Chapter 21 Ethnicity and Culture & Chapter 23 Community Health, Public Health, and Home Health Care

Community

a group of people having a common interest or identity. It goes beyond physical environment and includes the physical, social, and symbolic characteristics that connect people within a group.

primary prevention

strategies include interventions designed to prevent disease or disability. Examples are immunization programs, employee wellness initiatives, fitness classes, and nutrition education to increase consumption of fresh fruits and vegetables in homes, schools, and community at large. preventative health care.

analytical epidemiology

generates a hypothesis as to why the disease might be occurring in the community and then tests the hypothesis. Would consider intrinsic or host factors like ethnic/cultural dietary and health practices and extrinsic factors or environmental factors like parks and grocery stores.

Tertiary prevention

involves interventions for those already experiencing symptoms of disease and disability. Focuses on maintenance or restoration of health, and rehabilitation. Tertiary interventions include client support groups, pain management counseling, and cardiac rehabilitation programs. For children already diagnosed with diabetes the school nurse may monitor their glucose & administer insulin injections.

Race

is a socially constructed concept that tends to group people by common descent, heredity, or physical characteristics.

Generalizations

is a statement, idea, or principle that has a broad application. Typically they draw or infer conclusions from many factors. They're a beginning point but one should gather information to ascertain whether a generalized statement is appropriately applied to an individual or group.

Edpidemiology

is the study of disease incidence and prevalence "pervasiveness or extent". Health care workers who specialize in epidemiology study factors that determine and influence the frequency and distribution of disease, injury, and other health related events and their causes in a defined human population. The purpose of their work is to establish programs to prevent the development of disease and control its spread.

Acculturation

mechanism of cultural change achieved through the exchange of cultural features resulting from firsthand contact between groups. One or both groups change after contact with each other but their groups stay intact. The contact brings cultural changes in language like pidgin, technologies, food, clothing, music, etc.

Early Intervention

program strategies introduced at the first detection of a possible health problem "secondary intervention". that involves clients, families, and caregivers that can change health outcomes for community members of all ages.

target population & population of interest

referring to groups or clients within a community young, elderly, homeless, inmates, or residents of particular cities or other geographic or government defined areas. This designation connotes that the plan of care focuses on more than one person and includes groups of people residing within a defined geographic area.

Gender identity

refers to a person's basic sense of being a man or boy, a woman or girl, or another gender like transgender, bigender, or genderqueer a rejection of the traditional binary classification of gender. Gender identity can be congruent or not congruent with one's assigned sex at birth based on genitalia "transgender".

Discrimination

refers to policies and practices that harm a group and its members. The principle of distributive justice (fair allocation of resources) along with the ethical principles of nonmaleficence and beneficence expects health care providers to provide safe, quality health care without discrimination.

Environmental factors or Extrinsic factors

relate to the immediate physical environment, the biologic environment including food sources and vectors of disease such as animals and insects, & socioeconomic influences, such as workplace conditions or residence in an urban versus rural setting, and the potential impact of social unrest or disaster on a community.

ambulatory care

settings in physician's office or outpatient clinic. Also this is a provision of skilled nursing care in community.

Family

the basic unit of society in all cultures. From economic perspective, a family is a social unit that works together to meet material needs. from a sociologic perspective a family is a social unit that interacts within a larger society. The basic unit of which personality is developed between parent and child. single-parent, blended, and extended families the nurse must understand the impact of how that will affect their patient care.

stereotypes

Set of fixed ideas, often unfavorable, about members of a group. The difference between a generalization and a stereotype lies not in the content but in the usage of the information. The stereotype says this person MUST be this way because their race. Where generalization says this person MAY be this way. Accepting stereotypes is to ignore individuality of people within a culture & ignore many other aspects about them like ethnicity, religion, education, gender, sex, socioeconomic level, sexual orientation, etc. Nurses unwillingness to obtain all this info through the patient assessment/interview & just accepting stereotypes can lead to poor quality care that is not holistic or patient centered.

