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NUR 452 Exam 1
Objectives 8 questions
1. Compare and contrast community-oriented and community-based nursing. 3 Q’s
●Community based
○ Focus on illness care
○Of individuals and families
○ Manage acute and chronic illness in the community
○ Family centered illness care
●Community oriented
○ Goal is to preserve, protect, promote, or maintain health
○ Of Individuals, families, groups, populations, communities
○ Health care to promote quality of life
○ Also called population health/population focused/population oriented
○Main focus is community/population health
Community-oriented nursing (aka
population health)
Community-based nursing
Client components
● Individuals at risk
● Families at risk
● Groups at risk
● Communities
● Usually healthy
● Culturally diverse
● Autonomous
● Able to define their own
problems
● Primary decision makers
● Individuals and families
● Families
● Usually ill
● Culturally diverse
● Autonomous
● Able to define their own
problems
● Involved in decision making
Examples of above
● Teen moms
● Autism
● School health-educate groups
of asthmatic students, buses
idling by playground
● Cancer
● Asthmatic
● Child med admin
● Stops at individual and
family; asthmatic child med
admin, family for med refill
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Major goal of practice
● Preserve, protect, promote, or
maintain health and prevent
disease
● Care of the
population/community
(client=community)
● Manage acute or chronic
conditions
● Care of individuals and
family
Client entry into the
HCDS (healthcare
delivery system)
● Outreach
● Individual or family initiates
services
Breadth and scope of
practice
● Health promotion and disease
prevention of
populations/communities (can
be acute and chronic illnesses).
Often long term relationships
● Acute and chronic illnesses
(episodic)
Provider and client
relationship
● Mutual participation
(community as partner)
● Usually provider driven, can
be mutual
2. Apply the public health core functions to the health of a community/population. 3 Q’s
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●Core Function: Assessment
○ Monitor health status to identify community health problems
○ Diagnose and investigate health problems and health hazards in the
community
●Core Function: Policy Development
○Inform, educate, and empower people about health issues
○ Mobilize community partnerships to identify and solve health problems
○ Develop policies and plans that support individual and community
health efforts
●Core Function: Assurance
○ Enforce laws and regulations that protect health and assure safety
○ Link people to needed personal health services and assure the
provision of health care when otherwise unavailable
○ Assure a competent public health and personal healthcare workforce
○ Evaluate effectiveness, accessibility, and quality of personal and
population-based health services
○ Research for new insights and innovative solutions to health problems
● Three levels of public health practice
○Population based Individual-focused practice
■ Changes knowledge, attitudes, beliefs, practices, and behaviors
of individuals.
■ Individuals receive services because they are identified as
belonging to a population-at-risk.
○Population based community-focused practice
■ Goal: Improve population health
■ Aims to change community norms, community attitudes,
community awareness, community practices, and community
behaviors.
○Population based systems-focused practice
■ Most public health problems are addressed at all three levels,
often simultaneously.
■ Changes organizations, policies, laws, and power structures.
■ Often a more effective and long-lasting way to impact health
than addressing individuals.
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3. Differentiate upstream versus downstream thinking in community health. 2 Q’s
●Upstream determinants of public health are overarching factors that are
largely outside of the control of the individual and which have significant
trickle-down effects on other, more proximal determinants of public health.
●Downstream determinants of public health can be seen as the outcomes of up
and midstream factors and variables. In some respects, downstream
determinants are more easily mitigated or prevented by the individual, such
as a change in eating habits or reducing risk of injury on the job.
