| Course | NU 655 Foundations of Public Health Nursing |
|---|---|
| Unit | Unit 4 |
| Paper type | Prevention level classification |
| Length | About 800 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Public Health Nursing |
| Updated | October 2026 |
Free sample paper for NU 655 Unit 4
Pertussis in Infants in a Rural County: Classifying Nine Public Health Activities by Level of Prevention, and Why Two of Them Change Level
Student Name
Department of Nursing, Herzing University
NU 655: Foundations of Public Health Nursing
Instructor Name
February 12, 2026
Pertussis in Infants in a Rural County: Classifying Nine Public Health Activities by Level of Prevention, and Why Two of Them Change Level
The Reference Condition
The condition is pertussis, whooping cough, in infants in a composite rural county, particularly infants under 6 months, who have not yet received all three infant doses and in whom pertussis is most likely to cause hospitalization, apnea, and death. The county has about 450 births a year. The activities below are those the county health department and its partners actually carry out, and each is classified by definition: primary prevention acts before infection or disease occurs; secondary prevention finds disease at an early stage, in people already affected, to shorten or soften its course; tertiary prevention reduces complications and disability in people with established disease (Leavell & Clark, 1965).
The Activities, Sorted
The table lists each activity as it is delivered in the county, with its level for the reference condition, infant pertussis.
| Activity as delivered | Level for infant pertussis | Reason |
|---|---|---|
| Tdap vaccine offered to every pregnant patient at 27 to 36 weeks, at the prenatal clinic and health department | Primary | Maternal antibodies cross the placenta and protect the infant before any infection |
| Tdap for household members and caregivers of newborns, offered at the WIC office | Primary | Reduces the chance that an adult brings infection home |
| DTaP series for infants at 2, 4, and 6 months | Primary | Builds the infant's own immunity before exposure |
| Registry-based reminder calls when an infant is late for a DTaP dose | Primary | Its purpose is to get the vaccine given; it acts before disease |
| Public health nurse education of new parents on early pertussis symptoms | Secondary | Aims at earlier recognition of disease that is already present |
| Testing an infant with apnea or a paroxysmal cough at the clinic | Secondary | Detects disease early so treatment and isolation start sooner |
| Antibiotic treatment of an infant diagnosed with pertussis | Secondary for that infant | Early treatment can shorten the course; also prevents spread, discussed below |
| Hospital care for an infant with severe pertussis, including respiratory support | Tertiary | Limits complications of established disease |
| Follow-up of an infant who had severe pertussis for developmental effects | Tertiary | Reduces disability after disease |
Why Maternal Vaccination Is Primary for the Infant
Tdap in pregnancy is given to the mother but aimed at the infant. The mother's antibodies cross the placenta and give the newborn protection during the first months, before the infant's own vaccines take effect. An evaluation of the U.S. maternal Tdap program found that vaccination during pregnancy was highly effective in preventing pertussis in infants under 2 months (Skoff et al., 2017), and national recommendations call for Tdap during every pregnancy (Liang et al., 2018). The activity is primary prevention for the infant's disease even though the infant never receives an injection.
Where the Level Changes With the Reference Condition
Two activities in the table change level if the reference condition changes, which is the reason the condition had to be fixed first.
First, antibiotic treatment of a diagnosed infant is secondary prevention for that infant's pertussis. But treating a case, and giving preventive antibiotics to the infant's household contacts, also prevents infection in the siblings, parents, and other infants those contacts would otherwise expose. For the contacts, the same public health response is primary prevention. The health department's case investigation, which identifies household contacts and arranges prophylaxis, is therefore primary prevention for the contacts and part of the secondary response for the index case.
Second, the registry reminder call is primary prevention when the reference condition is infant pertussis, because it gets vaccine into the infant before any infection. If the reference condition were instead under-vaccination itself, which the county also tracks as a problem in its own right, the same call would be secondary prevention: it finds a child who has already fallen behind and acts early, before the gap grows into several missed doses. Nothing about the call changes; only the outcome it is measured against. A nurse presenting these activities to the board of health must therefore state the reference condition at the start, or the same program will be described at different levels in different reports.
A Common Misclassification
Education of new parents about symptoms is sometimes called primary prevention because it happens before a child is sick. By definition, it is secondary: its aim is to have parents recognize disease that has begun and seek care early. Education about vaccination for parents and household members, in contrast, is primary, because its aim is vaccination. The same educational encounter can serve both purposes, and the classification follows the purpose.
How the Activities Were Collected
The list was built from what the county actually does, not from a textbook list of possible interventions. I reviewed the health department's program descriptions and the last year of clinic logs, asked the prenatal clinic and both family medicine clinics what they do for pertussis prevention, and sat in on one WIC session. Two activities that appear in guidance were left off because they do not happen here: a hospital-based program offering Tdap to parents at delivery, since the county has no birthing hospital, and pertussis surveillance in child care centers, which the department has not had staff to run. Listing only real activities keeps the classification honest about the county's effort, and the two omissions are themselves findings: both would be primary prevention, and both are gaps in the level that matters most for a vaccine-preventable disease in infants.
