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Chapter 33: Advocating for Population Health

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Chapter 33: Advocating for Population Health

14 problems · 0 figures

Case Study 33.2.1 §33.2 source ↗

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

A nurse working in a public health role in an urban community with a high rate of homelessness is assigned to assist 52-year-old Tanesha White. Tanesha lost her job at a local department store 4 months ago when her diabetes and hypertension caused her to miss work for nearly 2 weeks. Two months later, Tanesha lost her apartment when she was unable to pay her rent. She presented to the homeless clinic as she needed more insulin to treat her diabetes. Her clothes are worn, she wears ill-fitting shoes, and she states her right foot is sore. Tanesha’s teeth show evidence of decay, she has a productive cough, and she has smoked a pack of cigarettes a day for many years. Tanesha shares that she has “never felt more down” and has been relying on alcohol to get through the tough days. She has difficulty finding food and relies on the food kitchen about three times a week. She does not have a consistent health care provider and is uninsured. She is living in her car and has lost contact with her daughter and son. She left her husband after he physically abused and sexually assaulted her 3 years ago and has had trouble trusting anyone. At present, she has no social or family support. Her temperature is 101.2°F, and her blood pressure is 178/94 mm Hg. Her blood sugar is 302 mg/dL.

Tanesha is clearly experiencing a multitude of problems. Of these, your immediate priority of care is managing her:
  1. a.
    blood glucose
  2. b.
    hypertension
  3. c.
    respiratory status
  4. d.
    mental health

Answer

C. respiratory status
Tanesha may be developing a respiratory infection. However, managing her hypertension, blood sugar, and mental health should also be rapidly assessed. When working with communities, it is important to address their most pressing issues first. When there are many issues, it is important to identify and manage the most life-threatening conditions first.

Case Study 33.2.2 §33.2 source ↗

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

A nurse working in a public health role in an urban community with a high rate of homelessness is assigned to assist 52-year-old Tanesha White. Tanesha lost her job at a local department store 4 months ago when her diabetes and hypertension caused her to miss work for nearly 2 weeks. Two months later, Tanesha lost her apartment when she was unable to pay her rent. She presented to the homeless clinic as she needed more insulin to treat her diabetes. Her clothes are worn, she wears ill-fitting shoes, and she states her right foot is sore. Tanesha’s teeth show evidence of decay, she has a productive cough, and she has smoked a pack of cigarettes a day for many years. Tanesha shares that she has “never felt more down” and has been relying on alcohol to get through the tough days. She has difficulty finding food and relies on the food kitchen about three times a week. She does not have a consistent health care provider and is uninsured. She is living in her car and has lost contact with her daughter and son. She left her husband after he physically abused and sexually assaulted her 3 years ago and has had trouble trusting anyone. At present, she has no social or family support. Her temperature is 101.2°F, and her blood pressure is 178/94 mm Hg. Her blood sugar is 302 mg/dL.

What agency or service would the public health nurse reach out to first in order to help clients like Tanesha?
  1. a.
    The local homeless shelter
  2. b.
    The area agency on aging
  3. c.
    A social worker
  4. d.
    An advanced practice nurse or physician

Answer

D. An advanced practice nurse or physician
Clients like Tanesha require medical care to regulate their immediate health concerns. They also need social services to help them obtain housing, food, mental health care, and Medicaid insurance to help them to meet their health care needs.

Case Study 33.3.3 §33.3 source ↗

Read the following 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.

Tanesha has been staying at the homeless shelter for the past 2 days. She was placed on antibiotics for lower lobe pneumonia, and her blood glucose level and blood pressure have stabilized. She has been able to shower and obtain shoes that fit her feet. She has a small diabetic ulcer at the base of her right great toe that has been cleaned and bandaged. Her car was moved to a safe place in the parking lot. She expresses concern about staying in the shelter; she fears that she will be assaulted and will be unable to protect herself as men have been seen sneaking into the women’s ward. She said that she left home because she was assaulted and admits that she still feels afraid. She mentioned that she couldn’t sleep well at the shelter because babies were crying all night. She said that she plans to return to her car to live soon if the conditions do not improve in the shelter.

