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Chapter 17: Assessment, Analysis, and Diagnosis

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Chapter 17: Assessment, Analysis, and Diagnosis

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Case Study 17.1.1 §17.1 source ↗

Read the scenario, and then answer the questions that follow.

After contacting community members, Tia joined an assessment team with the goal of implementing interventions to combat the opioid crisis. The team chose the PRECEDE-PROCEED model to guide its assessment and planning for intervention. During the first phase, social assessment, data regarding community needs and desires are collected. The team found that community members are concerned about the current opioid crisis and would like to reduce substance misuse and overdose death rates. During the second phase, epidemiological assessment, the team gathers data from primary and secondary sources and considers behavioral and environmental factors contributing to the opioid crisis. During the third phase, educational and ecological diagnosis, the team identifies predisposing, enabling, and reinforcing factors of the opioid crisis.

The team plans to gather qualitative information from key community partners regarding the opioid crisis during the first step. Which of the following data collection strategies would be appropriate?
  1. a.
    Collecting survey responses from community members
  2. b.
    Using GIS to map incidences of opioid overdose deaths
  3. c.
    Gathering local overdose statistics to compare to national data
  4. d.
    Conducting a focus group with local emergency responders

Answer

D. Conducting a focus group with local emergency responders
Focus groups gather qualitative data from participants who have experience with the topic. Participants provide their perspectives of the issue in a discussion-based setting. It would be appropriate to gather this information from local emergency responders because they have firsthand experience responding to drug overdoses. Additionally, these data are not consistently reported by methods that the team could easily access in another way.

Case Study 17.1.2 §17.1 source ↗

Read the scenario, and then answer the questions that follow.

After contacting community members, Tia joined an assessment team with the goal of implementing interventions to combat the opioid crisis. The team chose the PRECEDE-PROCEED model to guide its assessment and planning for intervention. During the first phase, social assessment, data regarding community needs and desires are collected. The team found that community members are concerned about the current opioid crisis and would like to reduce substance misuse and overdose death rates. During the second phase, epidemiological assessment, the team gathers data from primary and secondary sources and considers behavioral and environmental factors contributing to the opioid crisis. During the third phase, educational and ecological diagnosis, the team identifies predisposing, enabling, and reinforcing factors of the opioid crisis.

Which of the following would be categorized as an enabling factor for addressing opioid misuse?
  1. a.
    A drug rehabilitation center is located within the community.
  2. b.
    Local media promotes community naloxone training.
  3. c.
    High school students gain knowledge of the consequences of opioid misuse.
  4. d.
    A cycle of drug misuse is linked to specific families in the community.

Answer

A. A drug rehabilitation center is located within the community.
A drug rehabilitation center is located in the community. Enabling factors are characteristics of the environment and community that make it easier for community members to change their behavior or their environment. This includes community programs, services, and resources. Media is a reinforcing factor to motivate specific behaviors. Knowledge, beliefs, values, and attitudes of the individual are predisposing factors. Attaining knowledge in high school and values learned from family are predisposing factors.

Case Study 17.4.3 §17.4 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

After selecting the PRECEDE-PROCEED model, Tia’s CHA team completed phases 1–3. During the assessment, the team collected the following data:

• GIS data shows one neighborhood with a disproportionate number of drug overdoses. This area also has high poverty and unemployment rates and is located by an entrance/exit on the interstate.

• EMS calls for overdoses have tripled since the last CHA.

• Drug overdose deaths are higher than the national benchmark (Healthy People 2030).

• Provider opioid prescriptions have decreased in the area.

• Reported opioid use (attained by any method—legal or illegal) has increased. Heroin usage has increased by 10 percent.

• Availability of heroin mixed with fentanyl has increased over the past 6 months.

• Infection rates related to needle use have increased at the local hospital.

• Local schools continue to educate on drug abstinence using the Drug Abuse Resistance Education (DARE) program.

• Naloxone training is available from the public health department, but utilization goals have not been reached.

• Local EMS staff are volunteers, and the station is not regularly staffed.

• A drug rehabilitation center is located within the community but frequently has a waiting list for outpatient appointments and inpatient admission.

Although the PRECEDE-PROCEED model does not require a community nursing diagnosis, the team decided to create one in order to clearly identify the aggregate and characteristics of the community.

The team has started planning for program implementation and wants to begin by promoting and enhancing available community resources, such as education within the schools, community naloxone training, education for providers related to opioid prescriptions, and drug rehabilitation. According to the PRECEDE-PROCEED model, phase 4, administrative and policy diagnosis, the team focuses on administrative and organizational concerns that should be addressed prior to program implementation.

