Culture and Special Populations&Health Literacy Flashcards
levels of prevention
primary
secondary
tertiary
level of prevention that promotes health/intended to prevent disease/injury/disability
primary prevention
examples of primary prevention
Health education
providing vaccinations
needle exchange programs
level of prevention: Interventions designed to help diagnose conditions early
secondary prevention
examples of secondary prevention
Health screenings
testing for Covid/strep
self-breast exams/self-testicular exams
blood pressure screening
level of prevention: Interventions aimed at limiting disability of a condition
tertiary prevention
examples of tertiary prevention
Medications treating HTN
dialysis
physical or mental health rehabilitation/treatment
A combination of culturally congruent behaviors, practice attitudes, and polices that allow nurses to work effectively in cross-cultural situations
cultural competence
why should we strive for cultural competence
The nurse’s culture often differs from that of the client, leading to different understandings of communication, behaviors, and plans for care
Nonculturally competent/insensitive care can:
increase the cost of health care
and, most importantly, can negatively affect client health outcomes.
barriers to being culturally competent
Bias (prejudice/discrimination) and implicit bias
cultural conflict
cultural blindness
guidelines for providing culturally competent care
- Critical self-reflection …always… check your own inner responses/feelings. Assess yourself first
- Knowledge of cultures – talk to others – ask directly if there is anything related to their culture (even of the patient/client appears to be in the country’s mainstream culture)
- Education and training in culturally competent care
- Cross-cultural communication – adapting where you can
- Patient advocacy and empowerment -
- Evidence-based practice and research -
a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations
culture
a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings)
race
shared feeling of peoplehood among a group of individuals
ethnicity
Refers to the degree of variation that is represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time
Also includes the awareness of the presence of differences among the members of a social group or unit
cultural diversity
Although all cultures are not the same, all cultures have the same basic organizing factors:
Communication (verbal and nonverbal)
Space
Social organization
Time perception
Environmental control
Biological variations
Nutrition
***Also may have varying health practices
not a citizen but allowed to both live and work in the United States also known as lawful permanent residents
legal immigrant
admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views
refugees
admitted to the United States for a limited duration and specific purpose (i.e., students, tourists), DACA
nonimmigrants
may have crossed the border illegally or legal permission expired; eligible only for emergency medical services
unauthorized immigrant
how many immigrants living in the US
44.7 million
appr how many immigrants are uninsured
1/3
poor health outcome factors for immigrants:
-Fear of immigration reinforcement often prevents seeking healthcare
-Live in low-income and segregated neighborhoods
-Work in low-wage occupations
-Unsafe working situations (i.e. exposure to toxic chemicals)
factors to consider for providing health care for immigrants
Financial constraints (uninsured)
Language barriers
Differences in social, religious, and cultural backgrounds between the immigrant and the health care provider
Providers’ lack of knowledge about high-risk diseases in the specific immigrant groups for whom they care
Traditional healing or folk health care practices that may be unfamiliar to their US health care providers
When working with immigrant populations, consider how your own background, beliefs, and knowledge may be significantly different from those of the people receiving care.
skills when working with immigrant populations
- Self-awareness…assess yourself
- Identify the client’s preferred or native language.
- Learn the health-seeking behaviors for your immigrant client and their family members.
- Get to know the community where the immigrant client lives. Read about the culture of your clients.
- Get to know some of the traditional practices and remedies used by families and communities.
- Learn how cultural subgroups explain common illnesses or events.
- Try to see things from the viewpoint of the client, family, and community and accommodate rather than squash the client’s view.
- Conduct a cultural assessment focusing on what is working, what is not working, and changes that need to be made to accommodate cultural norms and promote positive health behaviors.
fewer years of formal education leads to:
lack of health literacy
rural health characteristics and health care for immigrants
Less likely to engage in preventive behavior
More likely to smoke and report higher rates of alcohol use and obesity
Tend to be working poor/not have insurance – delay care
Difficulty accessing care due to transportation – no public transportation
Cultural and social norms about health behaviors, lack of privacy (everybody knows everybody else’s business)
problems for health providers to give care
May live and practice in a particular community for decades
May provide care to people who live in several counties
Small staff to service large area
Limited public health budgets and fewer staff
Rural Women’s Health Including Maternal and Infant/Child Health
Higher infant and maternal morbidity rates
May have higher proportion of racial minorities near the town/city center and fewer specialists
Extreme variations in pregnancy outcomes
Children are more likely to work on farms (risk of injury)
particularly at risk are women who:
Live on or near Native Indian reservations
Are migrant workers
Are of African American descent
impacts of Covid in rural america
-Appears that rural Americans are more vulnerable to the pandemic than urban Americans due to the proportion of elderly persons, higher smoking rates, and prevalence of certain chronic diseases
-Lack of healthcare professionals, nearly half of rural hospitals operate in a financial deficit and many had to close, lay-off or temporarily furlough staff.
