module 3 exam nu426

Public health nursing, by definition, consists of these key elements:

-A focus on the health needs of an entire population -Assessment of population health using a comprehensive, systematic approach -Attention to multiple determinants of health -An emphasis on primary prevention -Application of interventions at all levels -individuals, families, communities and the systems that impact their health.

cultural needs

-Are as important as physical and psychological needs. -Nurse should avoid imposing personal cultural values on the client -Provide care without stereotyping and ethnocentrism

why ethnocentrism is bad

-Can block effective communication by creating biases and misconceptions about human behavior. -Causes serious damage to interpersonal relationships and interferes with the effectiveness of nursing interventions

providing cultural care

-Consider the uniqueness of each client. -Be familiar with cultures represented in the local community. -it is essential to assess cultural beliefs and practices when developing a plan of care. Consider that there are variations within each culture.

Nurse's role in continuity of care

-Coordination of care with the inter-professional team -Acting as a liaison; be the advocate for client/family -Complete admission, transfer, discharge and post-discharge prescriptions -Initiate, revise and evaluate the plan of care -Report client's status -Coordinate discharge planning -Facilitate referrals and use of community resources

cultural assessment - social organization/norms

-Does the client's culture emphasize individuality or group action? If the emphasis is on the group, an individual might forego own health care needs for the sake of the good of the group. -Does the family make decisions as a whole or is one member of the family the primary decision-maker?

native americans health beliefs and practices

-Folk medicine -Traditional healers -Herbal remedies - health and dietary practices are closely tied to cultural and religious beliefs -Emphasize harmony in nature - earth is a living organism and should be respected; purification rituals to heal the body

african americans - health problems

-Higher mortality rate - life expectancy 75.1 years compared to 78.7 years among Whites -Risk factors include stress and discrimination, poverty, lack of education, high rates of teen pregnancy, inadequate housing, inadequate health care/insurance, limited presence of male role models -Higher rates of HTN/CV disease/stroke, cancer, diabetes, cirrhosis, infant mortality, homicide, accidents, malnutrition, and mortality from AIDS and TB -Lower rates of suicide and COPD

African Americans - population characteristics and culture

-Higher number of single-parent families, with mother in home -Disparities in income, social/legal climate, education, employment, and access to health care -Great diversity within the ethnic population -Major language is English, but may be a variation and have different vocabulary

Hispanic Americans health problems

-Leading causes of death are heart disease, cancer, unintentional injuries, stroke and diabetes -High rates of TB, HTN, obesity, asthma, COPD, suicide, liver disease -Issues related to young population with high birth rate -PTSD is major problem among refugees from Central and South America who have experienced war and physical and emotional torture

Arab & Muslim population characteristics and culture

-Many have college degrees, with professional employment, home ownership -Arabic is a common language -Islam is the fastest-growing global religion -Only 18% of Muslims live in Middle Eastern countries -Many Arabs are Christian -5 Tenets of Islam: Faith, Prayer, Almsgiving, Fasting, Pilgrimage -Practices of Islam vary greatly, with strict orthodox/radical ideas and more liberal -Various divisions of Islam exist -Gender separation with dress regulations for females (hajab)

The U.S. health care system has been guided on policies which focus on:

-Medical treatment -Fee-for-service financing -Employment-based insurance -Significant investment in medical technology and pharmaceuticals -Limited financial support for prevention and public health These options differ from what many peer countries select and, according to the IOM report, might be a factor in U.S. health disparities.