Which community nursing diagnosis is written appropriately, reflects the data gathered during assessment, and aligns with community perceptions and needs?
  1. a.
    Risk for overdose among opioid/heroin users related to increased availability of heroin mixed with fentanyl, inconsistent EMS staffing, lack of availability/access to drug rehabilitation resources, increased opioid usage in the community, lack of knowledge of consequences of opioid misuse, and lack of utilization of community naloxone training
  2. b.
    Opioid misuse among community members living next to the highway who are unemployed and lack financial resources
  3. c.
    Risk for infection related to heroin injection, lack of knowledge of aseptic technique for injection, and availability of clean needles
  4. d.
    Increased opioid use in the county related to availability of heroin

Answer

A. Risk for overdose among opioid/heroin users related to increased availability of heroin mixed with fentanyl, inconsistent EMS staffing, lack of availability/access to drug rehabilitation resources, increased opioid usage in the community, lack of knowledge of consequences of opioid misuse, and lack of utilization of community naloxone training
The nursing diagnosis includes all parts. The other responses do not contain all parts and/or do not align with community perceptions and needs.

Case Study 17.4.4 §17.4 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

After selecting the PRECEDE-PROCEED model, Tia’s CHA team completed phases 1–3. During the assessment, the team collected the following data:

• GIS data shows one neighborhood with a disproportionate number of drug overdoses. This area also has high poverty and unemployment rates and is located by an entrance/exit on the interstate.

• EMS calls for overdoses have tripled since the last CHA.

• Drug overdose deaths are higher than the national benchmark (Healthy People 2030).

• Provider opioid prescriptions have decreased in the area.

• Reported opioid use (attained by any method—legal or illegal) has increased. Heroin usage has increased by 10 percent.

• Availability of heroin mixed with fentanyl has increased over the past 6 months.

• Infection rates related to needle use have increased at the local hospital.

• Local schools continue to educate on drug abstinence using the Drug Abuse Resistance Education (DARE) program.

• Naloxone training is available from the public health department, but utilization goals have not been reached.

• Local EMS staff are volunteers, and the station is not regularly staffed.

• A drug rehabilitation center is located within the community but frequently has a waiting list for outpatient appointments and inpatient admission.

Although the PRECEDE-PROCEED model does not require a community nursing diagnosis, the team decided to create one in order to clearly identify the aggregate and characteristics of the community.

The team has started planning for program implementation and wants to begin by promoting and enhancing available community resources, such as education within the schools, community naloxone training, education for providers related to opioid prescriptions, and drug rehabilitation. According to the PRECEDE-PROCEED model, phase 4, administrative and policy diagnosis, the team focuses on administrative and organizational concerns that should be addressed prior to program implementation.

Using the data collected during assessment and tentative plans for the program, what administrative and organizational concerns must the team address before program implementation?
  1. a.
    Reduced rates of opioid prescriptions by providers in the area
  2. b.
    Availability of appointments at the local drug rehabilitation center
  3. c.
    Response times of local EMS to overdose calls
  4. d.
    Increased availability of heroin in the community

Answer

B. Availability of appointments at the local drug rehabilitation center
Availability of appointments at the local drug rehabilitation center could be a barrier to program implementation. Promoting drug rehabilitation would be ineffective if appointments were not available.

17-1 §17.RQ source ↗

A nurse assesses a client’s health literacy prior to providing education. The client is able to use interactive websites, identify multiple resources to gather health information, and assist others in health decision-making. Which health literacy level describes the client’s skills?
  1. a.
    Functional health literacy
  2. b.
    Interactive health literacy
  3. c.
    Critical health literacy
  4. d.
    Organizational health literacy

Answer

B. Interactive health literacy
A client with interactive health literacy has skills that have advanced beyond the functional, or basic, health literacy level. This client is able to use a variety of sources to answer health questions and apply that information to real-life scenarios.

17-2 §17.RQ source ↗

Which secondary data source would the public health nurse utilize to benchmark local health patterns to national (U.S.) patterns?
  1. a.
    Healthy People 2030
  2. b.
    Key informant interview
  3. c.
    U.S. Census data
  4. d.
    Focus group report

Answer

A. Healthy People 2030
Benchmarking involves comparing local information to other measures or standards. Healthy People 2030 provides national objectives to improve health and well-being over the next decade.