Time orientation

Time orientation and punctuality vary from group to group and from place to place. It is important for the nurse to identify the time orientation of the patient as past, present, or future as it relates to how they view medical care and adapt to the patients time orientation.

Demographic Assessment tools and community health planning resources for public health nurses

WHO data and statistics United States Census State and local department of health websites CDC Healthy people 2020 OSHA Geocoding Public Health Surveillance.

Language and Linguistics

When nurse and patient speak a different primary language the use of abbreviations, acronyms, humor, slang, and jargon should be limited. speakl slow. Use a professional interpreter and not a family member to translate if needed to avoid mistranslation of medical terminology. Nurse must assess the patient's ability to read and write regardless of their native language.

Pidgin

A language that developed because of acculturation. Pidgin english is spoken at many parts of the world and is a mix of language. It's good for nurses to speak languages of the region like pidgin.

Ethnocentrism

the belief that one's own culture is superior to that of another while using one's own cultural values as the criteria by which to judge other cultures. Western medical practitioners might think their pharmaceuticals are better than non-western medicine practices although their roots came from eastern & native medicine practices. Nurses must also not think others way of thinking is "ignorant" or "inferior". Don't be closed minded non-members of your culture may have valid points.

Stakeholders

the individuals or groups that have an interest, stake, or claim in the actions and overall performance of a topic. For example the occupational health nurse in a large manufacturing plant identifies a risk for injury from inconsistent use of safety goggles by drill press operators, the owners of the company and the workers themselves are the stakeholders.

Ethnicity

the person's identification with or membership in a particular racial, national, or cultural group and observations of the group's customs, beliefs, and language.

Socialization

the process of being reared and nurtured within a culture acquiring its characteristics. Occurs on many different levels within families, communities, schools, and spiritual or religious groups. Usually occurs within the structure of a group that influences the health care behaviors and beliefs of its members and can indirectly affect the administration of health care by the nurse.

Culture

the totality of socially transmitted behavioral patterns, beliefs, values, customs, life ways, arts, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision making. Culture is learned, symbolic, shared, and integrated.

Transcultural Assessment Model

tool to get data from a patient with 6 cultural domains: 1) Communication: "What do you do to help others understand what you are trying to say?" 2)Space "When you talk to family how close do you stand?" 3)Social Orientation "What is your roll in the family unit?" 4)time "What is late to you?" 5)environmental control "Can visitors show up unannounced?" 6)biologic variation "What illnesses are common in your family?"

Racism

unfounded belief that race determines a person's character or ability and that one race is superior or inferior to another. Science doesn't support it but some people still think their race is better than all others. Race includes physical characteristics that are similar among members of the same group like skin color, hair and eye color. Although less than 1% genetic difference in race it can be significant enough when doing health assessments & prescribing medications.

Nutritional needs

Being a culturally competent nurse is being aware of the patient's nutritional preferences based on culture, religion, lifestyles, and economics. Ask the right questions. "Do you have access to the foods you need?" "what foods do you eat to be healthy?"

Symbols

Culture is based on symbols . Much of human behavior is mediated by symbols. Symbols are signs, sounds, clothing, tools, customs, beliefs, rituals, and other items that represent meaningful concepts. Language is the most important & extensive use of symbols in a culture because verbal symbols are used to communicate & share cultural beliefs/ideas. Non-verbal symbols are images, such as flags of countries, that represent shared ideas or beliefs.

OASIS Data Set

Home care assessment by nurses look into: -current/past medical history -vaccinations -living arrangements, safety & functionality "tub, carpeting, stairs, etc." -sensory status and neurologic, emotional, behavioral -skin status -respiratory/cardiac status -elimination status -Neurologic status -medication regimen understanding by client/caregiver -therapy can the client do hygiene, call for help, home clean, fire alarms work? -emergent needs

Infrastructure

In culture one pattern system is "infrastructure" which provides the basic necessities of life.

social structure

In culture the 2nd pattern system is "social structure" which determines how people interact with one another

Superstructure

In culture the 3rd pattern system is "superstructure" which is worldview, provides a belief system that helps people identify themselves, their society and the world around them.