Arab&Muslim population health beliefs and practices

-Modesty is core value -Strict sexual taboos and social practices, with violators socially rejected or killed -Past-oriented. Stigma of lost honor can continue for generations. Sharaf (honor) is affected by drug addiction, mental illness, unwed pregnancy, unapproved marriage. -Individual achievement reflects on entire family -Some areas practice female circumcision, which can result in urinary or fecal fistulas. Male circumcision is customary. -Traditional medicine -A prayer is said into the infant's ear at birth. -Cleanliness is highly regarded and ritualistic, especially before prayers and after sexual intercourse -The left hand is used for cleaning genitals (toileting) and the right hand for eating

Arab&Muslim health problems/issues

-Most frequently lifestyle related, e.g. obesity, smoking, lack of physical exercise, use of smokeless tobacco -Major concerns are related to motor vehicle accidents, maternal-child health, TB, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infections -Pregnancy/delivery can be complicated by affects of female circumcision -Large, closely spaced families -Childbearing continues until menopause -Family planning may be considered against Islamic law but some accept contraception practices -Infanticide is not accepted. -Abortion may be permitted in some circumstances but generally is not accepted.

Policy making and community health advocacy

-Public health nurses must have an understanding of health policy to better understand the issues affecting the communities they serve. -Although nurses have different opinions on health policy, they must be actively involved in politics and policy-making.

other uses for technology

-Public service announcements for wide dissemination of health information -Maintenance of client clinical records -Documentation of services provided -Maintenance of financial records -Creation and management of organizational plans

advantages of EHR

-Reduces redundancy and errors. Data entered previously can be used again. -Optimizes work flow and supports decision-making -Fosters translation of knowledge to improve collaboration -Allows extraction of actionable knowledge to leverage analytics -Provides evidence to improve nursing practice

hispanic americans health beliefs and practices

-Religion is important, especially Catholicism, but may be blended with folk religion of native country/ethnic group -Magicoreligious practices -Illness may be punishment from God -Cope with illness through prayer and faith that God will heal -Traditional healers -Herbal medicines -Some illnesses are caused by supernatural forces and cannot be treated by Western medical practices -Use specific foods to treat certain illnesses (hot/cold) -Present-oriented, hence not as concerned about time schedules

african americans - health beliefs and practices

-Some retain ideas/practices of ancestors, e.g. health is sign of harmony with nature and illness is evidence of disharmony (evil spirits, God's punishment, or hex cause disharmony) -Beliefs in healers to treat body, mind and spirit, e.g. prayer and laying on of hands -Use folk medicine or home remedies -Higher degree of participation in religious activities, associated with less illness, positive mental health and substance abuse

disadvantages of EHR

-Sometimes adopted without adequate planning or training of personnel -Use of different EHR systems within the same agency -Different systems do not communicate with each other, prohibiting continuity of care and frustrating users

asian americans health beliefs and practices

-Stigma/shame associated with mental illness can lead to hiding symptoms, not seeking treatment -Ideas of illness and health are variations of hot/cold (not temperature), e.g. yin/yang -May view illness as God's punishment, result of a deviation from a moral standard, or visitation by evil spirit -Traditional healers -Alternative, self-care practices, e.g. acupuncture, cupping/coining, herbal medicine

CLAS

-The Office of Minority Health requires culturally and linguistically appropriate services (CLAS) -CLAS standards promote development of a healthcare workforce to respond effectively to needs of a diverse population. -standards include provision of language assistance and information to a client in their preferred language throughout the delivery of care. -they promote ongoing improvement and accountability for culturally appropriate care.

why cultural care is important

-The link between health beliefs and practices is greatly influenced by an individual's culture. -Congruency between culture and health care is essential to the well-being of the client.

acculturation

-The process of merging with or adopting the traits of a different culture. -Requires changes in daily living practices, related to language, education, work, recreation, social experiences and health care system

An individual who is health literate can....

