Chapter 3 And 5 Study Guide

Question 1

What were Lillian Wald’s contributions (organizations/people)?

Answer 1

-Teachers College of Columbia University
-National Organization for Public Health Nursing
-Henry Street Settlement
-Miss Elizabeth Tler
-Worked to establish NYC Board of Child Hygiene
-Metropolitan Life Insurance Co.
-National rural nursing service
-Worked to establish Federal Children’s Bureau

Question 2

What were Lillian Wald’s contributions?

Answer 2

-First to use the term Public Health Nurse

-Expanded roles of nurses

-Used trained nurses instead of lay people to provide care

-Developed project to address childhood illness, reducing school absenteeism

-Began first school nursing program

-Published Windows on Henry Street describing work and views on public health nursing

-Influenced social reforms:
1. To establish health and social policies, improvements were made in child labor and pure food laws, tenement housing, parks, city recreation centers, treatment of immigrants, and teaching of mentally handicapped children

-Emphasized illness prevention and health promotion through health teaching and nursing intervention, as well as epidemiological methodology as early EBP

Question 3

What was the Henry Street Settlement?

Answer 3

-Started by Lillian Wald in 1893 to provide nursing and welfare services to the poor in NYC Lower East Side

-Visited many sick children and families in their homes

-During one of the worst periods of depression, nurses from this organization:
1. Supplied individuals and families with ice for keeping food fresh, meals, medicine, and sterilized milk
2. Made referrals to hospitals and clinics, as needed
3. “Emphasized the human dignity of even the poorest” tenement families

Question 4

Who was Miss Elizabeth Tler?

Answer 4

-Hired by Lillian Wald
-First Black public health nurse to serve African American community leading to a satellite office at Stillman House

Question 5

What did Lillian Wald and the Metropolitan Life Insurance Co. work to do?

Answer 5

Reduce death rates by using visiting nurses to provide services to policyholders

Question 6

What was the National Rural Nursing Service?

Answer 6

-Plan was developed by Lillian Wald with the American Red Cross

-Formed the American Red Cross Rural Nursing Services, later Town and Country Nursing Service

-Then became the Bureau of Public Health Nursing

-Program ended in 1947

Question 7

What was the National Organization for Public Health Nursing?

Answer 7

-Lillian Wald was a co-founder with Mary Gardner and first president in 1912

-Purpose was to set standards for PHNs

-In 1931, developed “general and specialized objectives” regarding work with individuals, families, and communities

-In 1940, added 12 functions of PHNs; began using community health nurse as a more inclusive gesture

-Merged with the National League for Nursing (NLN) in 1952

Question 8

What did Lillian Wald do for the Teachers College of Columbia University?

Answer 8

-Encouraged improved coursework to prepare public health nurses for practice

-Modeled how nursing leadership, involvement in policy formation, and use of epidemiology led to improved health for the public

Question 9

What were Margaret Sanger’s contributions?

Answer 9

-The Comstock Act of 1873 prevented her from providing her female clients any information on contraception, despite the fact that affluent and educated American had reliable contraception

-Was prohibited from discussing contraception with her clients

-Published the monthly newsletter The Woman Rebel to promote contraception and was charged with distributing illegal “birth control” information

-Opened her first birth control clinic

-After being arrested, she persisted and other clinics succeeded, resulting in the eventual formation of the International Planned Parenthood Federation

-Founded the American Birth Control League to distribute contraception information

Question 10

What were Florence Nightingale’s contributions?

Answer 10

-Increased health standards and practice

-Reformed military health care

-Changed perceptions of women as nurses

-Developed standards of education for nursing practice

-Served in the Crimean War as nurse and administrator

-Advocated holistic, population-focused care

-Incorporated health promotion and disease prevention into practice model

-Pioneered the use of statistics to change practice

-After publication of Notes on Hospitals, her work became associated with long pavilion-style hospital wings, emphasizing light and ventilation

-Advocated for poor and disenfranchised, especially in military

Question 11

What are Nightingale’s five essential components to optimal health and healing?

Answer 11

-Pure air
-Pure water
-Efficient drainage
-Cleanliness
-Adequate lighting

Question 12

What is Nightingale’s Model?

Answer 12

-A standard for proper education and supervision of nurses in practice

-Principles presented in Notes on Nursing relate to the:
1. Environment of patients
2. Need for keen observation
3. Focus on the whole patient rather than the disease
4. Importance of assisting nature to bring about a cure

Question 13

What are the four stages of community health nursing development?

