Community Assessment and Evaluation

1. Which of the following is the best brief definition of community?

a.
A geographic area or political division under common leadership
b.
A group sharing a common bond such as a profession or occupation
c.
A group working together to confront a common problem
d.
A social group with common goals within a geographic area

ANS: D

According to WHO, “A community is a social group determined by geographic boundaries and/or common values and interests. Its members know and interact with one another. It functions within a particular social structure and exhibits and creates norms, values and social institutions.” The correct answer includes aspects of people, place, and function or aims.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 211

2. A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse?

a.
Providing care to an active caseload of 50 families in the neighborhood
b.
Inviting all the parents of asthmatic children in the school to meet together for mutual support
c.
Sharing assessment findings and health goals with every community group that will listen
d.
Writing articles for the local newspaper highlighting the various programs and services of the local health department

ANS: C

Although it is not possible to know the nurse’s goals from the nurse’s behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn’t necessarily help eligible clients access care. Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals.

DIF: Cognitive Level: Apply (Application) REF: p. 213

3. Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don’t simply focus on helping persons who engage in poor health behaviors to behave appropriately?

a.
Addicts don’t have the willpower to change their behavior.
b.
It is too rewarding to continue the behavior for a person to be able to change.
c.
Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change.
d.
Society must offer healthy choices, offer support, and practice helpful policies.

ANS: D

Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies.

DIF: Cognitive Level: Apply (Application) REF: pp. 213-214

4. A nurse is focusing on the process dimension of a community’s health. Which of the following interventions will the nurse most likely implement?

a.
Assessing the health care services available in a community
b.
Establishing screening programs to diagnosis diseases as early as possible so treatment can begin
c.
Implementing health promotion activities such as education programs
d.
Planning for new programs to be developed based on identified needs

ANS: C

When the emphasis is on the process dimension—usually the level of intervention of the nurse in community health—the best strategy is usually health promotion, such as various primary prevention strategies.

DIF: Cognitive Level: Apply (Application) REF: p. 215

5. A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action?

a.
A change in the distribution or redistribution of power and influence
b.
An increase in awareness of the importance of health
c.
Continued ongoing interest in community health activities
d.
Improved family functioning and involvement in health activities

ANS: A

Partnership is the informed, flexible, and negotiated distribution and redistribution of power among all participants in the processes of change for improved community health. Such changes may be unexpected by those in formal power positions in the community.

DIF: Cognitive Level: Apply (Application) REF: pp. 216-217

6. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community’s strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants?

a.
To ensure that others agree with the nurse’s plans for interventions
b.
To confirm the nurse’s initial findings and conclusions
c.
To encourage community partners to feel they “own” the data
d.
To generate nonstatistical data such as values, beliefs, and perceived needs

ANS: D

Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community’s knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation.

DIF: Cognitive Level: Apply (Application) REF: pp. 219-220

7. A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment?

a.
To allow participant observation by the nurse
b.
To ensure that the nurse would care about her intervention outcomes
c.
To maximize convenience and minimize commuting time for the nurse
d.
To save gasoline in these difficult economic times

ANS: A

Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse “observations” of the community’s life.

DIF: Cognitive Level: Apply (Application) REF: p. 219

8. A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurse’s reason for driving through the community twice in the same day?

a.
On the second trip, the nurse can carefully confirm the results of the first assessment.
b.
Repeating the experience ensures that the nurse absorbed all the relevant details.
c.
Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home.
d.
When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

ANS: C

When doing a windshield survey as part of community assessment, the nurse should observe two times: once during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. Rather than continually stopping to write down her findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings.

DIF: Cognitive Level: Apply (Application) REF: pp. 219-220

9. Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity?

a.
To avoid confronting the community until the nurse is thoroughly oriented
b.
To become familiar with previous goals and priorities of the agency
c.
To help get a better understanding of the assigned community
d.
To save time and effort and perhaps have new insights

ANS: D

Although the nurse might review materials for any of these reasons, the nurse uses previously gathered data because it saves time and effort. Many sources of data are readily available and useful for secondary analysis.

DIF: Cognitive Level: Apply (Application) REF: p. 221

10. A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse?

a.
A problem that affects the most disadvantaged residents in the community
b.
A problem that is very easy and inexpensive to address
c.
A problem that is of high concern to the community
d.
A problem in an area in which the nurse has a great deal of expertise

ANS: C

Choice of priority must depend on the community’s awareness of the problem—and their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities.

DIF: Cognitive Level: Apply (Application) REF: p. 222

11. Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan?

a.
All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition.
b.
Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class.
c.
95% of children will be immunized by 1 year of age.
d.
There will be a 25% reduction in health disparities by 2015.

ANS: B

Objectives must be precise, behaviorally stated, and measurable. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1 year old.) A 25% reduction by 2015 is a goal, not an objective. Only the option about mothers receiving nutrition counseling represents a specific, measureable behavior as an objective.