17-3 §17.RQ source ↗

Which community nursing diagnosis has the nurse written appropriately?
  1. a.
    Ineffective coping related to multiple stressors as evidenced by the client crying and stating she has no support system
  2. b.
    Risk of ineffective health maintenance among individuals who do not have access to a primary care provider
  3. c.
    Risk of cardiovascular disease related to poor diet, sedentary lifestyle, and lack of access safe places to exercise
  4. d.
    Risk of obesity among school-age children related to lack of access to healthy food choices and opportunities for physical activity

Answer

D. Risk of obesity among school-age children related to lack of access to healthy food choices and opportunities for physical activity
Community nursing diagnoses must include “risk of” to describe the health need or problem, “among” to describe the aggregate or population that is affected, and “related to” to describe community characteristics or factors that influence the health need.

17-4 §17.RQ source ↗

Which of the following would the community health nurse include in an assessment of community systems?
  1. a.
    Age, gender, and race
  2. b.
    Water quality reports
  3. c.
    Health care providers
  4. d.
    Morbidity patterns

Answer

C. Health care providers
Community systems are services and resources that are available to community members. The number and location of health care providers falls under community systems and is used to determine access to health care providers.

17-5 §17.RQ source ↗

A team is using the American Hospital Association Community Health Assessment (CHA) toolkit to conduct a CHA. They have defined the community and gathered data from multiple sources. According to the toolkit, what is the next step?
  1. a.
    Share results with the community
  2. b.
    Prioritize community health problems
  3. c.
    Evaluate progress
  4. d.
    Plan implementation strategies

Answer

B. Prioritize community health problems
After data is collected and reviewed, the team analyzes the data in order to prioritize community health problems. The team plans implementation strategies after the top health priorities are chosen. Results are shared with the community after the data is analyzed. Evaluation occurs after the CHIP has been implemented.

17-6 §17.RQ source ↗

Which health literacy skill would the nurse anticipate in a client with functional health literacy skills?
  1. a.
    Understanding a prescription label
  2. b.
    Following blood glucose trends
  3. c.
    Recognizing personal health risks for cardiovascular disease
  4. d.
    Following directions to reduce radon levels in the home

Answer

A. Understanding a prescription label
A client with functional health literacy has basic health literacy skills and is able to obtain relevant information and apply it to prescribed activity, such as reading a prescription label and taking the medication accordingly.

17-7 §17.RQ source ↗

The nurse is developing a teaching plan for a client newly diagnosed with diabetes. Which action by the nurse focuses on the psychomotor domain of learning?
  1. a.
    Providing reinforcement for efforts toward self-care
  2. b.
    Teaching about the relationship between insulin and blood glucose levels
  3. c.
    Instructing the client on self-administration of insulin
  4. d.
    Discussing the symptoms of hypoglycemia and hyperglycemia

Answer

C. Instructing the client on self-administration of insulin
The psychomotor domain is the performance of skills that require neuromuscular coordination. An example is self-administration of insulin.

17-8 §17.RQ source ↗

Which action will the nurse take when utilizing constructivist theory to teach a community health education program about smoking cessation?
  1. a.
    Reward positive behaviors toward smoking cessation
  2. b.
    Encourage reflection about smoking cessation
  3. c.
    Model desired behaviors needed for smoking cessation
  4. d.
    Assess knowledge to build upon what is already known about smoking cessation

Answer

B. Encourage reflection about smoking cessation
In constructivist learning theory, learners actively use experiences and reflection to build upon preexisting knowledge rather than passively taking in information.

17-9 §17.RQ source ↗

Which method will the nurse use when teaching a client who is an auditory learner?
  1. a.
    Pictures and images
  2. b.
    Videos
  3. c.
    Interactive activities
  4. d.
    Discussion

Answer

D. Discussion
Auditory learners process information and learn best through listening; appropriate educational methods are verbal lecture, discussion, music, podcasts, and reading aloud.

17-10 §17.RQ source ↗

Which activity will the nurse perform during the continuously improve the community phase of the Mobilizing for Action through Planning and Partnership (MAPP) framework to improve the health of a community?
  1. a.
    Complete partner profiles
  2. b.
    Strengthen community engagement
  3. c.
    Perform Community Partners Assessment
  4. d.
    Establish Community Health Improvement (CHI) leadership

Answer

A. Complete partner profiles
During the Continuously Improve the Community phase of MAPP, power analyses and partner profiles are completed.

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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.