A community health nurse has just been newly assigned to a small rural community. Which of the following are some steps that the nurse can take to address the community's needs? (Select All that Apply.)

Choice A Reason:
Considering the individual characteristics first focuses on personal attributes such as age, gender, genetics, and personal health behaviors. While these factors are important, the ecological model emphasizes the broader context in which individuals live. Starting with individual characteristics may overlook the larger environmental and social influences that significantly impact health outcomes.

Choice B Reason:
Close social circles, including family, friends, and immediate social networks, play a crucial role in shaping health behaviors and providing support. These relationships can influence lifestyle choices, stress levels, and access to resources. However, focusing on close social circles first may not capture the broader environmental and societal factors that also affect health.

Choice C Reason:
Social and cultural factors encompass the norms, values, and practices of the community. These factors influence health behaviors, access to healthcare, and overall well-being. While social and cultural factors are vital, they are part of a larger context that includes the physical environment. Addressing these factors without considering the environment may provide an incomplete picture of the community's health.

Choice D Reason:
The environment includes the physical, social, and economic conditions in which people live. This encompasses factors such as housing quality, access to green spaces, pollution levels, and availability of healthcare services. The environment sets the stage for individual and community health by influencing exposure to risks and access to resources. Starting with the environment provides a comprehensive understanding of the context in which individuals and communities operate, making it the most appropriate starting point for an ecological assessment.

Choice A: Implementing the Teach Back Method When Prescribing Medication
The Teach Back Method is an effective communication strategy where healthcare providers ask clients to repeat back the information given to ensure understanding. While this method can improve medication adherence and health literacy, it does not directly address the broader systemic issues related to poverty. It is a useful tool but not the most impactful intervention for breaking the cycle of poverty.

Choice B: Replacing Medicare Programs with Medigap Policies
Medigap policies are supplemental insurance plans that cover costs not included in traditional Medicare. However, replacing Medicare programs with Medigap policies would not necessarily improve outcomes for clients impacted by poverty. Medigap policies can be expensive and may not be affordable for low-income individuals. This intervention does not address the root causes of poverty or improve access to essential health services.

Choice C: Eliminating the Use of Client Portals or Virtual Visits
Eliminating client portals or virtual visits would likely have a negative impact on client outcomes, especially for those in poverty who may have limited access to transportation. Virtual visits and client portals provide convenient access to healthcare services, allowing clients to communicate with providers, access medical records, and receive care without the need for in-person visits. Removing these options would reduce access to care for many individuals.

Choice D: Opening a Community Health Center in an Underserved Area
This is the correct choice. Opening a community health center in an underserved area directly addresses the lack of access to healthcare services, which is a significant barrier for individuals living in poverty. Community health centers provide comprehensive primary care, preventive services, and support for managing chronic conditions. They often offer sliding scale fees based on income, making healthcare more affordable and accessible for low-income populations. By improving access to healthcare, community health centers can help break the cycle of poverty and improve overall health outcomes.