OASIS

In home health care must be completed by nurses working for Medicare-certified home health agencies. Called Outcome and Assessment Information Set. Oasis is a data set of outcome measures for adult home health care clients that is used to track outcome-based quality improvement. For adult clients who receive skilled care nursing & respiratory care, IV therapy, chemotherapy, wound care, diabetes self-management training, and renal dialysis. OASIS-C2 is 27 pgs & completed every 2 months.

Gender roles

Nurses must be mindful that the equalization of genders is a western concept and is not universally accepted. Some cultures may not permit women to speak or make healthcare decisions. Be sensitive to other cultures where women look to their husband or father , recognizing although the woman has a legal right to consent to her own choices but she may feel like she can't based on culture.

Skin color

Skin color is the most significant biological variation nurses encounter in the delivery of competent care. Variations may be genetic makeup or mutations and environmental factors. In assessing darker skin patient for oxygenation, it is very important to examine the least pigmented areas, such as the buccal mucosa, lips, tongue, nail beds, and palms of the hands. But examiner should not rely on skin tone alone. A baseline skin color can be established by assessing a patient in direct sunlight or by asking family members who are familiar with patient's appearance.

Health disparity

higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group.

Rule of descent

assigns race to a person on the basis of a societal dictate that associates social identity with ancestry. This practice divides society and perpetuates disparities in health care because it assigns people to groups that have been historically deprived of equal access to health care, wealth, power, and privilege.

Palliative care

home health service for comfort care offered to clients at any stage of a serious illness.

Hospice care

home healthcare services typically involving pain management of a terminally ill care or End-of-life care for patient. The nurses goal is to relieve suffering throughout illness and support & work with family providing grief support after death.

Cultural Sensitivity

begins with the recognition of the often pronounced differences among cultures. BUT doesn't mean only being aware of difference to provide quality care. It helps health care providers move beyond sensitivity and biases that create barriers.

The 4 Cs of Culture

call, caused, cope, and concerns 1) What do you CALL your problem? 2) What do you think CAUSED your problem? 3) How do you COPE with your condition? 4) What are your CONCERNS regarding the condition and/or recommended treatment? The key is learning to ask the right questions to elicit an understanding of the patient's point of view.

health care disparity

inequality related to access, use, and quality of care existing depending on a person's age, race, ethnicity, socioeconomic status, sexual orientation, gender, disability, and physical location. In the U.S.A. hispanics, blacks, American Indians/Alaska Natives, and low-income individuals are more likely to be uninsured relative to Whites and those with higher incomes.

descriptive epidemiology

consist of studies that are conducted once a disease is evident. Data collected in descriptive epidemiology studies include the time and place of occurence of the disease and the characteristics of people affected by the disease. In examining cohort of community members, the nurse would describe the characteristics of those who have a certain and those who do not. This analysis determine which variables are most associated with people who have the disease.

Rituals

formal, stylized, and repetitive actions performed in special places at special times. Although their repetitive nature and generational transmission, translate into enduring messages, values, and sentiments. Death and birth rituals vary in cultures. All of these activities have implications for their delivery of nursing care. Rituals can sustain and provide support for patients during a time of illness or suffering.

Transcultural nursing

-Speciality/general practice founded by Madeleine Leininger. She discovered the need to address culture as its critical to nursing care through her specialty in psychiatry. Created the Sunrise Model to depict her Theory of Cultural Care Diversity and Universality. -Research in this field of nursing focuses on two perspectives: 1) EMIC- perspective focuses on the local, indigenous, and insiders culture. 2) ETIC- perspective focuses on the outsider's world, and on professional views. -Focuses on CULTURAL OPNENESS

windshield survey

-The community or public health nurse drives or walks through a community assessing components -provides descriptive overview of community nurse looks for: -pets and animals -evidence of drug abuse/substance abuse -origin/race/ethnicity of population -general appearance of neighborhood -social systems: clinics, hospitals, dentists, parks & rec, worship places, stores, public protection & transport

