A nurse is teaching a client who has a child with pertussis. Which of the following information should the nurse include?

Choice A reason: The best first step for a community health nurse is to connect directly with the people who are most affected by the issue. Meeting with community members allows the nurse to assess their concerns, gather information on how the playground is currently used, and explore what resources and willingness the residents have to participate in solutions. This approach promotes community engagement, empowerment, and ownership of the issue, which are critical to ensuring that any interventions are both sustainable and culturally appropriate. Without this initial dialogue, actions taken may not address the true barriers or may fail to gain community support.

Choice B reason: Partnering with city officials and community members to improve the playground condition is not the first action that the nurse should take. This is a tertiary intervention that can help to restore the playground to its optimal state, but it does not address the immediate issue of the garbage accumulation.

Choice C reason: Working with local businesses to sponsor more trash receptacles in the playground is not the first action that the nurse should take. This is a secondary intervention that can help to prevent the recurrence of the problem, but it does not address the immediate issue of the garbage accumulation.

Choice D reason: Engaging families to monitor trash buildup in the playground focuses on surveillance and maintenance, but this step requires prior discussion and buy-in from the community. Asking families to monitor the site without first understanding their concerns, availability, and willingness could lead to resistance or lack of participation. This is a useful strategy after community dialogue has occurred but not as the first step.

Choice A reason: A fee-for-service health care insurance program is not a payment structure of a health maintenance organization. In a fee-for-service program, the client pays a premium to the insurer, and the insurer pays the provider for each service rendered, regardless of the outcome or quality of care.

Choice B reason: A fixed sum payment for the client on a monthly or yearly basis is a payment structure of a health maintenance organization. In this structure, the provider receives a set amount of money per client per period of time, regardless of the number or type of services provided. This encourages the provider to deliver preventive and primary care, and to avoid unnecessary or costly procedures.

Choice C reason: A percentage of the total costs for each service rendered by the provider is not a payment structure of a health maintenance organization. This is a type of cost-sharing arrangement, where the client pays a portion of the expenses and the insurer pays the rest. This may result in higher out-of-pocket costs for the client and higher utilization of services by the provider.

Choice D reason: A predetermined percentage of the cost of services is not a payment structure of a health maintenance organization. This is a type of discounted fee-for-service arrangement, where the provider agrees to accept a lower fee than the usual charge for each service. This may reduce the costs for the insurer, but not necessarily for the client or the provider.