Answer 13

-Early home care nursing (before mid-1800s)

-District nursing (mid-1800s to 1900)

-Public health nursing (1900–1970)

-Community health nursing (1970 to present)

Question 14

What was Early Home Care Nursing (Before mid-1800s)?

Answer 14

-Focus:
1. Sick
2. Poor

-Nursing orientation:
1. Individuals

-Service emphasis:
1. Curative

-Institutional base:
1. Lay, religious and charitable groups

-Highlights
1. Elizabethan Poor Law
2. St. Vincent de Paul
3. Industrial revolution
4. Florence Nightingale and Mary Seacole

Question 15

What was the Elizabethan Poor Law?

Answer 15

-Written in England in 1601
-Provided medical and nursing care to the poor and disabled

Question 16

Who was St. Vincent de Paul?

Answer 16

In 1617 he started the Sisters of Charity in Paris, France

Question 17

What was the Sisters of Charity?

Answer 17

-An organization composed of nuns and laywomen dedicated to serving the poor and needy

-They emphasized preparing nurses and supervising nursing care, as well as determining causes and solutions for clients’ problems, thereby laying a foundation for modern community/public health nursing

Question 18

What was the Industrial Revolution?

Answer 18

-Led to increased migration to cities

-Hospitals were built in larger cities, and dispensaries were developed to provide greater access to physicians

-However medical education has no standardized curriculum until 1904

-Hospitals were mostly used by the indigent; for most others, nursing care was still given in the home

Question 19

What were the public health challenges of the Industrial Revolution?

Answer 19

-In both Europe and America, overcrowding and poverty led to epidemics, high infant mortality, occupational diseases and injuries, and increasing mental illness

-Disease was rampant; mortality rates were high; and institutional conditions, especially in prisons, hospitals, and “asylums” for the insane, were deplorable

-The sick and afflicted were kept in filthy rooms without adequate food, water, cover, or care for their physical and emotional needs

Question 20

Who was Mary Seacole?

Answer 20

-Established a boarding house to care for sick and injured soldiers in the Crimean War

-Lay nurse that cared for soldiers and their families in her hotel in the Crimea

Question 21

What was District Nursing (mid-1800s to 1900)?

Answer 21

-Focus:
1. Sick
2. Poor

-Nursing orientation:
1. Individuals
2. Preventive

-Service emphasis:
1. Curative
2. Beginning of organized home visiting

-Institutional base:
1. Voluntary
2. Some government

-Highlights
1. 1881: Clara Barton founded American Red Cross
2. 1885: Visiting nurse association established in New York

Question 22

What is the definition of district nursing?

Answer 22

-Also called visiting nursing

-Nurses working outside hospitals in community settings, such as homes, focusing on care and health promotion

-As the service grew, visiting nurses were assigned to districts in the city

-Although district nurses primarily cared for sick individuals, they also taught cleanliness and wholesome living to their patients even during that early period

Question 23

What are some milestones in the history of the American Red Cross?

Answer 23

-August 1881: A chapter was founded in Dansville, New York

-September 1881: A devastating forest fire in Michigan claimed 800 victims; this was the newly formed organization’s first disaster response, setting the stage for future fire response

-1898: Clara Barton went to Havana, Cuba, during the Spanish–American War with supplies for victims, the first record of Red Cross military collaboration

-1905: The American Red Cross was chartered by the Congress to provide relief during disasters and emergencies, support the military, help communities become more resilient, and conduct other well-known activities, such as blood collection

Question 24

What was Public Health Nursing (1900-1970)?

Answer 24

-Focus:
1. Needy public

-Nursing orientation:
1. Families

-Service emphasis:
1. Curative
2. Preventive

-Institutional base:
1. Government
2. Some voluntary

-Highlights
1. Lillian Wald
2. Margaret Sanger
3. National League of Nursing Education
4. Visiting Nurses Association
5. Frontier Nursing Service
6. Characterized by service to the public, with the family targeted as a primary unit of care
7. Official health agencies, which placed greater emphasis on disease prevention and health promotion, provided the chief institutional base

Question 25

What was the Visiting Nurse Associations (VNAs)?