Public Health Nursing Process

1) diagnose the greatest needs 2) establish goals 3) plan interventions for primary, secondary, and tertiary prevention levels 4) evaluate the effectiveness of the interventions in meeting community health care goals. Critical that public health nurses collab with many professionals and agencies like administrators of daycares, PCPs, governors/mayors/city counsel, city parks/recreation, media outlets tv/radio/online in the process.

culturally congruent care

A culturally competent clinician realizes the importance of caring for patients as people with unique experiences, belies, values, and language. -Care providers take a self assessment to see how willing they are based on their personal beliefs care for patients of diverse backgrounds. -health care providers/organizations should also be linguistically competent. -multiple cultures to balance: the nurses personal, the hospital culture that the nurse represents, and the patients culture all need balance.

Intervention of home health nurses

A key intervention is discharge planning in collaboration with acute care nurses, discharge planners, social workers, client caregivers, family and community services. Nurses must use informatics when communicating to use tech effectively and maintain client confidentiality. Nurses should be familiar with the many referral services.

Community based nursing

Ambulatory care setting that focuses on interventions necessary to help individuals prevent illness, maintain or regain their health, or die with dignity while living in a community. The term client is used instead of patient is used.

Body Odor

Body order may result from poor personal hygiene, inability to care for oneself, or cultural acceptance that natural body odors are normal. In some cultures BO is offensive and connected to attractiveness & efforts are made to mask it and they'll judge others for not bathing frequently. Nurses need to sensitively asses the reasons for BO.

agents of disease and etiologic factors

Contributors to disease causation that can affect community health that public health nurses must assess and analyze like Excessive or deficient nutritional intake, Chemical and airborne agents like carbon monoxide or ragweed, Physical agents like radiation, Infectious agents like bacteria and viruses.

present-oriented cultures

Cultures that are less likely to embrace preventative care. The orientation is focussed on here and now. How they're feeling dictate their future health practices. Doctor may diagnose patient with a disorder but "they feel good" so the patient doesn't take the medicine prescribed "they'll wait and see". Economic pressures may be a big factor & nurses must be mindful when patients make choices that conflict with their recommendations or if they missed their appointment based on public bus transportation or cultural reasons. Also past oriented cultures see time as flexible arriving late. Typically African American & Hispanic cultures.

Past-Orientation Cultures

Cultures that are oriented to the past tend to look to traditional approaches to health and healing rather than new approaches. Tend to belief that if it worked for my ancestors it will work for me. Australian, British, and Chinese cultures tend to be like this,

Enculturation

Culture is learned and not biologically inherited. Thus Enculturation is the process whereby a culture is passed from generation to generation & it begins at birth as parents/family members begin to teach the child what is expected in terms of family responsibility and contributions both consciously and unconsciously taught.

Culture is integrated

Cultures are integrated, pattern systems. The foundation of culture includes three structural elements that work together to keep the culture strong: An (1) Infrastructure, (2) Social structure, and (3) Superstructure.

Future-oriented cultures

Cultures that tend to delay immediate personal gratification if it interferes with their ability of future plans like buying a home, planning a family, or pursuing higher education. Usually middle-class Americans regardless of ethnic background view health care system like this. They structure time rigidly, adhere to a time-structured schedule. Nurses providing care must speak of events in relationship to the future and stick to planned schedule.

vulnerable populations

Defined groups of people at high risk for health problems are of particular concern to community health nurses. people in communal living environments in which communicable diseases can spread like prisons, dorms, and extended-care facilities. Refugees, immigrants, homeless, minorities, mentally ill/disabled, the abused, very young/old, international travelers, substance abusers etc.

