Question 1

When working with the community to develop effective plans to meet the needs of people with disabilities, the community health nurse reviews the statistics involving individuals with disabilities. The nurse incorporates which statistic as reflecting the number of persons with ongoing disability?

Accepted Answer

Currently, over 61 million persons report living with some sort of disability in the United States, or approximately 26% of the population. The other statistics of 10 million, 27 million, and 150 million are inaccurate.

Question 2

A community health nurse is conducting a program for a group of community leaders who are working to improve the health of persons with disabilities. When explaining the concept of disability to this group, which description would be most appropriate for the community health nurse to include?

Accepted Answer

Long-held negative views of disabilities have been replaced with new and more positive approaches that view individuals and their challenges from a more holistic standpoint. The emphasis is on "functioning" and takes into account body functions and structures, activities and participation, environmental factors, and personal factors. Thus, a disability is something that a person has, not something one is. No two persons with the same disease or disability are the same nor do they have the same level of functioning. Even persons who have the same disability would have quite different care plans. Earlier terminology equated disability with an inability or incapacity or handicap that presents a more negative view of the condition.

Question 3

A community health nurse is working in the community with the population of individuals experiencing disabilities. The nurse is developing programs to foster the achievement of the Healthy People 2020 goals for this population. On which area would the nurse focus?

Accepted Answer

In Healthy People 2020, the section "Disability and Health," further strengthens Healthy People's approach to disability to emphasize the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illnesses. Rather than narrowly defining individuals with disabilities and/or chronic illnesses through their limiting conditions, Healthy People 2020 developers understand that individuals with disabilities and/or chronic illnesses have the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole. The focus is on improving the conditions of daily life and removing barriers, and subsequently, maintaining an optimal state of health so that the highest quality of life can be maintained.

Question 4

A community health nurse is reading a journal article about Healthy People 2030 goals, the International Classification of Functioning, Disability, and Health, and the call for public action. Using this information as the basis for developing programs in the community, the nurse would most likely expect to focus activities on which areas? Select all that apply.

Accepted Answer

The three areas that Healthy People has identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health include improving the conditions of life for persons with disabilities; addressing the inequitable distribution of resources among people with disabilities and those without disabilities; and expanding the knowledge base and raising awareness about determinants of health for people with disabilities. The plan to ensure the health of people with disabilities by changing many social and physical factors is too broad. Public health activities need to focus only on preventing disability is a misconception.

Question 5

The community health nurse is invited to speak to a group of community leaders about individuals with disabilities. As part of the discussion, the nurse intends to describe the International Classification of Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. After the discussion, the nurse determines that the group has understood the information when they identify which terminology as being standardized? Select all that apply.

Accepted Answer

The ICF included definitions for body functions and structures, activities, and environmental and personal factors. Terms such as disability, impairment, and handicap have been removed from the definition and replaced with functioning, which is more holistic and positive.

Question 6

A community health nurse is working with a group of community health leaders from various locations to develop programs to address the leading health risks facing these areas. The group incorporates understanding of the global risks for health in the development. Which health risk would the group need to address as the priority?

Accepted Answer

The 10 leading health risks identified by the WHO are as follows: (1) air pollution and climate change, (2) noncommunicable diseases, (3) global influenza pandemic, (4) fragile and vulnerable settings, (5) antimicrobial resistance, (6) Ebola and other high-threat pathogens, (7) weak primary health care, (8) vaccine hesitancy, (9) dengue, and (10) HIV (WHO, 2019b). Across the globe, these 10 health risks affect low- and middle-income countries; low levels of socioeconomic status are correlated with poor health and lower quality of life (WHO, 2019B). For those with disabilities, individuals and their families "…are at increased risk for poor health and quality-of-life outcomes when their disability status affects their socioeconomic standing" (American Psychological Association, 2019, para 6).

Question 7

A community health nurse is conducting a presentation for a local community group on disabilities and includes information about Healthy People 2020 goals. When addressing these goals, the nurse identifies differences from the goals addressed by Healthy People 2010. The nurse determines that additional discussion is needed when the group identifies which concept as a critical difference?

