The History of Public Health and Public and Community Health Nursing

MULTIPLE CHOICE

1. A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing?

a.
Its autonomy and independence
b.
Its focus on acute care and immediately visible outcomes
c.
Its collaboration with other health care professionals
d.
Its flexibility and higher wages

ANS: A

In-patient acute care nurses (not public health nurses) focus on acute care with outcomes known fairly quickly. Unlike in-patient nursing, in which there are other health care professionals and staff with whom to interact, public health nursing is known for its autonomy and independence.

DIF: Cognitive Level: Apply (Application) REF: p. 15

2. The Elizabeth Poor Law of 1601 is similar to which current law?

a.
Welfare
b.
Food stamps
c.
Medicaid
d.
Medicare

ANS: C

The Poor Law guaranteed medical care for poor, blind, and “lame” individuals, similar to Medicaid.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 15

3. How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate?

a.
Economic and political wars resulted in frequent death and injuries.
b.
Incredible plagues consistently and constantly swept the European continent.
c.
Migration and urbanization resulted in increased demand for care.
d.
Caregivers could easily find other employment, so they demanded to be paid.

ANS: C

Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 15

4. A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed?

a.
Establishing schools of nursing
b.
Developing vaccines to administer to large numbers of people
c.
Collecting vital statistics and improving sanitation
d.
Developing public housing and almshouses

ANS: C

The other choices are events that happened after the colonial period.

DIF: Cognitive Level: Apply (Application) REF: p. 16

5. Why did American citizens become interested in establishing government-controlled boards of health?

a.
They were afraid of infectious diseases such as yellow fever.
b.
The government could force the poverty-stricken to accept care.
c.
Such boards could tax and thereby ensure adequate funds to pay for care.
d.
Such a system would allow for accurate records of births and deaths.

ANS: A

Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 16

6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have completed?

a.
Setting policy on quarantine legislation for immigrants
b.
Establishing hospital-based programs to care for the sick at home
c.
Identifying and improving environmental conditions
d.
Providing health care for merchant seamen

ANS: D

Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities.

DIF: Cognitive Level: Apply (Application) REF: p. 16

7. What was the outcome of the Shattuck Report?

a.
Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated.
b.
Environmental sanitation efforts became an immediate priority.
c.
Guidelines for modern public health organizations were eventually developed.
d.
Local and state governments established boards of health after its publication.

ANS: C

It took 19 years for the first of Shattuck’s recommendations to be implemented, but his report was the first effort to create a modern public health organization.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 16

8. Which of the following nurses is famous for creating public health nursing in the United States?

a.
Florence Nightingale
b.
Frances Root
c.
Lillian Wald
d.
Mrs. Solomon Loeb

ANS: C

Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 18

9. Which of the following would have been the focus of a school nurse in the early 20th century?

a.
Investigating causes of absenteeism
b.
Teaching school as well as being a nurse
c.
Promoting nursing as an autonomous practice
d.
Providing medical treatment to enable children to return to school

ANS: A

Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

DIF: Cognitive Level: Apply (Application) REF: pp. 18-19

10. A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which of the following accomplishments of today was started within this organization?

a.
Requiring that public health nurses have a baccalaureate degree in nursing
b.
Standardizing public health nursing education
c.
Developing nursing cooperatives
d.
Opening the Henry Street Settlement

ANS: B

The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

DIF: Cognitive Level: Apply (Application) REF: pp. 19-20

11. Why were nurses so unprepared for public health nursing in the early twentieth century?

a.
Community health nursing had not yet been created as a field.
b.
No one would teach the nurses how to engage in public health activities.
c.
Nightingale’s textbook did not include content on public health nursing.
d.
Nurses were educated in diploma schools, which focused on hospital nursing.

ANS: D

Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 20

12. A nurse is considering joining the American Public Health Association. What information about this organization should be considered when making this decision?

a.
APHA focuses on the public health concerns of the medical profession.
b.
APHA represents concerns of nursing specialty practices.
c.
APHA provides a forum for nurses to discuss their public health concerns.
d.
APHA focuses on providing health promotion education to the public.

ANS: C

APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing.

DIF: Cognitive Level: Apply (Application) REF: p. 20

13. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders?

a.
Creating such a service was the morally correct thing to do.
b.
Employing nurses directly was less expensive than paying taxes to the city for the same purpose.
c.
Having the company’s nurses make home visits increased worker morale.
d.
Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company.

ANS: D

Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children. The insurance company attributed this improvement and the associated reduced costs to the visiting nurses.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 21

14. Which client would have been most likely to receive care from the Frontier Nursing Service?

a.
An injured soldier
b.
A homebound, elderly male
c.
A woman in labor
d.
A child with measles

ANS: C

The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

DIF: Cognitive Level: Apply (Application) REF: pp. 21-22

15. A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development?

a.
Comprehensive assessment and planning done in the community
b.
Documented needs of the local community
c.
Federal funding for priority diseases or groups
d.
Nursing staff’s expertise and skills

ANS: C

Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally.

DIF: Cognitive Level: Apply (Application) REF: p. 23

16. A nursing student during World War II would likely join which group?

a.
The Public Health Service of New York City
b.
The Marine Nurse Corps
c.
The Frontier Nursing Service
d.
The Cadet Nurse Corps

ANS: D

The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 23

17. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic?

a.
The Future of Public Health
b.
Healthy People 2020
c.
Patient Protection and Affordable Care Act
d.
Scope and Standards of Public Health Nursing Practice

ANS: B

The Healthy People documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 26

18. A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts?

a.
To promote the nursing profession
b.
To increase funding for public health nursing
c.
To address the concerns of nurses
d.
To help improve health care access

ANS: D

Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life.

DIF: Cognitive Level: Apply (Application) REF: p. 26

MULTIPLE RESPONSE

1. How did Florence Nightingale help bring about community health nursing? (Select all that apply.)

a.
She convinced socially prominent wealthy women to volunteer to give care.
b.
She focused on all soldiers and their environment.
c.
She interacted with each individual person, assessing his or her needs and acting to meet those needs.
d.
She kept careful records on what was done and what were the results.

ANS: B, D

Nightingale progressively improved the soldiers’ health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes.

DIF: Cognitive Level: Remember (Knowledge) REF: pp. 17, 26-27

2. A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.)

a.
Establishing the Henry Street Settlement
b.
Developing health programs geared toward improving the health care of the rural populations
c.
Blazing a nursing trail through the Rockies, providing nursing care to miners and their families
d.
Ensuring positive outcomes for pregnancies among women in the Appalachian region

ANS: B, D

Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement.

DIF: Cognitive Level: Apply (Application) REF: p. 22

3. How did nursing education change in the 1950s? (Select all that apply.)

a.
Baccalaureate nursing programs typically included public health nursing concepts.
b.
Diploma schools of nursing continued to expand their student numbers.
c.
Junior and community colleges began offering nursing programs.
d.
Nurses were strongly encouraged to have a scientific basis for their practice.

ANS: A, C

In the 1950s public health nursing became a required part of most baccalaureate nursing education programs. In 1952 nursing education programs began in junior and community colleges.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 25

4. How did health care and its delivery change during the 1980s? (Select all that apply.)

a.
Funding to public health increased as funding for acute hospital care decreased.
b.
Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco.
c.
Nurse practitioners were increasingly used to provide care.
d.
Public health programs suffered reduced political support, financing, and effectiveness.

ANS: B, C, D

During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 25