Answer 25

-Some of the district nursing services that remained privately funded an administered, offering their own home nursing care

-In some places, city, or county health departments joined administratively and financially with VNAs to provide a combination of services, such as home care of the sick and health promotion to families

Question 26

What was the Frontier Nursing Service?

Answer 26

-An innovative example of rural nursing

-Started by Mary Breckinridge in 1925

-Served mountain families in Kentucky

-From six outposts, nurses on horseback visited remote families to deliver babies and provide food and nursing services (combined general public health nursing and midwifery)

-Breckinridge insisted on accurate record keeping; this was used to assess patient risks and treatments

Question 27

What was the National League of Nursing Education?

Answer 27

-Was the American Society of Superintendents of Training Schools for Nurses in the United and Canada

-Founded in 1893 by Isabel Hampton Robb

-The first collegiate public health nursing program

-Purpose was to establish educational standards for nursing

-Became the National League of Nursing Education in 1912, the forerunner of the current National League for Nursing (NLN), established in 1952

Question 28

What was the Community Health Nursing (1970 to Present)?

Answer 28

-Focus:
1. Total community

-Nursing orientation:
1. Population
2. Illness prevention

-Service emphasis:
1. Health promotion
2. Practice

-Institutional base:
1. Many kinds
2. Some independent

-Settings
1.Community-based clinics
2. Worksites
3. Schools

Question 29

What did the ANA’s Division of Community Health Nursing do?

Answer 29

-Developed A Conceptual Model of Community Health Nursing in 1980 to distinguish generalized preparation at the baccalaureate level from specialized preparation at the masters or postgraduate level

-Defined the generalist as one who provides nursing service to individuals and groups of clients while keeping “the community perspective in mind”

Question 30

What did the U.S. Department of Health and Human Services, Bureau of Health Professions, Division of Nursing do in 1984?

Answer 30

-Convened a Consensus Conference on the Essentials of Public Health Nursing Practice and Education in Washington, DC

-Identified community health nursing as the broader term, referring to all nurses practicing in the community, regardless of their educational preparation

-Identified public health nursing as a part of community health nursing involving a generalist practice for nurses prepared with basic public health content at the baccalaureate level and a specialized practice for nurses prepared in public health at the master’s level or beyond

Question 31

What did the Association of Community Health Nursing Educators (ACHNE) do in 2009?

Answer 31

Released an updated revision of their original document, Essentials of Baccalaureate Education for Entry-Level Community/Public Health Nursing, noting that both terms encompass population-based practice

Question 32

Who provided primary healthcare to rural and underserved populations in the mid-1960s?

Answer 32

-The nurse practitioner (NP) movement, starting in 1965 at the University of Colorado, was initially a part of public health nursing and emphasized primary health care to rural and underserved populations

-The number of educational programs to prepare NPs increased, with some NPs continuing in public health and others moving into different clinical areas

Question 33

What is ethnocentrism and how does it affect the nurse’s interaction with the client?

Answer 33

-Bias that a person’s own culture and belief is the best approach to life and others are wrong or inferior

-Can block effective communication in a culturally diverse enviornment by creating biases and misconceptions about human behavior

-This can cause serious damage to interpersonal relationships and interfere with the effectiveness of nursing interventions

Question 34

What is culture?

Answer 34

The beliefs, values, and behaviors that are shared by members of a society and provide a template or “road map” for living

Question 35

What is race?

Answer 35

Refers to a biologically designated group of people whose distinguishing features, such as skin color or facial characteristics, are inherited

Question 36

What is an ethnic group?

Answer 36

-An assemblage of people with common origins and a shared culture and identity

-They may share a common geographic origin, race, language, religion, traditions, values, and food preferences

Question 37

What is cultural diversity?

Answer 37

-Also called cultural plurality

-Refers to the coexistence of a variety of cultural patterns within a geographic area

-This diversity can occur both between and within countries and communities

-Cultural diversity within communities has unique advantages and challenges
1. Language barriers and misunderstanding of cultural values can occur, whereas cultural practices, celebrations, and food traditions can enrich the community

Question 38

Why is cultural awareness important for the nurse?

Answer 38

-Means recognizing the values, beliefs, and practices that make up one’s own culture and becoming sensitive to the impact of one’s culturally based responses

-Although C/PHNs may think they are being helpful when operating from their own sets of cultural values and practices, doing so may actually have negative consequences and even cause damage to relationships with clients when cultural values differ

-Developing this awareness will reward you with a more effective understanding of self and an enhanced ability to provide culturally relevant service to clients

Question 39

How is a cultural assessment conducted?

