregates; must be skillful in screening & evaluating behaviors, consultation, crisis intervention, family/community assessment, conflict resolution, group dynamics & assessment of entire caseload
Professional Certification
A process that validates an individual RN’s qualifications, nursing practice & knowledge in a defined area of nursing & acknowledges that the nurse’s education, experience & knowledge meet standards determined by the profession.
Generalists
Have baccalaureate nursing degree & may be certified as community/public health nurses or school nurses
Specialists
Usually have a master’s degree & provide support, orientation, staff development, consultation, & professional leadership to generalists
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