-Understand and complete self-care instructions, including complex daily medical regimens -Plan and attain necessary lifestyle adjustments to improve their health -Make positive, informed health-related decisions -Know when and how to access necessary health care -Address health issues in their community and society by sharing health-promoting activities with others

culture

-design for living; it provides a set of norms and values that offer stability and security for members of a society. -Culture is the set of beliefs, values attitudes and behaviors shared by a group of people and transmitted from generation to generation.

client barriers to the referral process

-lack of motivation -inadequate information about community resources -inadequate understanding of the need for a referral -accessibility needs -priorities -finances -cultural factors

Hispanic American population characteristics and culture

-largest ethnic group in the U.S. -Lower education level, higher poverty level -Highest rate of uninsured -Value extended, cohesive family -Generally patriarchal, with males viewed as superior and females the family-bonding life force

asian amercians

-largest groups are from china and Philippines -Leading causes of death are cancer, heart disease and stroke -Lower rate of smoking -Health problems include malnutrition, TB, mental illness, cancer, respiratory infections, arthritis, parasitic infestations, chronic diseases of aging -Suicide and stress-related illness rates high

characteristics of culture

-learned from others -dynamic (it changes) -mostly tacit -shared -integrated systems of customs and traits

Native Americans

-poverty rate is twice the U.S. national average and unemployment is almost 3x the national rate -illness associated with poor living conditions (TB, malnutrition, high maternal and infant death rates) -in adults, rates of diabetes, TB, and obesity are higher -Deaths from TB, alcoholism, diabetes, unintentional injuries and suicide/homicide are higher -associated with alcoholism are domestic violence, child abuse/neglect, traffic injuries/death, homicide

policy competence means being able to:

1. Assess the impact of public policies on one's domain of interest or responsibility 2. Understand policy and the policy process sufficiently to be able impact policy 3. Exert influence on the policy-making process

steps in a referral process

1. Engaging in a working relationship with the client 2. Establishing criteria for the referral 3. Exploring resources 4. Accepting the client's decision to use a given resource 5. Making the referral 6. Evaluating the outcome

The Department of Health and Human Services developed the National Action Plan to Improve Health Literacy, based upon two principles:

1. Everyone has the right to health information that helps them make informed decisions. 2. Health services are delivered in ways that are understandable and beneficial to health, longevity and quality of life.

three trends in the strategic use of mHealth (mobile health):

1. Interactive - enables 2-way flow of information that engages patients more actively in their health management 2. Integrative - uses multiple self-management applications to share health information between patients and providers through text message, centralized web-based tracking and management programs and mobile monitoring 3. Multimedia - uses games and quizzes to communicate preventive messages and motivate behavior changes

cultural assessment

A cultural assessment provides information to the health care provider about the effect of culture on: -Communication -Space -Environmental control -Time orientation -Social organization/norms -Biological variations in health

public office

A nurse in public office serves society and advocates for change by influencing policy development through public service.

cultural brokering

Advocating, mediating, negotiating and intervening between the client's culture and health care culture on behalf of the client.

cultural preservation

Allowing preservation of the client's traditional values

meaning of vocabulary

An individual's interpretation of the meaning of words depends upon factors such as age, education, cultural background and primary spoken language. Community health nurses must learn to detect minute verbal and nonverbal cues that intended meaning has not been perceived correctly and gently question the veracity of the message sent and perceived. For example, words used by one age group may have different meanings for a different generation.

cultural repatterning

Assisting the client to modify cultural practices that are not beneficial to the client's health

Ethnocentrism

Bias that one's own culture is best and others are wrong or inferior

Nurses' role in health policy

Change agents Lobbyists Coalitions Public office

Muslim & Arab dietary restriction

Dietary restrictions (haram) include avoidance of pork, gelatin (marshmallows and other confections made with gelatin), animal shortening, alcohol (including vanilla extract), illegal drugs, some shellfish and animals with fangs. Permitted food must be lawful (halal), slaughtered during a ritual. Fasting occurs during 9th lunar month (Ramadan).