What would the nurse consider a priority for clients like Tanesha?
  1. a.
    Suicide precautions
  2. b.
    Mental health evaluation
  3. c.
    Nutritional assessment
  4. d.
    Sleep assessment

Answer

B. Mental health evaluation
Tanesha has experienced domestic and intimate partner trauma, and the shelter may ignite fear related to a possible recurrence. Nutritional and sleep assessments are also important. She has not shown signs of potential suicide risk.

Case Study 33.3.4 §33.3 source ↗

Read the following 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.

Tanesha has been staying at the homeless shelter for the past 2 days. She was placed on antibiotics for lower lobe pneumonia, and her blood glucose level and blood pressure have stabilized. She has been able to shower and obtain shoes that fit her feet. She has a small diabetic ulcer at the base of her right great toe that has been cleaned and bandaged. Her car was moved to a safe place in the parking lot. She expresses concern about staying in the shelter; she fears that she will be assaulted and will be unable to protect herself as men have been seen sneaking into the women’s ward. She said that she left home because she was assaulted and admits that she still feels afraid. She mentioned that she couldn’t sleep well at the shelter because babies were crying all night. She said that she plans to return to her car to live soon if the conditions do not improve in the shelter.

What health policies might the nurse advocate for to best serve homeless individuals like Tanesha?
  1. a.
    Early childhood health education
  2. b.
    Safe housing programs for families with children
  3. c.
    Free mental health screening for veterans
  4. d.
    Education on how to access health care

Answer

D. Education on how to access health care
Knowledge and access to health care could have prevented Tanesha’s situation from devolving into homelessness.

33-1 §33.RQ source ↗

Which activity would a nurse mentor recommend to a new nurse to begin to advocate for the profession?
  1. a.
    Lobby for health care reform to cover preventive services
  2. b.
    Educate families about the scope of nursing practice
  3. c.
    Serve as a volunteer for a state legislator’s campaign
  4. d.
    Set up a flu shot clinic at a neighborhood church

Answer

B. Educate families about the scope of nursing practice
Nurses can advocate for the profession by talking about their work and the scope of nursing practice so the public learns about the professional role of nursing. A good place for new nurses to begin this advocacy is by educating their clients and families about the nursing profession.

33-2 §33.RQ source ↗

Which information would the nurse provide to a state legislator about the need for safe staffing ratios in hospitals?
  1. a.
    A six-client-to-one nurse ratio on a medical-surgical unit is ideal for positive client outcomes.
  2. b.
    Inadequate client-nurse ratios increased mortality during the COVID-19 pandemic.
  3. c.
    Client-to-nurse staffing ratios do not adversely affect client outcomes.
  4. d.
    Safe staffing ratios should be set by each hospital.

Answer

B. Inadequate client-nurse ratios increased mortality during the COVID-19 pandemic.
Research shows that during the COVID-19 pandemic a lack of adequate nurse staffing led to an increase in hospital mortality, length of stay, and readmissions.

33-3 §33.RQ source ↗

Which communication skill should the nurse use when preparing to meet with community partners about the need for increased health access for vulnerable populations?
  1. a.
    Concisely present key issues within the first minute
  2. b.
    Prepare an in-depth, detailed speech
  3. c.
    Provide a multipage fact sheet to support the conversation
  4. d.
    Present facts and avoid using client stories

Answer

A. Concisely present key issues within the first minute
When speaking with community partners about a need for change, the nurse should stay on point and succinctly communicate key information within the first minute of a conversation.

33-4 §33.RQ source ↗

Which concept should the nurse consider when providing maternal-child health care to immigrants who have newly arrived in the United States from various countries around the world?
  1. a.
    The rate of infant mortality is consistent around the world.
  2. b.
    Deaths from eclampsia are lower in Black women than White women.
  3. c.
    Black women are more likely to die from pregnancy-related cardiomyopathy.
  4. d.
    Global disparities in maternal-child deaths cannot be changed.