Answer 39

-Ethnic/racial background
1. Where did the group originate, and how does that influence their status and identity?

-Language and communication patterns
1. What language is preferred, and what are the group’s culturally based communication patterns?

-Cultural values and norms
1. What are the values, beliefs, and standards regarding family roles education, child-rearing, work and leisure, aging, dying, and rites of passage?

-Biocultural factors
1. What unique physical or genetic traits predispose this group to certain conditions or illnesses?

-Religious beliefs and practices
1. What are the common religious beliefs, and how do they influence roles, health, and illness?

-Health beliefs and practices
1. What are the beliefs and practices regarding illness prevention, causes, and treatment?

Question 40

Why is a cultural assessment important?

Answer 40

-Learning the culture of the client first is critical to effective nursing practice

-Instead of making assumptions or judging client’s behavior, the nurse first must learn about the culture that guides that behavior

Question 41

What is Phase I of the two-phase cultural assessment process?

Answer 41

Data collection
-Step 1: Assess values, beliefs, and customs (e.g. ethnic affiliations, religion, decision-making patterns)

-Step 2: Collect problem-specific cultural data (e.g. cultural beliefs and practices related to diet and nutrition)

-Step 3:
1.Make nursing diagnoses
2. Determine cultural factors influencing nursing intervention (e.g. child-rearing beliefs and practices that might affect nurse teaching toilet training or child discipline)

Question 42

What is Phase II of the two-phase cultural assessment process?

Answer 42

Data organization
-Step 1: Compare cultural data with
1. Standards of client’s own culture (e.g. client’s diet compared with culture norms)
2. Standards of the nurse’s culture
3. Standards of the health facility providing service

-Step 2: Determine incongruities in above standards

-Step 3: Seek to modify one or more systems (client’s, nurse’s, or the facility’s) to achieve maximum congruity

Question 43

What are the characteristics of culture?

Answer 43

-Learned
-Integrated
-Shared
-Generally tacit
-Dynamic

Question 44

What is Culture is Learned?

Answer 44

-Patterns of cultural behavior are acquired, not inherited

-People are not born with a cultural belief system but gain it through enculturation, the process of learning one’s culture

-Aspects one learns through enculturation include beliefs, dress, diet, language, expressions of emotions (sadness, grief, joy, and happiness), smiling, laughter, and humor

-Although culture is learned, each individual may experience life in a singular way, which affects the process and results of that learning

-People might change certain cultural elements or adopt new behaviors or values

-Some individuals and groups are more willing and able than others to try new ways and thereby influence change

Question 45

What is Culture is Integrated?

Answer 45

-Culture is a functional, integrated whole, not merely an assortment of customs and traits

-As in any system, all parts of a culture are interrelated and interdependent

-The components of a culture, such as its social norms or religious beliefs, perform separate functions but come into harmony with each other to form an operating and cohesive whole
1. Therefore, each component should be viewed in light of its connection to other components and to the whole, not independently

-To provide effective nursing care, nurses may find their own cultural beliefs, and practice systems need to be adjusted or reintegrated to accommodate the cultural beliefs and practices of others
1. This is necessary for health, and health is essential for productivity in work and career, quality of life, and achieving life goals
2. A client’s beliefs and values in these areas may not be completely congruent with the nurse’s

Question 46

What is Culture is Shared?

Answer 46

-Culture is the product of aggregate behavior, not individual habit

-Certainly, individuals practice a culture, but customs are phenomena shared by all members of the group

-No matter the culture, shared values give people in a specific culture stability and security and provide a standard for behavior, helping them know what to believe and how to act

-When community/public health nurses (C/PHNs) know that culture is shared, their understanding of human behavior expands, and their ability to provide effective care to members of specific cultures increases

Question 47

What is Culture is Generally Tacit?

