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Chapter 10: Socio-Ecological Perspectives and Health

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Chapter 10: Socio-Ecological Perspectives and Health

10 problems · 0 figures

10-1 §10.RQ source ↗

The nurse is providing education to a client with a family history of hypertension. Which statement by the client does the nurse recognize as requiring further teaching about familial risk?
  1. a.
    “My family history increases my risk for hypertension.”
  2. b.
    “Genetics alone predict my own health and diagnoses.”
  3. c.
    “The interaction of genetics and environment affects health.”
  4. d.
    “Lifestyle factors affect the genetic expression of a disease.”

Answer

B. “Genetics alone predict my own health and diagnoses.”
Genetic associations are only one component of a client’s health, which includes lifestyle, environment, and social factors.

10-2 §10.RQ source ↗

The nurse is developing an education program for a client on healthy family nutrition using Pender’s Health Promotion Model as the framework. Which client statement indicates to the nurse that the client has a high level of perceived self-efficacy?
  1. a.
    “Eating healthy is expensive but within our family budget.”
  2. b.
    “I am confident that I can create a healthy weekly meal plan.”
  3. c.
    “My children’s school encourages healthy lunches.”
  4. d.
    “It is hard to find time to shop and prepare healthy meals.”

Answer

B. “I am confident that I can create a healthy weekly meal plan.”
Pender’s Health Promotion Model helps nurses understand the determinants of health behavior to promote health through effective behavioral counseling. The model directs nurses to assess for eight beliefs when planning for behavior change and health intervention. The belief of perceived self-efficacy is the personal capability to organize and execute a particular health behavior and self-confidence in performing the health behavior successfully, such as this client’s verbalization of confidence in developing a healthy weekly meal plan for the family.

10-3 §10.RQ source ↗

The nurse is creating a community program to promote outdoor exercise using Bronfenbrenner’s Socio-Ecological Model and is working with town planners to obtain funding and approval for sidewalks and walking and biking trails. Which of Bronfenbrenner’s systems is the nurse utilizing?
  1. a.
    Microsystem
  2. b.
    Mesosystem
  3. c.
    Chronosystem
  4. d.
    Macrosystem

Answer

D. Macrosystem
The Socio-Ecological Model considers how human growth and behavior can accommodate and change given the environment and systems that exist around people and how people interact with such environments and systems. The five systems identified in this model are the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The macrosystem includes codified laws, regulations, and rules as well as economic, social, educational, and legal systems.

10-4 §10.RQ source ↗

The nurse is working to change negative social beliefs towards breastfeeding in a rural area using the UNICEF Socio-Ecological Model. At which level of this model is the nurse effecting change?
  1. a.
    Individual
  2. b.
    Community
  3. c.
    Organizational/institutional
  4. d.
    Policy/system and enabling environments

Answer

B. Community
The UNICEF Socio-Ecological Model uses a socio-ecological approach as a conceptual framework for many health-promoting initiatives at the individual/interpersonal, community, organizational/institutional, and policy/system enabling environments levels. The nurse is effecting change at the community level by focusing on social beliefs and norms about breastfeeding.

10-5 §10.RQ source ↗

Which situation is an example of a nurse engaging in the Socio-Ecological Model to guide nursing care?
  1. a.
    Administering insulin to a client with type 2 diabetes who has seen a worsening of their glycemic control despite taking metformin
  2. b.
    Evaluating the causative factors of an observed increase in the number of grade-school children with newly diagnosed asthma
  3. c.
    Evaluating the impact of lisinopril on a client’s blood pressure 3 months after starting the medication
  4. d.
    Planning an education session for a client following surgery with a goal of independently changing the surgical site dressing

Answer

B. Evaluating the causative factors of an observed increase in the number of grade-school children with newly diagnosed asthma
The Socio-Ecological Model considers how human growth and behavior can accommodate and change given the environment and systems that exist around people. Looking for causative factors for an increase in asthma diagnoses is an example of the environment that may be contributing to rising rates of asthma among grade-school children.

10-6 §10.RQ source ↗

Which statement by a client with a family history of diabetes indicates an understanding of the genetic component of this disorder?
  1. a.
    “Since I have a family history of diabetes, I will also develop diabetes.”
  2. b.
    “A family history alone does not mean I will develop diabetes.”
  3. c.
    “Eating healthy will not prevent diabetes since it’s in my family.”
  4. d.
    “Diabetes skips a generation, so I will not get it.”

Answer

B. “A family history alone does not mean I will develop diabetes.”
Family health history helps identify strong risk factors or predictors for acquiring certain conditions and disorders, such as diabetes. However, family history alone does not mean a person will develop a disease. Although genetic associations can be robust, genetics are still only one component in an overall health picture. As heritability and the presence of certain genes or attributes are measurable, scientists can calculate the impact of genetics versus lifestyle, social, and other factors on specific health risks.

10-7 §10.RQ source ↗

Using the UNICEF Socio-Ecological Model, which statement is an example of a community health center working at the organizational level to promote health care?
  1. a.
    Teaching a client how to self-administer insulin injections
  2. b.
    Assisting a new mother with breastfeeding
  3. c.
    Treating all clients regardless of their ability to pay
  4. d.
    Lobbying to ensure health care for transgender clients

Answer

C. Treating all clients regardless of their ability to pay
Treating all clients regardless of their ability to pay is an example of how health care can be affected by decisions made at the organizational level.

10-8 §10.RQ source ↗

The nurse is caring for a client with diabetes who is having a hard time managing blood glucose levels. Using Bronfenbrenner’s Socio-Ecological Model, which factor would the nurse identify as most likely contributing to the client’s difficulty managing their diabetes at the exosystem level?
  1. a.
    Limited access to healthy food options
  2. b.
    Family history of diabetes
  3. c.
    Sedentary job
  4. d.
    Lack of reliable transportation

Answer

A. Limited access to healthy food options
The Socio-Ecological Model considers how human growth and behavior can accommodate and change given environments, systems, and how people interact with them. The five systems identified in this model are the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The exosystem includes informal and formal social structures that do not contain the individual but encompass the settings where the individual lives, such as limited healthy food choices in a neighborhood.

10-9 §10.RQ source ↗

The nurse is counseling a client who is trying to stop smoking. According to the Theory of Planned Behavior, which factor would the nurse recognize as representing risk perception?
  1. a.
    The client’s partner smokes.
  2. b.
    The client’s clothes smell of smoke.
  3. c.
    The client has tried to quit several times.
  4. d.
    The client believes smoking is unhealthy.

Answer

D. The client believes smoking is unhealthy.
The Theory of Planned Behavior explains how intention, attitudes, subjective norms, perceived behavioral control, and risk perception influence behaviors. Risk perception include a person’s thoughts about the benefits and hazards of acting or not acting, such as the belief that smoking is unhealthy.

10-10 §10.RQ source ↗

The nurse is discussing the importance of exercise and eating healthy to a client with hypertension. Which client behavior would the nurse assess as being in the precontemplation stage of the Transtheoretical Model?
  1. a.
    The client states they will think about changing their diet.
  2. b.
    The client begins walking three times a week.
  3. c.
    The client meets with a dietitian to learn about healthy eating.
  4. d.
    The client believes that exercise will not lower blood pressure.

Answer

D. The client believes that exercise will not lower blood pressure.
The Transtheoretical Model, also called the Stages of Change, explains how individuals progress through different phases of behavior change. In the precontemplation stage, the client does not intend to take action in the next 6 months.

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Problems and answers are adapted from Population Health for Nurses by Jessica Ochs, Sherry L. Roper and Susan M. Schwartz, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/population-health/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.