nsg 152 health disparities
The nurse is caring for a Hispanic older adult in the emergency department who is intoxicated and was found unconscious on the ground outside of a local restaurant. The patient has a medical alert bracelet listing diabetes, hypertension, and epilepsy. Which health disparities in this patient does the nurse identify as unavoidable and acceptable?
Age and gender The health disparities that are unavoidable and acceptable should not be a concern for nurses. For example, in an emergency room, nurses could observe health disparities in emergency visits by age; in general, older people make more emergency visits compared with younger people. In this situation, age becomes a determinant of the disparity, and aging is unavoidable and acceptable. Gender is also unavoidable and acceptable. Alcohol use is avoidable. Diabetes and hypertension may be avoidable conditions dependent on the patient's lifestyle and diet choices.
The nurse is assessing the pain level for an Asian adult on the oncology unit who is undergoing treatment for bone cancer. The patient is grimacing and moaning; however, he states that he is not in pain. Which health disparities in this patient does the nurse identify?
Avoidable and Unacceptable A health disparity in cancer pain management exists between Asians and whites. This disparity can be avoided and is considered unacceptable. The nurse would assess for this disparity by recognizing that there is a difference in Asian cultural values and attitudes related to cancer pain and pain medications. The nurse would include additional teaching when recognizing this disparity. Avoidable and acceptable disparities are rare. An example would be a natural disaster where only certain populations or regions are affected. Health disparities that are unavoidable and unacceptable are a major concern for nurses. An example would be the high prevalence of diabetes among Hispanic populations might be partially due to genetic factors so that such a disparity in the prevalence of diabetes could be unavoidable. Unavoidable and acceptable examples include patients who present to the healthcare setting with emergencies. The patient's age and gender are unavoidable and an acceptable reason for health disparity.
When utilizing the social-ecological model, the nurse classifies physiological effects of aging within which system?
Chronosystem The social-ecological model aims to explain dynamic interrelations among various personal and environmental factors. The chronosystem could be either external or internal. For instance, the timing of a family member's death could be an external chronosystem, and physiological changes due to aging could be an internal chronosystem. The mesosystem is beyond the dyad or two-party relation, and link over two systems that a person lives. Also, mesosystems link the structures of the person's microsystem. This model basically evolved from the ecological systems theory of child development proposing five socially organized subsystems related to human development: microsystem, mesosystem, exosystem, macrosystem, and chronosystem.
A student nurse demonstrates effective understanding of health disparities when stating that which disparity is the most significant contributing factor to poor quality of care?
Lack of health insurance Health insurance is the most significant contributing factor to poor quality of care. Uninsured people are less likely to get adequate care for disease prevention (e.g., cancer screening, dental care, counseling about diet and exercise, and flue vaccination) and/or for disease management (e.g., diabetes care management) and more likely to visit the emergency department and be admitted to the hospital for ambulatory care-sensitive conditions. Many racial/ethnic, low socioeconomic status, and other minority groups lack adequate health insurance compared with their counterparts. For example, Hispanics and non-Hispanic African Americans have substantially higher uninsured rates, compared with Asian/Pacific Islanders and non-Hispanic whites. Also, minorities are disproportionately enrolled in lower-cost health plans that place greater per-patient limits on healthcare expenditures and available services
The nurse conducting research on health disparities applies the idea that the reality of life is based on a mental representation developed from socially shared understandings within a society. Which theoretical framework model is the nurse using?
Structural-constructivist The structural-constructivist model is based on an assumption of dual nature of human existence. The model adopts a constructivist perspective that the reality of life is based on a mental representation constructed socially shared understandings within a society. This perspective/model strongly supports the idea of social and cultural construction of race/ethnicity that frequently results in health disparities observed in healthcare systems and gives direction for nursing research and practice in understanding health disparities in clinical settings and community settings.
The nurse should identify which potential health disparities when conducting an admission assessment on a hospitalized patient? (Select all that apply.)
Unsatisfying, low-paying job Frequent smoker Recently divorced African-American male Determinants of health disparities can assist the nurse in identifying patients at risk. Exposure to stressful living, such as financial insecurity due to a low paying, is a risk factor for health disparity. Smoking is an example of an unhealthy behavior that is chosen. Being recently divorced places the patient at risk due to high stress. Natural, biological variations such as being African-American can be risk factors as African Americans are more prone to hypertension. Lack of health insurance is a disparity; but comprehensive health insurance is a positive attribute leading to improved health.
The community health nurse will be providing community education events for residents in the community. Which of the following data would be most useful for the nurse to determine health disparities?
What illnesses are prevalent in the community? Knowing what illnesses are prevalent in the community will not only allow the community health to develop teaching materials but will also give the nurse a sense of which health disparities exist in the community. Access to healthcare, providers available, and socioeconomic status are all important factors related to health disparities; however, these are not the most useful for determining educational needs in this scenario.
The nurse understands that which of the following contribute to biases and have the potential to result in a health disparity? (Select all that apply.)
age race or ethnicity sex or gender religion or beliefs Clinical decisions are shaped by the attributes of patients (e.g., age, sex, SES, race/ethnicity, language proficiency, religion, nationality, and insurance status), health care providers (e.g., specialty, level of training, clinical experience, age, sex, and race/ethnicity), and practice settings. Health care providers may have bias or prejudice against minorities, greater clinical uncertainty when interacting with minority patients, and beliefs or stereotypes about the health or health behaviors of minority patients.
A patient presents to the emergency department (ED) with an open wound. The healthcare team is unable to understand the patient because she is speaking Chinese. The nurse understands that this can lead to which of the following?
an increase in nonadherence to prescribed plan Patients who face language and cultural barriers are less likely than others to have a usual source of medical care. They receive preventive services at reduced rates and have an increased risk of nonadherence to medication.
A minority patient has recently had a Coronary Artery Bypass Graft (CABG). The nurse is assessing the patient's likelihood of the patient's ability to adhere to the follow up appointments and therapies that were prescribed. Which of the following will the nurse identify as the highest priority for adhering to the schedule?
transportation Transportation may be a major determinant of follow up care. The poorest one-fifth of U.S. families spend approximately 42% of their income on transportation. This massive expenditure on transportation can wipe out their already limited budget for out-of-pocket medical expenses, nutritious foods, and healthy recreational activities. Income, gender, and communication may play a role in adherence; however, transportation is the most important determinant for follow up care.