Answer

C. Black women are more likely to die from pregnancy-related cardiomyopathy.
Global disparities in maternal and infant mortality are higher among BIPOC populations, with Black women five times more likely to die from pregnancy-related cardiomyopathy and eclampsia than White women.

33-5 §33.RQ source ↗

The community health nurse has formed a coalition to provide programming and safe meeting spaces for adolescents after school. Which statement best describes the nurse’s purpose for forming a coalition?
  1. a.
    The nurse does not have the time to create this program without help.
  2. b.
    There will be shared blame if the program fails.
  3. c.
    The nurse does not possess the skills to develop such a program without help.
  4. d.
    Resources are shared to increase the likelihood of achieving success.

Answer

A. The nurse does not have the time to create this program without help.
A coalition is a group of people with shared vision or concerns who collaborate to support a cause. Nurses may form coalitions to maximize resources to improve the chances of successfully achieving these goals.

33-6 §33.RQ source ↗

Which goal would a nurse utilize when developing a program to improve care for vulnerable populations based on the Future of Nursing Report 2020–2030?
  1. a.
    Provide scholarships for student nurses to improve diversity
  2. b.
    Increase the number and quality of shelters for the homeless
  3. c.
    Improve quality of life and prevent disease, injury, disability, and premature death
  4. d.
    Increase clinical hours for nurses obtaining advanced degrees

Answer

C. Improve quality of life and prevent disease, injury, disability, and premature death
The National Academy of Medicine developed the Future of Nursing Report 2020–2030, which set goals for public health and emerging health policies. One of its goals is to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.

33-7 §33.RQ source ↗

A nurse has joined a political action committee (PAC) through the state nursing organization. The nurse explains to community health nursing colleagues that the PAC performs which of the following functions?
  1. a.
    Making political contributions
  2. b.
    Conducting judicial reviews
  3. c.
    Identifying issues of concern
  4. d.
    Lobbying government officials

Answer

A. Making political contributions
PACs form to generate and spend funds to elect political candidates that align with a particular agenda.

33-8 §33.RQ source ↗

Which of the following is a reason why a nurse might contact the Nurses on Boards Coalition (NOBC)?
  1. a.
    To get help in contacting their senator on a health care bill
  2. b.
    To develop specialized clinical skills
  3. c.
    To gain leadership skills in advocacy
  4. d.
    To obtain funds for a new community hiking trail

Answer

C. To gain leadership skills in advocacy
NOBC collaborates with other associations and health care and business partners to provide nursing leadership as members on the boards of directors for organizations. NOBC provides mentors to help nurses develop leadership skills and advance in organizations.

33-9 §33.RQ source ↗

To meet the health care needs of a community, a public health nurse has been asked to join a coalition. Which characteristic of a coalition should the nurse anticipate?
  1. a.
    An informal group that disbands when its goal is met
  2. b.
    A social group set up for networking
  3. c.
    A group that focuses on a specific nursing specialty
  4. d.
    A formal group with clearly defined positions

Answer

D. A formal group with clearly defined positions
A coalition is a formal group with a defined leadership team, such as a chairperson, facilitator, individual members, staff, a steering committee, a lead agency, and member organizations.

33-10 §33.RQ source ↗

As a member of the Campaign for Action coalition, in which activity would the public health nurse participate?
  1. a.
    Developing community walking trails
  2. b.
    Working at the state level to attract diverse students to nursing
  3. c.
    Lobbying at the state level for Medicaid expansion
  4. d.
    Collaborating with the CDC to promote vaccine education

Answer

B. Working at the state level to attract diverse students to nursing
The Campaign for Action coalition brings together nurses, providers, consumers, educators, and businesses at the state level to implement strategies that support the Future of Nursing report, such as increasing diversity in the nursing profession.

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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.