Objectives: 14 questions
1. Explore the nursing roles a community-oriented nurse would use in caring for a
community/population. 2 Q’s
●Focus is on the collective or common good of the population
●Population centered practice = community oriented practice
● Seeks healthful change for the whole community’s benefit
● May care for individuals, families, groups as a means to a healthy community
(the main focus is the community’s health)
● Direct clinical care part of population-focused community health practice
●Highlights the complexity of the change process. Change at 3 levels:
○ Individual level
○ Family level
○ Community level
●Community as partner
○ Collaborative practice models – nurse and community work together
○ Community members have knowledge that professionals lack
○ Shared roles, process, power, responsibility
○ Variety of disciplines
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2. Apply public health interventions as a component of nursing care of communities/
populations. 4 Q’s
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3. Explore various subspecialties within community-oriented nursing practice. 3 Q’s
●Home health - provide one-on-one care for patients in their homes
●Hospice - A hospice nurse cares for people who have been diagnosed with six
months or less to live
●School health - provides health education by providing health information to
individual students and groups of students through health education, science,
and other classes
●Occupational health - provides for and delivers health and safety programs
and services to workers, worker populations and community groups. The
practice focuses on promotion and restoration of health, prevention of illness
and injury, and protection from work-related and environmental hazards
●Correctional health - provide healthcare to those incarcerated in the criminal
justice system
●Forensic nursing - collecting evidence, photographing injuries for evidence,
working with victims of domestic abuse or violence, connecting with law
enforcement and legal teams to help victims, providing testimony in court
cases, working with medical examiners when victims die
●Epidemiology nurse - focuses on making sure that patients receive optimal
care, but who also reduce overall infection risks and focus on prevention
measures
●Mission nurse - cares for patients in underdeveloped and developing regions
of the world, usually through work with religious groups or churches, non-profit
●Public health department - focus on reducing exposures or other factors that
may lead people to seek a nurse's care.
●Camp nurse - provide routine and emergency care to campers, monitor their
chronic conditions, collaborate with management to provide a healthy
environment
●Parish/faith nurse - help individuals and families understand and cope with
health concerns and identify healthcare needs
●Global health - WHO - international health nurse may work on a wide range
of global health issues in a number of settings, contribution to health services
covers the whole spectrum of health care, promotion and prevention, as well
as health research, planning, implementation, and innovation.
●Infection Control nurse - helps prevent and identify the spread of infectious
agents like bacteria and viruses
4. Examine the different types of law related to community health issues. 2 Q’s
● Constitutional Law
○ From Federal and State Constitutions
○ US Constitution for Federal government, then all other power/functions are state
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government
○ Community’s over individual’s rights when threat to public health (i.e TB, COVID)
■ Compelling state interest
■ Isolation necessary to protect the public or individual
■ Reasonable manner
● Legislation and Regulation
○ From legislative branches of government; federal, state, local (statue law)
○ Specific statements of law related to defining pieces of legislation - specific
statements that operationalizes, implements, and enforces statutory law
■ State board of nursing
■ Federal Medicare or state Medicaid legislation and regulation
■ Example of current AZ legislation passed in Supplemental Resources in
Module
● Judicial and Common Law
○Judicial law – based on court or jury decision
○Case law – opinions of the courts
○ Case Law and Common Law often used to mean the same.
○ Court uses previous court decisions or cases as part of decision making
○ Precedent – judges bound by previous decisions unless no longer relevant
○ Principles of common law to assist with decision making include:
■ Justice
■ Fairness
■ Respect for an individual’s autonomy
5. Apply the nurse’s role in the policy process to influence health care (including how a
bill becomes a law). 3 Q’s
●Nursing Advocacy - Advocacy begins with the art of influencing others (politics) to
adopt a specific course of action (policy) to solve a societal problem.
●Writing to legislators
●Regulatory action - When the legislature passes a law and delegates its oversight
to an agency, it gives that agency the power to make regulations. Because regulations
flow from legislation, they have the force of law.
●Legislative Action
●Common methods of influence of health policy:
○ Face to face, personal letters, emails, phone calls, testimony, petitions, reports,
position papers
PROCESS OF REGULATION -After a law is passed, the appropriate executive
department begins the process of regulation by studying the topic or issue. Advisory
groups or special taskforces are sometimes formed to provide the content for the
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regulations. Nurses can influence these regulations by writing letters to the regulatory
agency in charge or by speaking at open public hearings.
● How a bill becomes a law:
1. The bill is drafted
2. The bill is introduced
3. The bill goes to a committee
4. Subcommittees review bill
5. Committee mark-up of the bill
6. Voting by the full chamber of the bill
7. Referral of bill to other chamber
8. Bill goes to the president (he can veto or not) and both House and
Senate have to approve of it first
9. Override of veto by Congress if needed
Objectives: 12 questions
1. Integrate community- as-client into the nursing process used for communities/
populations. 2 Q’s
●Assessment
○ To identify community needs
○ To clarify problems
○ To identify strengths and resources
○ Before data collection starts – Define your community using the 3
dimensions (Table 12-1)
■Place – What are the geographical boundaries of this
community?