Answer 47

-As a guide for human interaction, culture can be tacit, mostly unspoken and unexpressed at the unconscious level

-Members of a cultural group, without the need for discussion, know how to act and what to expect from one another

-Culture provides an implicit set of cues for behavior, not a written set of rules
1. Teaches the proper tone of voice to use for each occasion
2. Prescribes how close to stand when talking with someone familiar or unfamiliar
3. Guides how one should appropriately respond to elders and based on one’s gender, role, and status

-Because culture is mostly tacit, realizing which of one’s own behaviors may be offensive to people from other groups is difficult

-It also is difficult to know the meaning and significance of other cultural practices
1. Silence is valued and expected by many Native Americans and Islamic women but may make others uncomfortable
2. Offering food to a guest in many cultures is not merely a social gesture but an important symbol of hospitality and acceptance; to refuse it, for any reason, may be an insult and a rejection
3. Touching or calling someone by their first name may be viewed as a demonstration of caring by some groups but could be seen as disrespectful and offensive to others

-C/PHNs have a twofold task in developing cultural sensitivity: we must try to learn clients’ cultures and also must try to make our own culture less tacit and more explicit
1. Cross-cultural tension can be resolved through conscious efforts to develop awareness, patience, and acceptance of cultural differences

Question 48

What is Culture is Dynamic?

Answer 48

-Every culture undergoes change; none is entirely static

-Each culture is an amalgamation of ideas, values, and practices from many sources
1. This dynamic process is related to exposure to other cultural groups, and every culture is in a dynamic state of adding or deleting components
2. Functional aspects are retained; less functional ones are eliminated
3. Individuals may generate innovations within a culture and some members see advantages to changing behaviors, being willing to adopt new practices

Question 49

Why must community/public health nurses remember the dynamic nature of culture?

Answer 49

-Cultures and subcultures change over time; patience and persistence are key attributes when working toward improving health behaviors

-Cultures change as their members see greater advantages in adopting “new ways”
1. Describing the changes in language and context acceptable to the culture is essential
2. Successful nurses understand their clients’ culture when delivering culturally competent care

-Within a culture, change may occur because of certain key individuals who are receptive to new ideas and are able to influence their peers
1. Key individuals can adapt suggested changes to fit the cultural and group values

-The health care culture is dynamic; Westerners are beginning to appreciate the validity of non-Western practices such as acupuncture, meditation, and the use of therapeutic herbs and spices such as turmeric and fenugreek

-Our national health-related goals, the Healthy People initiative, change every 10 years
1. Healthy People 2030 includes a focus on eliminating health disparities and improving health literacy

Question 50

What are the different ethnocultural health practices?

Answer 50

-World community

-Integrated health care and self-care practices

Question 51

What is World Community?

Answer 51

-Beliefs about the causes and effects of illness, health practices, and health-seeking behaviors are all influenced by a person’s, a group’s, or a community’s perception of what causes illness and injury and what actions can best treat or cure the health problem
1. Biomedical view
2. Magicoreligious view
3. Holistic view
4. Folk medicine and home remedies
5. Herbalism
6. Prescription and over-the-counter drugs

Question 52

What is Biomedical View?

Answer 52

-Common in Western societies, the biomedical view theorizes that all aspects of health can be understood through the sciences of biology, chemistry, physics, and mathematics

-Furthermore, there is the belief that life can be manipulated by humans through physical and biochemical processes
1. Disease is the breakdown of the human machine through stress, injury, pathogens, or genetic/structural changes
2. Disease causes illness, which has a specific cause and a set of treatment requirements
3. Treatments can be aggressive including medication, surgery, and even genetic engineering

-Many health care professionals, including C/PHNs, believe this biomedical model is the only and best approach
1. As a result, they may have trouble understanding diverse cultures that incorporate the holistic or magicoreligious views, and clients may not receive culturally competent care

-To be effective with diverse clients, C/PHNs must be knowledgeable about and accepting of a range of cultural health practices

Question 53

What is Magicoreligious View?

Answer 53

-Many cultural beliefs are grounded in the magicoreligious approach, which focuses on control of health and illness by supernatural forces
1. Diseases are thought to originate from intrusion of a malevolent spirit, punishment for the deeds of ancestors, and other indications that God, the gods, or other supernatural forces are in control
2. Health is seen as a spiritual gift or reward and illness as an opportunity to be resigned to God’s will
3. Prayers for healing or well-being of self and others, participation in prayer groups, and requests for prayer are effective
4. Death rituals connected with religious faith are designed to ease human departure from this life and help others cope with grief and loss
5. Health and illness belong first to the community and then to the individual; communal activities are viewed as helpful
6. Ceremonies, wearing special garments, and work with spiritual healers are important

-Religious beliefs, an individual’s spirituality, and how these factors interface with wellness and healing practices are important to clients and cannot be separated from their culture

-Community/public health nurses who are familiar with and respect the magicoreligious viewpoint offer culturally competent care

Question 54

What is Holistic View?