Accepted Answer

A comparison among Healthy People plans over the last decades underscores the emergence of new approaches to identifying priority areas and planning to improve the health of individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was devoted to disability and chronic illness. Over the past two decades, interest in disability has accelerated. Areas that are focused on with Healthy People 2020 include the concepts that rather than individuals with disabilities and/or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole; the approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illness; and a growing realization that healthy life years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

Question 8

A community health nurse is compiling a list of organizations that serve the needs of persons with disabilities in an effort to assist local community centers to address this issue. Which agency would the nurse suggest the centers to contact as a federal agency?

Accepted Answer

The National Council on Disability is an independent federal agency. The National Organization on Disability, National Association of the Deaf, and American Foundation for the Blind are private organizations.

Question 9

A community health nurse is discussing the changes that have occurred in the national health goals over the years in relation to disabilities with a local government official in an effort to improve programs in this area. The nurse references the Healthy People 2010 goals in this discussion. Which concept would the nurse most likely cite as a major difference between Healthy People 2010 and Healthy People 2020?

Accepted Answer

The emphasis on "secondary conditions" in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. Key to addressing the barriers is for people with disabilities to "(1) be included in public health activities; (2) receive well-timed interventions and services; (3) interact with their environment without barriers; and (4) participate in everyday life activities. Without these opportunities, people with disabilities will continue to experience health disparities, compared to the general population."

Question 10

A community health nurse is reviewing the principles that resulted from the 2011 reassessment of global progress on addressing disability with a class. The nurse plans to include this information in a presentation to community leaders working to address policies and programs involving individuals with disabilities. Which information would be important for the nurse to emphasize?

Accepted Answer

In 2011, the WHO and the World Bank reassessed global progress on disability since the 2006 Convention on the Rights of Persons with Disabilities (UN, 2016). The convention provided guidance to governments globally, that it was their responsibility to improve the lives of individuals and families living with disability. Citizens of every country must and need to participate in their country's development. People living with disabilities must advocate for the removal of barriers that prevent their full participation in their communities, including access to health, education, employment, transportation, and information services. To assure full participation of people with disabilities in their communities, stakeholders in each country-and globally-must establish an inclusive world characterized by enabling environments, rehabilitation and support services, adequate social protection, and relevant policies, programs, standards, and legislation (WHO & World Bank, 2011).

Question 11

A community health nurse is integrating information from the World Health Report into plans for community programs for individuals with disabilities. Which concept would the nurse most likely emphasize?

Accepted Answer

The World Health Report (WHR) 2002: Reducing Risks, Promoting Healthy Life (WHO, 2002b) heightened the standard for addressing global health. The World Health Organization challenged the global community to increase the focus on unhealthy behaviors that can ultimately lead to chronic disease, disability, and early mortality. Although infectious diseases and malnutrition require continuing surveillance because of their ongoing impact on populations in many parts of the world, WHO has stressed that these are not the only threat. Lifestyle choices are also one of the key contributors to morbidity and mortality levels in both affluent and poor countries. In heightening the focus on unhealthy lifestyle choices, the 2002 report underscored a twofold purpose: to quantify the most important risks to health and to assess the cost-effectiveness of interventions designed to reduce those risks.

Question 12

A community health nurse notices that a client with a disability has not undergone breast cancer screening for quite a few years due to a lack of accessible equipment and personnel at the local clinic. The nurse works with the clinic to obtain appropriate equipment to facilitate screening as well as ensuring that adequate personnel are available to help with the screening. The nurse is assuming which role?

Accepted Answer

When working with the clinic to ensure adequate equipment and personnel to facilitate the screening, the nurse is acting in the role of advocate. The nurse would act in the researcher role by contacting other clinics to investigate if they were having similar issues. The researcher role may also be used again to collect data about screenings done in future years to evaluate the effect. The nurse would act as a coordinator by arranging transportation or the necessary services to get the individuals to the clinic for the screening. The nurse would act as the educator by providing information to the population about the importance of screening as well as getting the word out in the community about the program.

Question 13

A community health nurse is planning to apply the International Classification of Functioning, Disability, and Health to clinical care in the community. The nurse could use this document as a basis for which of the following?