-Many farmworkers fear testing for COVID since a positive test might mean a permanent job loss.
occupational and environmental health problems in rural areas
lack of OSHA regulation for farming and ranching
Common injuries/lack of training
Common health issues for farmworkers
Pesticide exposure
Migrant farmworkers may not be informed of exposure risk, no workman’s compensation
Symptoms of pesticide poisoning
Heat stress/ heat exhaustion
Lack of education related to the risks of the work
rural health care delivery issues and barriers to care
Lack of health care providers and services and great distances to obtain services
Lack of personal transportation
Unavailable public transportation or outreach services
Unpredictable weather or travel conditions
Inability to pay for care or lack of health care insurance
Lack of know-how to procure publicly funded entitlements and services (health literacy issue)
Inadequate provider attitudes and understanding about rural populations
Language barriers (caregivers are not linguistically competent)
Care and services not culturally and linguistically appropriate
Travels to do farm work; unable to return to permanent residence within the same day
migrant farmworker
Returns to permanent residence each day; works in farming at least 25 days or part-days per year; but does not work year-round in agriculture
seasonal farmworker
reasons why migrants may have lack of health care
Lack of knowledge about services
Inability to afford care
Affordable Care Act or health insurance subsidies
Availability of services
Transportation
Hours of service
Mobility and tracking
Language barriers
Discrimination
Documentation
Cultural aspects
Children of migrant workers
Dental disease
Substance use
Incidence of TB
Incidence of HIV/AIDS
Prevalence of diabetes
Depression
Anxiety-related disorders
Domestic violence
Children of migrant workers
high risk groups/ vulnerable populations
Poor, Homeless, Pregnant Teens, and Mentally Ill, LGBTQ+
what we need to consider with high at-risk groups/vulnerable populations
Identify health care needs, barriers to care, and essential health care services for each of these groups (all very similar issues related to access and ability to obtain proper care).
where to find federal income poverty guidelines
Temporary Assistance to Needy Families (TANF)
Supplemental Nutrition Assistance Program (SNAP)Women, Infants, and Children (WIC)
Head Start
effects of poverty across life span
Higher rates of chronic illness/more complex
Higher infant morbidity and mortality
Shorter life expectancy
More significant complications and physical limitations resulting from chronic disease
Hospitalization rates three times more than for persons with higher incomes
Lack of a fixed, regular, and adequate nighttime residence
homeless
types of homelessness
Chronic homelessness, transitional, and episodic, couch surfing (staying at someone’s house for short periods of time)
Living in car
Youth kicked out of their home (High population of LGBTQ+)
health risk for those experiencing homeslessness
Hypothermia and heat-related illnesses
Communicable diseases
Trauma
Mental illness
Use and abuse of tobacco, alcohol, and illicit drugs
Barriers to getting adequate health care, including dental care
Sexual trauma, prostitution or “survival sex” and unintended pregnancy
high risk populations dealing with homelessness
Pregnant women -
Children
Adolescents
Older adults
Veterans
-women especially report military sexual trauma
Focus on moving people with mental health conditions out into the community, but resources were not in place => spike (that continues) in homeless population which includes people with mental health conditions or are cognitively limited
deinstitutionalization
at risk populations for mental health conditions
Children and adolescents (especially the LGBTQ+ population)
Veterans
Adults with serious mental illness
Older adults
People from other cultures/isolation
role of the nurse with homelessness
Create a trusting environment.
Show respect, compassion, and concern.
Avoid making assumptions.
Advocate for accessible health care services/care coordination
Focus on prevention/reduction of harm
Develop a network of support for yourself.
Introduction to care of clients who abuse substances and experience Addiction*
Leading national health problem
Causes more deaths, illnesses, and disabilities than any other health condition
Substance abuse and addiction affect all ages, races, sexes, and segments of society.
Affects the loved ones of the person
primary preventions of abuse of substances and addiction
Promotion of healthy lifestyles and resiliency factors
-Assisting clients to achieve optimal health
-Teaching assertiveness and decision-making skills
-Teaching stress reduction and relaxation techniques
Drug education
-Teaching that no drug is completely safe and that any drug can be abused
-Helping persons learn how to make informed decisions about their drug use to minimize potential harm
nurses role for drug addiction
Knowledge of community resources and how to mobilize them.
Nurses are in ideal roles to assist with tertiary prevention for both the addicted person and the family.
community care of those experiencing violence
Violence is a pervasive public health, social, and developmental threat.
It is leading cause of death and disability that disproportionally affects youth, low-income populations, and people of color.
Significant mortality and morbidity result from violence
Step-by-step approach that is applicable to any community
Public Health Approach to Violence Prevention
- Identify the problem: Collect data to determine the “who”, “what”, where”, ‘when,’ and “how”. This is an epidemiological approach.
- Identify the risk factors. Why do one person or one community experience violence, and another does not?
- Develop and test prevention strategies and share this information with others.
- Disseminate and implement the strategies in step 3.
types of fmaily violence
Intimate partner abuse
Signs of abuse
Abuse as a process
Abuse of older Adults – by family or other carers, including extended care facilities
nursing interventions for family violence
Box 27.2: Assessing risk factors for violence in a community context
Box 27.3: Prevention strategies for violence
Box 27.4: Common Community Agencies/Services
Human Trafficking Resources
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”
health literacy
Those most at risk of low health literacy:
Older adults (>65)/cognitive issues
Minority populations, substantial part is r/t clinician (structural racism) issues/implicit bias
English not the primary/first language
Low socioeconomic status – why?
principles of health literacy
Use of plain language
Focus on the most important concepts
Reader friendly material
Rate of concept presentation
Health Literacy – change in focus at CDC
Emphasize people’s ability to use health information rather than just understand it
Focus on the ability to make “well-informed” decisions rather than “appropriate” ones
Acknowledge that organizations have a responsibility to address health literacy
Incorporate a public health perspective – recognizes that health literacy is connected to health equity
main components of teach back method
Caring tone of voice and attitude – non-shaming
Comfortable body language/eye contact
Plain language -
Asking patient to explain back in own words
Non-shaming, open-ended questions
Avoiding yes or no questions
Taking responsibility for explaining clearly
Explaining again and re-checking for understanding
Reader-friendly materials to support teaching
Documenting use of teach-back
if the patient cannot teach back after several times:
Include a family member (on the phone/Face Time if not present)
Record the information for the patient
Ask another member of the healthcare team to explain the information
