NR503 Midterm Exam Study Guide Chamberlain College of Nursing

Week 1

1. How do social justice and health inequities influence population healthcare provision? Why is this critical information for the provision of evidence-based care?
   • Answer:
     • Social justice is known to improve overall population healthcare provision, while health inequity delays the achievement of universal healthcare provision.
     • The number of health disparities, particularly among people of color, is increasing daily. Therefore, the healthcare system must ensure that these populations are enlightened about evidence-based practice (EBP) to achieve overall EBP-based healthcare.
2. Are you able to both define and apply key terms, such as:
   • Answer:
     • Vital statistics: Population statistics, such as the number of births, deaths, or marriages that occur.
     • Morbidity: Illness.
     • Mortality: Deaths.
     • Cases:
       • Incidence: New cases.
       • Prevalence: Current cases.
     • Social justice: Distribution of wealth, opportunities, and privileges within society.
     • Epidemiology: The study of widespread diseases.
     • Population health: Risk factors, data, demographics, outcomes.
     • Incidence: New cases.
     • Prevalence: Current cases.
     • Outcomes: End results.
     • Inter-professional collaboration: When multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care.
     • HP2020: Identifying individual and population risk factors and health indicators that can be impacted through the three levels of prevention.
     • Determinants of health: The social and economic environment, the physical environment, and the person’s individual characteristics and behaviors.
     • Risk analysis: The process of identifying and analyzing potential issues that could negatively impact key business initiatives or critical projects, helping organizations avoid or mitigate those risks.
3. What is the Campaign for Action?
   • Answer:
     • Launched in November 2010 following the release of the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” to implement solutions to the challenges facing the nursing profession and build upon nurse-based approaches to improving quality and transforming healthcare.
4. Explain the differences between primary, secondary, and tertiary interventions.
   • Answer:
     • Primary prevention: Preventing disease before it occurs. Typically, this occurs through applying epidemiological concepts and databases to assess risk factors and target populations with the greatest impact on outcomes, warding off impending disease or unhealthy outcomes.
     • Secondary prevention: Screening and diagnosis of disease. This is one of the most cost-effective strategies to improve current health status and prevent chronic, debilitating disease states by screening individuals and populations.
     • Tertiary prevention: Interventions aimed at facilitating the rehabilitation of the patient to the highest level of functioning while addressing risk factors that could further deteriorate the patient’s health.

Week 2

1. Is screening a tertiary intervention? If yes, why? If not, what is it?
   • Answer:
     • No, screening is a secondary intervention. Tertiary prevention focuses on people already affected by a disease. The goal is to improve quality of life by reducing disability, limiting or delaying complications, and restoring function.
2. How does a provider determine the usefulness and appropriateness of a screening test? Where would an NP look to find a screening test? What determines if a screening test should be used?
   • Answer:
     • Determining whether a screening test is appropriate requires the APRN to address several aspects of the disease of interest. The target population needs to be identifiable, with sufficient numbers to make the study cost-effective. The preclinical period should allow treatment before symptoms appear so that early diagnosis and treatment can positively impact outcomes.
3. Can you explain what “descriptive epidemiology” means? What is its purpose? How is it used?
   • Answer:
     • Descriptive epidemiology is the study of the distribution (frequency, pattern) of health-related states or events in particular populations. It can develop theories about potential disease etiologies, plan and review public health treatments, and monitor population health. Although effective, it has drawbacks, such as the inability to prove a link between exposure and illness, and biases like recall bias and selection bias.
4. How are causation and descriptive epidemiology related, and how do they work together to aid evidence-based care?
   • Answer:
     • Descriptive epidemiology is the first step in any epidemiological investigation or health problem analysis from a research perspective. It begins with defining the differences, similarities, and correlations of key areas of any health problem. This information is gathered through active surveillance, where each person’s data is entered into a database, potentially changing the disease’s natural history.
5. What does “causation” mean? Can you relate causation to primary, secondary, and tertiary interventions?
   • Answer:
     • Causation: An increase in a causal factor or exposure leads to an increase in the outcome of interest (disease).
       1. Primary intervention: The yearly use of flu vaccines to prevent illness.
       2. Secondary intervention: Testing for the influenza virus in a patient.
       3. Tertiary intervention: Administering Tamiflu to a flu-positive patient, knowing that the influenza virus causes the flu, and taking appropriate actions.

Week 3

1. What is a case-control study, and how does it differ (or how is it the same) from a cohort study design?
   • Answer:
     • Cohort study design: Identifies people exposed to a particular factor and a comparison group not exposed to that factor, measuring and comparing the incidence of disease in the two groups. A higher disease incidence in the exposed group suggests an association between that factor and the disease outcome. This design is ideal for an outbreak in a small, well-defined source population.
     • Case-control design: Uses a different sampling strategy, where investigators identify individuals who have developed the disease (cases) and compare them to individuals without the disease (controls). The cases and controls are compared regarding the frequency of one or more past exposures. If cases have substantially higher odds of exposure to a particular factor than controls, it suggests an association. This strategy is better suited for large, ill-defined populations, particularly when the disease outcome is uncommon.
2. Can you discuss the ways bias shows up in a study design (e.g., selection bias)?
3. What is different in a randomized control trial compared to a case-control study (or a cohort study)? What does it mean to show a causal relationship?
4. What is each type of study used for, its purpose, and its outcomes? How are the outcomes different in each study design? How are they measured?
5. What is an intervention group? Where is it found?
6. Can you explain a retrospective versus a prospective study design? What are the pros and cons of each? How are groups selected for each of the study designs?
7. What is meant by “scientific misconduct”?
8. Differentiate random error, systematic error, and confounding error.

Week 4

1. What is the highest level of data findings? How is evidence appraised?
2. Can you describe the various levels of studies and how they are rated in terms of their use for integration into practice?
3. What factors determine the quality of care?
4. How is a website’s credibility determined?
5. What are key indicators when assessing a model of care?
6. How would you explain the Triple Aim initiative (model) to a colleague?