■People/person – Which people are members of this
community?
■Function – What characteristics do they have in common?
■ For clarity about the boundaries of the community, so the nurse
knows what data is within the dimensions/boundaries
● For example – community/population is pregnant
teenagers in Maricopa County. You would not collect data
on non-pregnant teenagers in Maricopa County or
pregnant teenagers in New York
○ Now start collecting data – Use Functional Health Patterns as a
framework
○ Requires the following 3 steps:
■ Gathering existing data (existing, readily available data) and
generating missing data (developing data that does not already
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exist)
■ Developing a composite database (putting all data together).
This is the FHP template.
■ Interpreting the database to identify community problems and
strengths
● (+) after strengths/resources and (-) after problems and
needs
●Diagnosis
○Review the FHP data’s strengths/resources (+) and
problems/weaknesses/needs (-)
○ Make summary statements in the form of Nursing Diagnosis
○ Some call them problem statements but remember, there are more
than just problems
○ There are risks and wellness that can be a focus for positive health.
●Planning
○ Analyzing the community health problems identified in the community
nursing diagnoses (done to some extent with the RT and AEB)
○Establishing priorities among the Nursing Diagnoses/problems
○Establishing goals and objectives
○Identifying intervention activities that will accomplish the objectives
○Goals are broad statements of desired outcomes
○Objectives are precise statements indicating the means of achieving
desired outcomes/goals
■ Precise, behaviorally stated, measureable.
■ Who, what, when, how
■ Example: 50% of the mothers of infants enrolled in WIC will
demonstrate three ways of incorporating WIC supplements into
their infants’ diets by October
○ Collaboration needed – community as
partner
○ Then from goals, interventions are
developed to reach the objectives
●Intervention/Implementation
○ The means by which the objectives are
met
○ Many different types of interventions to
choose from
○ Involves the work and activities aimed
at achieving the goals and objectives.
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○ Implementation is shaped by:
■The nurses’ chosen role (content expert, change agent, change
partner, problem solver)
■ The type of health problem selected as the focus for
intervention
■ The community’s readiness to take part in problem solving
■ Characteristics of the social change process
○Change -
■Ability to change RT:
● High socioeconomic status
● A perceived need for change
● The presence of liberal, scientific, and democratic values
● High level of social participation by community members
■Change is easier to accept when:
● It fits with community values, norms, customs
● Best communication mode
● Other community support change
● Opinion leaders ID and used
● Communication clear and straightforward
●Evaluation
○Formative
■ Evaluation throughout the nursing process
■ Before evaluation of the outcomes of care
■ During the “formation” of the nursing care & its delivery
■ Nursing care can be modified
○Summative
■ At the end, after the interventions
■ Measurement of outcomes and goal attainment
■ Was the intervention appropriate?
■ Were the objectives sensitive enough to measure change?
■ Has the health problem been resolved or the risk reduced?
■ Can use epidemiology rates and numbers
■ Look at changes before and after the intervention.
2. Apply a community- oriented nursing plan of care to a community/ population using
the nursing process (Community Assessment, Nursing Diagnosis/ Analysis, Planning,
Intervention/ Implementation, Evaluation). 6 Q’s
● Although this chart at the top of the study guide does not give examples of a
specific nursing plan of care, you can use it to differentiate the difference
between community oriented nursing and community based
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3. Implement Functional Health Patterns (FHP) as a framework for assessing
communities/ populations. 4 Q’s
● Like in the Nancy Grace video activity, being able to categorize different
problems or observations into a “concept map”
● This way, you can develop different diagnoses and prioritize the important
ones
Objectives: 21 questions
1. Describe the concept of health promotion. (Giddens PPT/textbook) 1 Q’s
●Health promotion is the process of enabling people to increase
control over and to improve their health. (World Health Organization)
2. Identify links between health promotion and health promotion models for the
individual and community. (Giddens PPT/textbook) 3 Q’s
● Most health promotion models that focus on share these commonindividuals
themes:
○ Cognition
○ Decision making
○ Motivation
○ Behavior
○ Environment
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● Most health promotion models that focus on share these commoncommunities
themes:
○ Focus on community values and norms
○ Legitimization of desirable behavior and environmental changes
○ Participation of community leadership
○ Planned change in which community members have control
3. Apply the concept of health promotion to the context of nursing and health care
(economy, vulnerable populations, assessment, and interventions) (Giddens
PPT/textbook) 2 Q’s
●Facts about vulnerable populations
○ Vulnerable populations are more likely to develop health-related
problems and experience worse outcomes.