DIF: Cognitive Level: Apply (Application) REF: p. 224

12. During which of the following activities is the nurse in community health acting as a partner in change?

a.
Administering vaccinations to preschoolers
b.
Analyzing community problems to determine the best interventions
c.
Establishing an elder-care center for older adults living with family members who work
d.
Teaching anger management skills to a group of teens in a halfway house

ANS: D

Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change agent roles stress gathering and analyzing facts and implementing programs, whereas change partner roles include those of enabler-catalyst, teacher of problem-solving skills, and activist advocate. The nurse establishing an elder-care center is acting as a change agent. The nurses administering vaccinations and analyzing community problems are carrying out other nursing roles.

DIF: Cognitive Level: Apply (Application) REF: p. 226

13. A nurse is assessing a community’s openness to change. Which of the following variables indicate that the community is ready?

a.
Commitment to current processes and policies
b.
High social-economic status in the community as a whole
c.
Long history of dependence on the community health agency and its staff
d.
Minimal level of social participation by community members

ANS: B

Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents.

DIF: Cognitive Level: Apply (Application) REF: p. 227

14. A nurse is working toward an objective to “Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care.” During which of the following phases of the nursing process would determination of the objective occur?

a.
Assessment phase
b.
Planning phase
c.
Implementation phase
d.
Evaluation phase

ANS: B

Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified.

DIF: Cognitive Level: Apply (Application) REF: p. 227

15. A nurse is assessing the status of a community’s health. Which of the following will the nurse examine?

a.
Community awareness
b.
Health facilities
c.
Health care manpower
d.
Vital statistics

ANS: D

The status of community health involving physical indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g., hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process.

DIF: Cognitive Level: Apply (Application) REF: p. 216

16. A nurse is assessing the structure of a community’s health. Which of the following data will the nurse examine?

a.
Health facilities and their staffing patterns
b.
Health risk profiles of selected aggregates
c.
Statistics of morbidity and mortality in comparison with similar communities
d.
Treatment and service use patterns from local health agencies and care providers

ANS: D

Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios

DIF: Cognitive Level: Apply (Application) REF: p. 216

MULTIPLE RESPONSE

1. A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the following best describes the rationale for this action? (Select all that apply.)

a.
Partnering results in increased effectiveness
b.
Involving community members results in contributions of time and money into the program
c.
Having many partners results in increased publicity for the program
d.
Participating in planning results in having a vested interest in the outcome

ANS: A, D

Although partners do indeed contribute time and effort in participation, the primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature.

DIF: Cognitive Level: Apply (Application) REF: pp. 215-216

2. A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate actions for the nurse to take to help ensure acceptance? (Select all that apply.)

a.
Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies)
b.
Attending community events such as festivals or fairs and interacting with participants
c.
Becoming involved in and contributing to volunteer community organizations
d.
Completing a comprehensive physical assessment on nearby neighbors

ANS: A, B

Gaining entry or acceptance into the community is perhaps the biggest challenge in assessment. The nurse is usually an outsider and often represents an established health care system that is neither known nor trusted by community members, who may therefore react with indifference or even active hostility. Entry into the community is critical. Often the nurse can gain entry by taking part in community events, visiting people in formal leadership positions, and clarifying community members’ perceptions of health needs. While an activity such as volunteering is a positive action, it is not the most efficient way to become involved in the wider community.

DIF: Cognitive Level: Apply (Application) REF: p. 222

3. A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by the nurse when making this decision? (Select all that apply.)

a.
The expected effect or outcome of each possible intervention
b.
How interested others are in helping in any particular intervention
c.
The nurse’s own interest in implementing each intervention
d.
The likelihood that the intervention will resolve the problem

ANS: A, B, D

The nurse can list each possible intervention and then consider the resources or barriers to that particular intervention, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective.

DIF: Cognitive Level: Apply (Application) REF: p. 224

4. A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful over a period of time. Which of the following data should the nurse examine? (Select all that apply.)

a.
Changes in staffing patterns and assignments in the health agency
b.
Demographic data
c.
Education and school statistics
d.
Environmental factors

ANS: B, D

To see the outcomes of chosen interventions, the nurse would examine changes in demographics, socioeconomic factors, environmental factors, health status, and/or use of health services.

DIF: Cognitive Level: Apply (Application) REF: p. 227

5. Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that apply.)

a.
Defining variables relevant to current public health problems
b.
Obtaining and interpreting information regarding risks and benefits to the community
c.
Implementing nursing care and subsequent evaluation outcomes
d.
Maintaining public health departments throughout the United States

ANS: A, B

Eleven core competencies for the nurse and other health providers working in the community have been defined by the Council on Linkages Between Academia and Public Health Practice. Defining variables relevant to current public health problems and obtaining and interpreting information regarding risks and benefits to the community are two of the eleven core competencies.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 211

6. A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be effective key informants for the nurse? (Select all that apply.)

a.
Community’s immigrant group activist
b.
Federal senators and representatives
c.
Health board members
d.
Local politicians such as the town mayor

ANS: A, D

Informant interviews, which consist of directed talks with selected members of a community about community members or groups and events, are basic to effective data collection. Talking to key informants is a critical part of the community assessment. Key informants are not always those who have a formal title or position. Key informants often have an informal role within the community. Examples of informal key informants would include a member of a minority group who is listened to by other members of the group, a church leader, and a parent who is active and vocal about the school health curriculum.

DIF: Cognitive Level: Apply (Application) REF: pp. 219, 221