Answer 54

-Approaching health from a holistic standpoint, the world is viewed as seeking harmonious balance; imbalance of natural forces can create chaos and disease

-Many cultural groups use a holistic approach in tandem with biomedical and magicoreligious beliefs

In this belief system, for an individual to be healthy, all facets of the individual’s nature—physical, mental, emotional, and spiritual—must be in balance

-The holistic viewpoint can be expressed by:
1. Use of specific foods, beverages, and herbs to balance hot or cold disease states
2. The Chinese concept of yin and yang, in which forces of nature are balanced
3. Considering that infectious disease such as tuberculosis is not only caused by an organism but also by the environment, malnutrition, and poverty

Question 55

What is Folk Medicine?

Answer 55

-All cultures have home remedies and aspects of folk medicine

-Treatments as part of folk medicine are verbally passed down from generation to generation and began when access to medical care was limited

-Some clients may never plan to seek Western medical treatment but may share with you, the C/PHN, a practice they are using to treat a family member
1. Your response and actions may mean the difference between health and illness or injury

-Folk practices are common in maternal and child health; some that may be encountered include the following:
1. Pregnant women not reaching above their head, as doing so will cause the umbilical cord to strangle the baby
2. Taping coins over a newborn’s umbilical area to prevent hernias
3. Giving catnip tea to infants because it soothes them
4. Holding a baby upside down by the heels to “wake up the liver”
5. Not letting a cat be near a sleeping baby, because it will “suck the life” out of the baby
6. Using vinegar to relieve hypertension and skin irritations

Question 56

What is Home Remedies?

Answer 56

-Individualized caregiving practices, often used before people seek advice from health care professionals

-Each of us has a set of home remedies our parents used on us that we are likely to use on ourselves or our own children before or instead of calling the pediatrician
1. Examples include using baking soda paste on a bee sting, ice on a “cold sore,” or cranberry juice to prevent a urinary tract infection

Question 57

What is Herbalism?

Answer 57

-Use of herbs to treat illness is a centuries-old practice that is gaining popularity in our American culture

-Clients may not consider the use of herbs to be a “medical treatment” and may not tell health care professionals about their use

-In an increasingly multicultural society, the source, form, and identity of many herbs, roots, barks, and liquid preparations are difficult for most C/PHNs to distinguish
1. A book with pictures and descriptions, botanical form, purported indications and uses, and implications for nursing management of herbs is an important tool to keep handy when interacting with clients

-Basic safety questions that C/PHNs should answer about an herb when teaching or interacting with families include:
1. Is the herb contraindicated with prescription medications the client is taking?
2. Is the herb harmful? Does it have negative side effects? How often is it used?
3. Is the client relying on the herb, without positive health changes, and neglecting to get effective treatment from a health care practitioner?

-Just because herbs are not regulated as drugs, they are not risk-free
1. Variations in quality, strength, processing, storage, and purity may occur, leading to unpredictable effects
2. For these reasons, herbs must be used only in moderation and with caution, preferably with guidance by a health care practitioner
3. Examples of potentially harmful herbal supplements include Ephedra, Ginko, and Goldenseal for those persons with cardiac conditions, as these herbs can increase blood pressure and heart rate, as well as heighten the risk of bleeding

Question 58

What is Prescription and OTC Drugs?

Answer 58

-The cautions mentioned about herbs can also apply to most dietary supplements and OTC preparations
1. Dietary supplements and OTC drugs undergo a less rigorous process of review and testing by the U.S. Food and Drug Administration than do prescription medications
2. Many OTC drugs were once available only by prescription and remain powerful medicines
3. Herbal or dietary supplements do not have to be FDA -approved before manufacturers can sell them
4. All drugs can have major side effects, may be contraindicated in people with certain conditions, and may not be safe to use in combination with certain other drugs
5. Many new prescription medications are so expensive that clients cannot afford to take them as prescribed
6. Often, older, less expensive, and more frequently used drugs work as well as the newer, more expensive ones, which are heavily marketed by drug companies to health care practitioners and consumers

-Community/public health nurses who see clients over time can assist them through medication review and instruction, advocating for them to receive a less expensive form of the same medication and reporting on the effectiveness of newly prescribed medications
1. Many pharmaceutical companies now have low-cost prescription assistance programs for those in need

Question 59

What is Self-Care Practices?