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○ Most vulnerable populations are persons with low socioeconomic
status and persons who are members of ethnic and racial minorities.
○ An assessment provides the basis for establishing a health promotion
plan.
●Individual assessment
○ Age, health status, presence of risk factors, health preferences and
values, social relationships
●Family assessment
○ Risk factors, family strengths, relationships among family members,
genetics
●Community assessment
○ Structure of community, community census, population demographics,
morbidity/mortality statistics, community resources
● Interventions include:
○ Education
○ Immunizations
○ Screenings
○ Nutritional health
○ Physical activity
○ Pharmacologic agents for smoking cessation and weight loss
4. Apply levels of prevention to community/ population health. 5 Q’s
●Primary
○ Interventions that promote health and prevent the occurrence of
disease, injury, or disability. Prepathogenesis.
●Secondary
○ Interventions designed to increase the probability that a person will
have the condition diagnosed early so treatment is likely to result in a
cure. Screenings-core.
●Tertiary
○ Interventions aimed at limiting disability and interventions that
enhance rehab from disease, injury, or disability
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○
5. Investigate the screening process and characteristics (including reliability and validity
[sensitivity, specificity]). 3 Q’s
●Screening: Testing of groups of individuals who are at risk for a specific
condition but do not have symptoms
○Goal – to determine the likelihood that these individuals will develop
the disease
●Reliability:
●
●Validity: whether it is really measuring what we think it is and how exactly
●Sensitivity:
○Quantifies how accurately the test ID those with the condition or trait
○Represents the proportion of persons with the disease whom the test
correctly ID as positive ( )TRUE POSITIVES
○High sensitivity is needed when early treatment is important and when
ID of every case is important
●Specificity:
○Indicates how accurately the test ID those without the condition or trait
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○The proportion of the persons whom the test correctly ID as negative
for the disease (TRUE NEGATIVES)
○High specificity is needed when rescreening is impractical and when it is
important to reduce false-positives.
●Know how to calculate this formula:
6. Analyze the ethics of screening in a screening program. 2 Q’s
● Needs to be ethical in the way that it is voluntary, confidential, must refer to
positives, and have distributive justice
7. Compare and contrast health promotion and disease prevention. 3 Q’s
● Health promotion:
○ Activities that have as their goal the development of human attitudes
and behaviors that maintain or enhance well-being
○ Promote health rather than avoid illness
○ Control your own well-being and improve health
○ Focus on whole populations – not just at risk populations
■ Example: getting appropriate amount of sleep for overall health
● Disease prevention:
○ Activities whose goal is to protect people from becoming ill as a result
of actual or potential health threats.
○ More specific
○Targeted to an actual or potential health threat
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■ Example: Folic acid for prevention of birth defects of brain and
spinal cord
8. Explore nutritional/ dietary implications of various cultures. 2 Q’s
●Buddhist religion – vegetarians as they are not allowed to harm or kill living
things and consume “intoxicants” (meat)
●Jewish – prohibits eating pork as a religious practice.
9. Explore the effects of special diets or nutrients on health and chronic health
conditions. (Not on exam 1 – tested on Nutrition ATI)
Don't look at this shit until the ATI exam lol
QUIZLETS
https://quizlet.com/226461247/nur-452-exam-1-flash-cards/
https://quizlet.com/257640356/w1-exam-1-flash-cards/
https://quizlet.com/315399156/nur-452-exam-1-flash-cards/