Cues that might signify a lack of effective communication

Efforts to change the subject: could indicate that the listener does not understand what was said and is attempting to talk about something more familiar. Absence of questions: often means that the listener is not grasping the message and, therefore, has difficulty formulating questions to ask. Inappropriate laughter, e.g. a self-conscious giggle, may indicate poor comprehension and signal an attempt to disguise embarrassment. Nonverbal cues: like a blank expression, may mean poor understanding. However, among some Asian Americans, it may reflect a desire to avoid overt expression of emotion. Avoidance of eye contact: may be a cultural expression of respect for the speaker among some Native Americans and Asian Americans.

language of nursing

Health care contains a unique vocabulary that lay persons may not understand. Nurses should refrain from using medical jargon, but seek to communicate in a style understood by the message receivers.

emotional influence

How a person feels at the time a message is sent or received influences the meaning. Senders can distort messages and receivers can interpret messages incorrectly when emotions cloud perception. Emotions can interfere with rational and objective reasoning. Nurses should be aware of their own emotions and ascertain the emotional status of clients of other healthcare professionals with whom they are communicating. For example, a family in crisis may communicate in anger and resort to confrontation because they feel powerless or overwhelmed.

cultural awareness

Includes self-awareness of one's own cultural background, biases and differences.

prescription/over-the-counter drugs

Like herbs, these products are not risk-free. Meds which used to require a prescription now may be OTC, which goes through a less rigorous testing/control process. Patients may not understand the effects of OTC meds with prescribed meds, leading to serious complications. Patients may think that OTC are less harmful and take more than is recommended. Some prescription meds are quite expensive and the PHN might work to find more affordable alternatives for patients.

filtering

Manipulation of information by the sender in order to make it seem more favorable to the receiver. Senders sometimes say what they believe receivers want to hear rather than the whole truth. Likewise, clients may give only partial or distorted information because they think it is what health professionals want to hear. Another way of filtering deals with how we view others through our filter of culture, ethnicity and socioeconomic class; this stereotyping often leads to misunderstanding.

selective perception

Persons receiving the message interpret it through their own perceptions, based upon their own experience, interests, values, motivations and expectations. Perception is projected onto the decoding and can lead to misinterpretation of the senders original intent. Nurses can prevent misunderstanding by asking clients to explain the message in their own words. Do not be satisfied with asking, "Do you understand?" and accept a nod in response.

cultural accommodation

Supporting and facilitating the client's use of cultural practices that are beneficial to the client's health

cultural assessment: environmental control

The belief in how the environment affects the individual. Clients who believe the environment can be mastered to affect health status will actively engage in health promotion, disease prevention and treatment. Clients who believe their outcome is predetermined (they cannot affect the outcome) may not be engaged in healthy behaviors. Clients who believe in harmony with the environment may use alternative medicine and spirituality to promote balance in health status.

communication

a fundamental to nursing. effective communication is a core competency needed in public health nursing. Communication is not just a cycle, it is two-way message, sending and receiving verbal and nonverbal cues simultaneously. Nurses should work on skills of sending and receiving messages, practice active listening, show respect and empathy, and develop trust and rapport.

minority

a group of people whose physical or cultural characteristics differ from the dominant culture or majority of people in a society

Subculture

a group of people, within a cultural group, who share characteristics that identify them as a distinct entity. Subcultures can be based upon ethnicity, age, gender, religion, occupation, geographical location, disability, sexual orientation.

change agents

advocate for needed change at the local, state, and federal level

discharge planning

an essential component of the continuum of care and is an ongoing assessment that anticipates the future needs of the client. The goal of discharge planning is to enhance the well-being of the client by establishing appropriate options for meeting the health care needs of the client.

health informatics

an interdisciplinary field of study that uses health information technology to improve the quality, efficiency, or delivery of health care

home remedies

are individualized caregiving practices also passed down within families. Even though people may routinely seek care of Western medical practitioners, they may try home remedies first.

Complementary therapies

are practices used in addition to Western, or biomedical interventions. Examples: specific diets for cancer, enemas, yoga, aromatherapy, music therapy, acupuncture, acupressure. These are becoming so popular that some states are developing policies and guidelines for their use.

nursing process

assessment, diagnosis, planning, implementation, evaluation

race

biologically designated groups of people whose distinguishing features, such as skin color, are inherited.