Answer 59

-Complementary and alternative medicine (CAM), a multibillion-dollar industry in the United States, includes a broad array of healing resources

-Self-care activities may include CAM, other medications, and spiritual and cultural practices

-These widely varied approaches are designed to promote comfort, health, and well-being and may include
1. Therapies and treatments (juice diets, fasting, coffee enemas, and biofeedback)
2. Exercise activities (T’ai chi, yoga, and dance)
3. Exposure (aromatherapy, music therapy, and light therapy)
4. Manipulation (acupuncture, acupressure, chiropractic, cupping, and reflexology)

Question 60

What is Integrated Health Care?

Answer 60

-Complementary therapies are often used in conjunction with Western medicine, an approach known as integrated health care, such as for pain relief during labor and to improve sleep in the intensive care unit

-Complementary therapies have become so commonplace that some have suggested developing policies and guidelines for their use

-The C/PHN should be aware of the variety of therapies available and how to get information for clients while remaining objective and supportive of the client’s choices

-When a therapy contradicts the recommendations of the client’s health care practitioner, the nurse may be able to provide the pros and cons of continuing the complementary therapy

-Also, the nurse may be able to suggest therapy forms that would complement Western medicine for the client, such as music to promote relaxation and reduce stress or biofeedback for chronic pain management

-Complementary and self-care practices should be uniquely chosen for each individual within the context of the client’s cultural group
1. The culturally competent nurse respects these decisions, while promoting client health

Question 61

What are examples of complementary therapies and self-care practices?

Answer 61

-Diet therapies

-Gastrointestinal treatments

-Balance and exercise activities

-Sensory exposure

-Therapeutic manipulation

Question 62

What are the steps in developing transcultural nursing?

Answer 62

-Providing culturally sensitive nursing service to people of an ethnic or racial background different from the nurse’s
1. Develop cultural self-awareness
2. Cultivate cultural sensitivity
3. Assess the client group’s culture
4. Show respect and patience while learning about other cultures
5. Examine culturally derived health practices

Question 63

How do you develop cultural self-awareness?

Answer 63

-To develop awareness, nurses can complete a cultural self-assessment by analyzing their own:
1. Influences related to racial and ethnic background
2. Verbal and nonverbal communication patterns
3. Values and norms (expected cultural practices or behaviors)
4. Health-related beliefs and practices

Question 64

How do you cultivate cultural sensitivity?

Answer 64

-Nurses should be aware of the significant impact of culture on behavior

-Cultural sensitivity requires recognizing that culturally based values, beliefs, and practices influence people’s health and lifestyles and need to be considered in plans for service

-It also first demands self-reflection about personally held stereotypes and biases, along with self-assessment of one’s own cultural influences

-A client’s cultural values and health practices may sharply contrast with those of the nurse

-Failure to recognize this contrast can lead to a communication breakdown and ineffective care

-Once differences in culture are recognized, it is important to accept and appreciate them

-As a part of developing cultural sensitivity, nurses need to understand clients’ points of view
1. By listening, observing, and learning about other cultures, the nurse can use culturally sensitive strategies for care and avoid ethnocentrism

-Nurses who attempt to understand the feelings and ideas of their clients, establish a trusting relationship and open the door to the possibility of their clients’ adopting new healthy behaviors

Question 65

What are some ways to ensure culturally sensitive care?

Answer 65

-View culture as an enabler rather than a resistant force

-Recognize feelings and reinforce dignity and worth as an individual or group

-Take time for a pleasant conversation and build rapport

-Involve significant family members in care

-Reassure the client regarding confidentiality

-Be aware of cultural diversity within the same ethnic group

-Communicate openness, acceptance, and willingness to learn

-When a cultural practice is unknown, ask the client to detail preferences, and then provide respectful care

-Incorporate cultural beliefs into the plan of care

Question 66

How do you assess the client group’s culture?