Accepted Answer

In clinical care, the ICF document would be helpful with a needs assessment. Using the ICF document for curriculum design would reflect education, using it for quality of life measures would reflect research, and using it for policy design would reflect social policy.

Question 14

A community health nurse is working with a group of visually impaired individuals and is developing a program to promote equality and integration of the blind into society. Which organization would be a valuable resource for the nurse?

Accepted Answer

The National Federation of the Blind (NFB) works toward equality and integrating the blind into society. Founded in 1940, its objective is to remove legal, economic, and social discrimination. It also works to educate the public to new concepts concerning blindness and the highlight the achievement of blind people based on talents and capacities as they function to their fullest abilities. The American Foundation for the Blind advocates for the visually impaired through increased state and federal funding. The American Council of the Blind provides services such as information and referral, scholarship assistance, public education, and industry consultation, governmental monitoring, consultation, and advocacy. The Guide Dogs for the Blind makes guide dogs available for the visually impaired.

Question 15

A community health nurse is making a home visit to a family. The family has a son with a disability who requires a motorized wheelchair. The family asks for the nurse's assistance. Which response by the nurse would be most appropriate?

Accepted Answer

One major obstacle for families with a disabled or chronically ill member may be obtaining needed assistive devices and technology. Just because the technology exists does not mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets limits on which products can be obtained or which brands are acceptable. Thus, the nurse working with the family would need to check with the insurance company first and determine what if anything is covered and then determine how to go about obtaining what the son needs. The nurse can assist families to weigh and select among online options, especially for families with limited access or experience with the Internet. It is equally helpful for the nurse to intervene with insurance providers if coverage of equipment is not easily obtained or to seek sources of funding for the equipment from private agencies. Referring families to community groups or charitable organizations that provide specific assistance can be very helpful.

Question 16

A community health nurse is developing a plan of care for a family who is providing round-the-clock care in their home for a daughter who is chronically ill. Which area would be most important for the nurse to integrate into the plan?

Accepted Answer

Respite care is another area of great importance for families of the disabled and the chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot perform self-care. This often leads to caregiver fatigue and increased stress. It is also important to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled siblings of a disabled child. Respite care offers some needed relief to the family and allows for uninterrupted attention to the nondisabled children. Whatever the source, some type of respite care is often vital to the family's health and should be a priority in the overall treatment plan of the family. Although insurance considerations, teaching, and flexible visiting would be issues to be addressed, respite care is a priority.

Question 17

A community health nurse is working as part of a community health team tasked with developing programs to assist individuals with disability and chronic illness. Which component would be most important for the nurse to integrate into the programs?

Accepted Answer

The role of the community health nurse with respect to disabilities and chronic illness requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve results. The community health nurse addresses current needs and plans for the future, not just episodes that require care.

Question 18

A community health nurse is providing information handouts that describe the need for annual gynecologic examinations to local health clinics that provide care for individuals with disabilities. The nurse is fulfilling which role?

Accepted Answer

Providing information handouts is a method for teaching. Therefore, the nurse is assuming the role of an educator at the community level. In the advocate role, the nurse would assist in arranging for the population to receive the appropriate screening, ensuring that any special modifications or adaptations would be available. In the coordinator role, the nurse might arrange for screening to be performed during a routine visit made by a client to a facility or make arrangements for transporting the clients to a facility for the screening. In the researcher role, the nurse might contact other community health nurses about their experience in ensuring screening for this population to discover if they have similar needs or problems.

Question 19

A community health nurse is meeting with a group of various private businesses and organizations who provide employment in the community about the Americans with Disability Act. One of the members of the group asks, "So how many employees must I have to be bound by the legislation?" Which amount if stated by the nurse would be most accurate?

Accepted Answer

The ADA currently applies to all employers with 15 or more employees (including religious organizations) and all activities of state and local governments irrespective of their size.

Question 20

When reviewing the concept of universal design with a group of community developers, the community health nurse recognizes that the emphasis is on which component as the underlying theme?

Accepted Answer

The underlying theme of universal design is ensuring access. Universal design is the design of products and environments to be usable by all people, including those with disability needs as well as chronic illness. The concept incorporated issues of adaptive design and safety measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the key issue is accessibility.

Quiz 24: Clients With Disabilities