Seventh Day Adventists

birth practices: Abortion is acceptable in some circumstances. Infant baptism is opposed. death practices: An autopsy is acceptable. Organ donation is acceptable dietary restrictions: Vegetarian diet is encouraged. Alcohol, caffeinated beverages and fermented beverages are prohibited. Pork and certain seafood, including shellfish are prohibited. health practices: Healing is accomplished through medical intervention and divine healing. Prayer and anointing with oil may be performed.

Judaism: birth, death, and health practices and dietary restrictions

birth practices: Abortion is permitted. Ritual circumcision of males is performed on 8th day of life. Orthodox Jewish males are not allowed in the delivery room. death practices: Autopsies are discouraged. Organ donation is permitted. Someone stays with body at all times. Ritual bathing and burial occur within 24 hours. Cremation is prohibited. dietary restrictions: Food is required to be kosher. Milk and meat cannot be served at the same meal or prepared on the same dishes. Pork, predatory fowl and shellfish are avoided. Fasting is required on Yom Kippur. Lactose intolerance is common among Jews of European origin. health practices: Saving a life overrides nearly all religious obligations. Prayers of well-being of the sick may be said. Anything that can be done to ease the client's suffering is encouraged. During the Sabbath, Orthodox Jews refrain from using electrical appliances.

christian science: birth, death, and health practices and dietary restrictions

birth practices: Abortion is prohibited. May opt for home delivery of infants. death practices: Unlikely to seek medical help to prolong life. Organ donation is discouraged. dietary restrictions: must abstain from alcohol health practices: Medications and blood products avoided. Healing ministers practice spiritual healing and do not use medical/psychological techniques

Catholicism: birth, death, and health practices and dietary restrictions

birth practices: Baptism is required. Contraception, abortion and sterilization are prohibited. death practices: Priest administers last rites. Organ donation is acceptable. Suicide may prevent burial in a Catholic cemetery. dietary restrictions: May abstain from meat on Ash Wednesday and on Fridays during Lent. health practices: May want visit by a priest when hospitalized. May request communion and confession to aid in healing. May wear a cross or medal or want to display religious statues.

Buddhism: birth, death, and health practices and dietary restrictions

birth practices: Beliefs include reincarnation. Contraception to prevent conception is acceptable. death practices: Ensure calm, peaceful environment. Chanting is common. Monk delivers last rites. Organ donation is encouraged. Cremation is common. dietary restrictions: Many practice vegetarian diet. Alcohol is avoided. health practices: May refuse care on holy days. Needs a quiet environment to practice meditation and prayer.

Hinduism

birth practices: Contraception is acceptable. Abortion may be prohibited. Males are not circumcised. Child is named on the 10th day of life. death practices: Beliefs include reincarnation. Natural death is preferred traditionally. Client may want to lie on floor while dying. A thread is placed around neck or wrist when dying. Organ donation is acceptable. Cremation preferred dietary restrictions: Vegetarian diet is encouraged. Must abstain from beef and pork and products made from animal fat. Right hand is used for eating and left hand for toileting and hygiene. Several days a year are set aside for fasting. health practices: personal hygiene is important

Mormons

birth practices: Contraception is at the discretion of the man and woman. Abortion is opposed except in certain maternal circumstances. Infants are not baptized. death practices: Organ donation is permitted. An autopsy is permitted. Believe that life continues beyond death. dietary restrictions: Alcohol and beverages containing caffeine stimulants are prohibited. Fasting is required once a month health practices: May want to use herbal remedies in addition to medical care. When blessing the sick a person is anointed with oil by two elders.

ethnic group

collection of people who have common origins and a shared culture and identity; they may share a common geographic origin, race, language, religion, traditions, values, and food preferences

folk medicine

consists of home remedy treatment practices usually handed down verbally through generations and is the first-line treatment preferred by many individuals who may never intend to seek Western medical providers. -examples: pregnant women eating handfuls of clay, dirt or cornstarch, taping coin on newborn's umbilicus to prevent hernia, holding a baby upside down to "wake up the liver", pregnant woman not reaching over her head so that the umbilical cord won't strangle the fetus.

culturally competent care is guided by four dimensions...

cultural preservation, cultural accommodation, cultural re-patterning, and cultural brokering

coalitions

facilitate the achievement of goals through the collaboration of two or more groups

biomedical view about illness

focuses on identifying a cause for every effect on the body; that the body functions like a machine. The is the basis for the U.S. health system and is science-based.

