Chapter 9: Working With the Community

Question 1

1. When involving the community–client as partner, during which phase does data collection
   take place to determine the community’s health and structure?
   a. Assessment phase
   b. Planning phase
   c. Implementation phase
   d. Evaluation phase

Answer 1

ANS: A
The community health assessment phase involves a logical, systematic approach to the initial
phase of the community health nursing process. Community health assessment helps to (1)
identify community strengths, resources, assets, capacities, and opportunities; (2) clarify
health concerns; (3) identify community constraints; (4) identify the economic, political, and
social factors affecting the community; and (5) identify the determinants of health affecting
community health.

Question 2

2. During which phase would the CHN determine the ability of specific interventions to achieve
   an increase to at least 90% in the proportion of all pregnant women who receive first-trimester
   prenatal care?
   a. Assessment phase
   b. Planning phase
   c. Implementation phase
   d. Evaluation phase

Answer 2

ANS: D
The measurement of outcomes is part of the evaluation process.

Question 3

3. Which objective is most appropriate for developing a community health nursing process?
   a. All monitored clients will receive abortion therapy within 3 minutes following
   recognition of lethal dysrhythmia.
   b. Of mothers receiving nutrition counselling, 80% will identify five sources of
   calcium by the end of class.
   c. Ninety-five percent of children will be immunized by the age of 1 year.
   d. There will be a 25% reduction in health disparities by 2015.

Answer 3

ANS: B
Objectives must be precise, measurable, and stated in terms of behaviour. Receiving abortion
therapy involves treatment in an acute care setting and would not be part of a community
health nursing process. The immunization option does not precisely state which children (in a
district? countrywide?) and which immunizations (since some immunizations are not
appropriate to give to children who are only 1 year old). Stating that there will be a 25%
reduction in health disparities by the year 2015 is a goal, not an objective.

Question 4

4. Which measure of community health will be examined by the CHN who wishes to assess the
   status of a community’s health?
   a. Community awareness
   b. Health facilities
   c. Health care manpower
   d. Vital statistics

Answer 4

ANS: D
Vital statistics (live births, neonatal deaths, infant deaths, maternal deaths) are measures of
community health status. Health care manpower (e.g., CHNs, physicians) and health facilities
(e.g., hospitals, clinics) are measures of community health structure. Community awareness is
a measure of process.

Question 5

5. Which measure of community health will be examined by the CHN who wishes to assess the
   process of community health?
   a. Health resource use patterns, such as bed occupancy days and client/provider visits
   b. Health risk profiles of selected aggregates
   c. Incidence and prevalence of leading causes of mortality and morbidity
   d. Participation of individual and group health care providers in local organizations

Answer 5

ANS: D
Community health assessment is the process of thinking critically about the community and
involves getting to know and understand the community client as partner. This helps the CHN
to understand the individual, family, and group health concerns and to know what community
strengths and resources are available for the CHN to work as a partner with the client to
address the client’s concerns.

Question 6

6. What is the best resource for the CHN who wants information about the leading causes of
   morbidity and mortality in a local region of the country?
   a. Hospital records and statistics
   b. Online information from Statistics Canada
   c. The local chamber of commerce
   d. The obituary columns of local newspapers

Answer 6

ANS: B
Morbidity and mortality information for all regions in Canada is available through the
Statistics Canada Web site.

Question 7

7. What CHN activity demonstrates the role of a change partner?
   a. Administers vaccinations to preschoolers
   b. Analyzes community problems to determine the best interventions
   c. Establishes a care centre for older adults living with family members who work in
   jobs outside the home
   d. Teaches anger management skills to a group of teens in a halfway house

Answer 7

ANS: D
Content-focused roles often are considered change-agent roles, whereas process roles are
called change-partner roles. Change-agent roles emphasize gathering and analyzing facts and
implementing programs, whereas change-partner roles include being an enabler–catalyst, a
teacher of problem-solving skills, or being an activist–advocate. The CHN who establishes a
care centre for older adults living with family members who work outside of the home is
acting as a change agent. The CHN who administers vaccinations or analyzes community
problems to help develop interventions is carrying out other nursing roles.

Question 8

8. The CHN identified that a knowledge deficit is the primary reason why new mothers in a
   region choose not to breastfeed and wants to determine the best strategy to implement an
   intervention. What should this intervention emphasize?
   a. Alternate dimension
   b. Process dimension
   c. Status dimension
   d. Structural dimension

Answer 8

ANS: B
When the emphasis is on process dimension, the best strategy is usually health promotion,
also a primary prevention strategy. For example, if education is lacking in a community, the
most effective strategy may be to initiate discussion and help community members develop
education programs

Question 9

9. When assessing immigrant access to regional health care, which data collection method would
   best provide key information about the community?
   a. Interviews with employees of the local health board
   b. Informant interviews with local community members
   c. Interview with a legislator or local politician
   d. Interview with a public health official

Answer 9

ANS: B
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 information providers is a critical part of the community assessment. Key
information providers are not always people with a formal title or position but may often be
people who have an informal role within the community, for example, a member of a minority
group who is influential among other members of the group, a spiritual leader, or a parent who
is active and vocal about the school health curriculum.