Public health nurses Evaluation

Like interventions that must be collaborative in a community setting evaluation of programs and services. The nurse designs tools that will determine if outcome criteria are met. Data and statistical analysis to support outcome findings is especially significant in working with business owners and government agencies that invest financially in primary, secondary, and tertiary prevention programs.

cultural competence

The ability to interact with and appreciate people of different cultures and beliefs. Attaining it is a lifelong process. It requires intentional effort to try to understand others who are different from self. Nurses use "cultural sensitivity" & "culturally congruent care" to demonstrate cultural competence. Divided into 2 categories: 1) INDIVIDUAL CULTURAL COMPETENCE: care provided for an individual patient by one or more nurses, physicians, social worker, etc. 2) ORGANIZATIONAL CULTURAL COMPETENCE: collective competencies of the members of an organization in meeting the diverse needs of patients, staff and community.

Case manager

The home health care nurse serves as a case manager aka coordinator of client care, needed services, and needed supplies in the home setting. Nurse must be a financial resource manager who is aware of what is and isn't covered on the client's insurance plan. If consultation is needed the nurse needs to be aware of the client's community resources like local pharmacy and meals on wheels program. Nurse must have strong teaching skills to instruct clients/family about the home health procedures.

The difference between socialization and enculturation

The main difference is that socialization is basically the process of learning to behave in a way that is acceptable to society, whereas enculturation is the process of being socialized into a certain culture.

School

The official place where generational transmission occurs of a society's accumulated knowledge and skills. Society values, cultures, traditions, & official heritage are taught. The curriculum can either reinforce family socialization or challenge it. In this setting people learn to communicate or negotiate with, or dominate, peers who are outside their immediate social circle and often are from diverse social backgrounds. social curriculum can reinforce gender role that starts with family & continue into peer group.

Assimilation

The process by which individuals from one group merge with, or blend into, a second group. Usually a minority individual joining/assimilating with the majority group. Coined "melting pot" and some say necessary for immigrants adapting to new life in another country. People lose their previous cultural identity and extreme examples of this is marriage into a different cultural group. Full assimilation might have some psychological adversities.

Predjudice

The process of devaluing an entire group because of assumed behavior, values, or attributes. People demonstrate prejudice when they apply group stereotypes to individuals and assume that all people within a group will act in a predetermined manner. Prejudice includes "labeling" groups or cultures for example, as lazy or materialistic.

Home Health care nursing

The purpose of home health care nursing is to promote, maintain, or restore health to an optimal level of functioning and to reduce the effects of disability and illness for homebound clients and their families. Alternative to a hospital or a nursing home and is actually a part of community nursing. types range from acute, long-term health conditions, permanent disability, and terminal illness. Their role is even broader than a nurse in acute care.

Leininger's Theory

Theory of Cultural Care Diversity and Universality. A basic tenet of the theory is that human beings are inseparable from their background, social, history, world view etc. Biology emotions and other things are studied from a holistic view and are not fragmented or seperated.

Early childhood home visiting programs

These programs backed by science use nurse & health care providers to provide long-term home visits for vulnerable parents and children. Interventions: -case management -childbirth prep -contraceptive education -referral to community resources Evidence of effectiveness: -reduce child abuse -reduce teen pregnancies -improved child development

social determinants of health

are conditions in which people are born, live, work, play, and age, and wider set of forces and systems shaping the conditions of daily life. Distribution of wealth, power, resources, and organizational and government policies affect a specific population's social determinants. Income, education, health literacy, where people live or work, early childhood development, social exclusion, family structure, the status and role of women, and vaccination adherence are examples. Public health nurses must analyze and assess them for their impact on health to the communities they serve.

Host factors or intrinsic factors

are individual variables such as genetics, age, gender, ethnic group, immunizations status, and human behavior that affect a person's health.

Public Health Nursing

examines the greater community as a whole—the city, county, state, nation, continent, world—and designs collaborative and interdisciplinary strategies to keep the population healthy by preventing or controlling disease and threats to human health.

secondary prevention

early identification of an illness or phenomenon and limitation of its impact or recurrence. BP screening, routine blood sugar testing, or asking patients about their exposure to domestic violence are examples of secondary prevention screening interventions. School nurses might address childhood obesity by encouraging eating of less processed foods and exercise. design early intervention programs for better outcomes.