___________ is an important step in the referral process

follow up; the nurse should: -monitor for completion of the referral -assess whether referral outcomes were met -determine if the client was satisfied with the referral

herbalism

is quite popular. It is based upon cultural knowledge passed down in a family and may also gain information from published resources. Herbal medicines are not regulated and are not risk free. Quality control of production is not guaranteed. Community health nurses would benefit from at-hand information with pictures, indications/uses and contraindications of various herbal remedies. Some herbs are emphatically contraindicated with certain medicines.

magico-religious view about illness

links health to supernatural forces, or good and evil. This view includes belief in faith healing used by some Christian religions. It also would include witchcraft or voodoo practices used in Caribbean culture.

advantages of mobile health

management of chronic disease, empowering the elderly and expectant mothers, reminding people to take medications, serving underserved areas, improving the efficiency of medical systems and ultimately, better health outcomes.

cultural diversity (cultural plurality)

means that a variety of cultural patterns coexist within a designated geographic area.

lobbyists

persuade or influence legislators. Individuals or professional nursing associations can participate in the lobbying process.

telecommunication technologies transmit physical, audio, and visual data:

physical data: blood pressure, weight, oxygenation saturation, blood glucose, heart rate, temperature, ECG results audio data: voice conversation, heart sounds, lung sounds, bowel sounds visual data: images of wounds and surgical incisions

continuity of care: case management

promoting: Promoting interprofessional services and increased client/family involvement decreasing: Decreasing cost by improving client outcomes providing: Providing education to optimize health participation reducing: reducing gaps and errors in care applying: applying evidence-based protocols and pathways advocating: advocating for quality services and client rights

case management nursing

provides client care coordination with the interprofessional team. Case management is a collaborative process to provide quality and continuity of care by minimizing fragmentation and high cost. The case manager is an advocate for the client and the client's family.

big data

refers to a large, complex data set that can be analyzed to reveal patterns, trends, and associations related to human behavior and interactions. "big" suggests the use of new statistical tools and the need for massive and/or multiple computers to process the data. -Big data can be "drilled down" (view detailed information), "drilled up" (see data in an aggregate view) or it can be "sliced and diced" (combining different data variables) -EHRs are not the sole source of big data. Computers. smart phones, wearable sensors, and imaging devices also supply information to databases.

mobile heath

refers to the use of mobile technology to improve health and health care

holistic/naturalistic view about illness

relates the individual as a part of nature or creation. An imbalance in nature is believed to cause disease. This is the basis of Eastern or Chinese medicine. Other cultures, e.g. Mexican culture, follow the hot-cold theory of balance in relation to health and illness that accompanies this belief framework.

barriers to effective communication

selective perception, filtering, emotional influence, meaning of vocabulary, language of nursing

characteristics of successful partnerships

shared power, shared goals, integrity, flexibility, negotiation, boundaries

informatics

the combination of nursing science with information and communication technologies in the delivery of nursing care

important feature of big data

the re-usability of data and for multiple purposes

health literacy

the skills, knowledge, motivation and capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care and take appropriate action. -involves tasks as basic as following prescribed medicine regimen to comprehension of complex health insurance policies. -Health literacy is critical to health promotion and disease prevention. It goes beyond basic definitions of literacy and may include cultural literacy and computer literacy, scientific, media and technological literacy.

resource barriers to the referral process

• Attitudes of health care personnel • Costs of services • Physical accessibility of resources • Time limitations • Limited expertise working with culturally diverse populations