Answer 66

-During a cultural assessment, the nurse obtains health-related information about the values, beliefs, and practices of a cultural group

-There usually is a culturally based reason for clients to engage in (or avoid) certain actions

-Interviewing members of a subcultural group can provide valuable data to enhance understanding

-The concept of cultural diversity can be understood in a general way, but each individual group should be appreciated within its own cultural and historical context

-It is not practical to deeply study all cultural groups the nurse encounters. Instead, a general cultural assessment can be accomplished by questioning key informants, observing the cultural group, and reading current professional literature

Question 67

How do you show respect and patience while learning about other cultures?

Answer 67

-When learning about other cultures, key behaviors are to demonstrate respect and to practice patience

-Some behaviors that help the nurse overcome language barriers include:
1. Allow enough time for communication
2. Maintain a relaxed and unhurried attitude
3. Arrange for an interpreter when needed
4. Speak to the client, not the interpreter
5. Use simple language and avoid slang and jargon
6. Watch for verbal and nonverbal cues
7. Ask open-ended questions
8. Validate feelings and understanding
9. Use any words you know in the client’s language

-Respect is evident when a nurse gives positive recognition to the importance of a client’s culture

-Attentive listening is a way to show respect and to learn about a client’s culture

Question 68

How do you consider culturally derived health practices?

Answer 68

-Some traditional practices, such as customary diet, birth rituals, and certain folk remedies, may promote both physical and psychological health

-Other practices, neither harmful nor health promoting, are useful in preserving the culture, security, and sense of identity of a cultural group

-Some traditional practices may be directly harmful to health

-Examples of harmful practices include:
1. Sole use of herbal poultices to treat an infected wound when antibiotics are needed
2. “Burning” the abdomen to compensate for heat loss associated with diarrhea
3. The use of Greta or Azarcon (common Hispanic home remedies for stomach discomfort), which contain lead

-Cultural health practice and aggregate health assessment can be combined to preserve accepted practices while incorporating Western medicine for full treatment efficacy

-If a group has a high incidence of low-birth-weight babies, pregnancy complications, skin infections, mental illness, or other health problems, it may be helpful to learn more about the group’s cultural health practices

-Practices clearly damaging to health can be discussed with group leaders and healers

-Knowing the group’s norms for authority and decision-making can be helpful to achieve improvements while respecting traditional health practices

Question 69

Who represents the largest minority group?

Answer 69

Non-Hispanics

Question 70

What is the culture of Latin Americans?

Answer 70

-Non-Hispanic White Americans tolerate at least 2.5 ft, whereas Latin Americans prefer a shorter distance, as little as 18 in

-Non-Hispanic White Americans may expect people to be on time for appointments and think it inconsiderate to keep someone waiting, whereas those from Vietnamese, Native American, and Hispanic cultures have a more elastic perception of time and do not interpret lateness for appointments as thoughtlessness

Question 71

What is the culture of Asian Americans?

Answer 71

-Non-Hispanic White Americans may expect people to be on time for appointments and think it inconsiderate to keep someone waiting, whereas those from Vietnamese, Native American, and Hispanic cultures have a more elastic perception of time and do not interpret lateness for appointments as thoughtlessness

-Hmong immigrants from Southeast Asia adopting selected aspects of U.S. culture

-Apart of a subculture

Question 72

What is the culture of African Americans?

Answer 72

-Apart of a subculture

-Share resources and housing

-For example, nurses working with recent African immigrants can explain to them the need for general health exams for all children entering school and that this does not mean their children are “in trouble”

Question 73

What is the culture of Muslims?

Answer 73

-A Muslim woman may ask to be examined by a person of the same sex

-Separation of genders is integral to her cultural beliefs, and it may be uncomfortable or even traumatic to receive care from a person of the opposite sex

Question 74

Which group would most likely refuse a blood transfusion?

Answer 74

-Parents who are Jehovah’s Witnesses may refuse a blood transfusion for their child

-This refusal may appear irrational or uninformed to those who do not understand their religious view of accepting blood and the need for bloodless procedures

-The single behavior of refusing blood transfusions, when viewed in context, is part of a larger belief system and a basic component of the family’s culture

Question 75

What is the role of the community health nurse?

Answer 75

-Preparation
1. Cultural awareness
2. Sensitivity

-Assessment

-Teaching

Question 76

What are the Transcultural C/PHN Principles

Answer 76

-Effective and culturally competent care involves:
1. Avoiding ethnocentric attitudes
2. Bridging cultural differences
3. Developing knowledge and skill in serving multicultural clients
4. Placing clients’ responses to care within the context of their lives