What the Classification Shows About the County's Effort
Most of the county's activity is primary prevention, which is appropriate for a vaccine-preventable disease. The weakest link, judging by the local data, is the reach of maternal Tdap: the county has no birthing hospital, and many pregnant residents receive prenatal care in the regional city, where the health department cannot see whether Tdap was given. A request to the regional obstetric practices for monthly Tdap rates for county residents would show whether the most effective primary intervention for young infants is reaching them.
References
Leavell, H. R., & Clark, E. G. (1965). Preventive medicine for the doctor in his community: An epidemiologic approach (3rd ed.). McGraw-Hill.
Liang, J. L., Tiwari, T., Moro, P., Messonnier, N. E., Reingold, A., Sawyer, M., & Clark, T. A. (2018). Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports, 67(2), 1-44.
Skoff, T. H., Blain, A. E., Watt, J., Scherzinger, K., McMahon, M., Zansky, S. M., Kudish, K., Cieslak, P. R., Lewis, M., Shang, N., & Martin, S. W. (2017). Impact of the US maternal tetanus, diphtheria, and acellular pertussis vaccination program on preventing pertussis in infants <2 months of age: A case-control evaluation. Clinical Infectious Diseases, 65(12), 1977-1983. https://doi.org/10.1093/cid/cix724
The Herzing NU 655 Unit 4 instructions
Unit 4 asks you to classify public health activities by level of prevention, primary, secondary and tertiary, for a specific condition. Expect to state the reference condition, list activities, assign each a level with reasons, explain activities that are hard to classify and draw conclusions about the balance of effort. Many versions ask whether one activity can occupy two levels. Check whether your section expects activities from a real health department. The reference condition matters, because the same activity can be primary for one condition and secondary for another. Leavell and Clark's original framework is the usual source. Building the list from what an agency actually does, rather than from a textbook, makes the classification useful for planning.
How the NU 655 Unit 4 example is put together
The classification opens by naming the reference condition and why it matters, the high risk to young infants. A table lists nine activities with level and a brief reason. Two sections explain cases that need more thought. Maternal vaccination is primary for the infant even though the mother receives it. Two activities change level depending on the reference condition, which the paper shows by switching the condition. A section corrects a common misclassification, explaining that symptom education aims at early detection and so is secondary. The method section describes how activities were gathered from county records. The final section looks at the balance of effort and notes that most activity is primary, which suits a vaccine-preventable disease.
Reading the NU 655 Unit 4 rubric
Herzing's rubric for a prevention classification usually covers the reference condition, the accuracy of classification, the reasoning for each level, discussion of ambiguous cases, conclusions about effort and writing. Accuracy and reasoning decide most of the grade: each activity needs the correct level and a sentence explaining why, tied to the reference condition. Reference condition points reward a clear, specific choice. Ambiguous case criteria look for activities that change level, explained carefully. Conclusion points go to observations about the balance of effort. A table helps presentation. Leavell and Clark's original text and the CDC pertussis vaccine recommendations by Liang and colleagues belong in the APA 7 list.
Common NU 655 Unit 4 mistakes, and how to avoid them
Classifications in Unit 4 usually lose points by assigning levels without naming a reference condition, which makes the levels meaningless. Another frequent error is calling education primary prevention whenever it happens before illness, even when its aim is early detection. Students often list textbook interventions rather than what an agency actually does. Screening is misclassified as primary. Activities that change level are ignored. Conclusions are missing, so the classification does not lead anywhere. Finally, explain each level in a sentence rather than marking it in a table alone, because graders need to see the reasoning, especially for maternal vaccination and contact treatment.
Get a NU 655 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 655 classroom, with the reference condition and the population already fixed. We write a custom example with the definitions attributed, placements defended one by one, the contested cases argued and one activity deliberately reclassified. First custom sample free, returned inside 24 to 48 hours.
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NU 655 Unit 4 questions, answered
How many activities should be sorted?
Enough that each level has company and the contested cases have somewhere to sit, which usually means a dozen or so. A list of three lets a writer avoid every hard placement. Where the instructions name a set, use it, and add one or two efforts from the population you are working with so the sorting is applied rather than rehearsed.
Is screening primary or secondary prevention?
It depends on what the screening looks for, which is exactly why this deliverable insists on a reference condition. Detecting disease already present in somebody without symptoms sits at the secondary level under most definitions, while a screening identifying risk before any disease exists is arguably doing something else. State the definition you are using and place the activity against it.
Can one activity occupy two levels?
It can serve two purposes, and the honest treatment is to say so and then show each purpose against its own reference condition rather than writing a single hedged placement. Programs are usually built to do more than one thing, and a classification pretending otherwise is tidier than the work it describes. Graders generally reward the writer who takes the complication head on.
Where can I find a free NU 655 Unit 4 sample paper?
The complete NU 655 Unit 4 pertussis classification is posted here free, nine activities sorted with reasons and the two that change level. A custom classification can sort activities for another condition your section names.
Is maternal Tdap vaccination primary prevention for infants?
Yes. It is given to the mother before the infant can be exposed, and her antibodies cross the placenta to protect the newborn. This sample classifies it as primary prevention for infant pertussis for that reason.