Chapters 5,6,7

what publications promote disease prevention

-The U.S. Preventive Services Task Force, Recommendations for Primary
Care Practice ( AHRQ,2018)

-The Community Guide (Community Prevention Services Task Force, 2018)

Health Care System Phases

1. The Preindustrial Era (1800-1900)

2. The Postindustrial Era (1900-1980)

3. The Corporate Era (1980-2019)

4. Challenges for the 21st Century (2020 and the current future)

challenges for the 21st century

-reemergence of old communicable and infectious diseases

-large food borne disease outbreaks

-acts of terrorism

-chronic disease

-health disparities

-technology

-labor force challenges

-changes in nursing education

-affordable care act

factors influencing health care costs

-age

-life expectancy

-health policy reform

-ethnicity and health disparities

financing of health care: public support

-medicare

-medicaid

-prospective payment system (PPS)

-diagnosis-related groupd (DRGs)

financing of health care: other public support

-TRICARE

-veterans administration

-indian health service

-affordable care act’s prevention and public health fund (PPHF)

financing of health care:private support

-evolution of health insurance

-employers

-individuals

-managed care

-health specific savings accounts

organization factors of culture

-communication

-space

-social organization

-time perception

-environmental control

-biological variations

-nutrition

social determinants of health

-economic instability

-education

-social environment

-health and health care

-physical environment

cognitive dimension

-cultural incompetent: oblivious

-culturally sensitive: aware

-culturally competent:knowledgeable

affective dimension

-cultural incompetent: apathetic

-culturally sensitive: sympathetic

-culturally competent: committed to change

skills dimension

-cultural incompetent: unskilled

-culturally sensitive: lacking some skills

-culturally competent: highly skilled

concepts of cultural competence

-cultural awareness

-cultural knowledge

-cultural skill

-cultural encounter

-cultural desire

dimensions of cultural competence

-cultural preservation

-cultural accommodation

-cultural repatterning

-cultural brokering

inhibitors to developing cultural competence

-stereotyping

-prejudice

-racism

-ethnocentrism

^cultural blindness

-cultural imposition

^cultural relativism

-cultural conflict

-cultural shock

what are the phases if in-depth cultural assessment

1. data-collecting phase

2. organizing phase

what are the five principles of a culturally competent organizational model

-valuing diversity

-conducting cultural assessment

-understanding the dynamics of difference

-institutionalizing cultural knowledge

-adapting to diversity

utilitarianism

-evaluates actions based on their outcomes or consequences

key concepts

-utility: the measure of happiness, well-being, or pleasure that results from a action

-consequences: the morality of an action depends entirely on its outcomes

-impartiality: everyone’s happiness or well-being is equally important

deontology

-evaluates actions based on their adherence to rules, duties, or obligations rather than outcomes

key concepts

-duty& obligations: actions are morally right i they follow established moral rules or duties

-moral absolution: some actions are always right or wrong. regardless of the consequences

-intrinsic morality: an action’s morality lies in its nature, not its results

utilitarianism: focus, morality basis, decision-making, strengths, weaknesses, examples

focus: consequences & outcomes

morality basis: greatest goo for the greatest number

decision making: flexible & situational

strengths: promotes overall well-being & equity

weaknesses: may violate individual rights

examples: allocating resources to save the most lives

deontology focus, morality basis, decision-making, strengths, weaknesses, examples

focus: adherence to rules, duties, or principles

morality basis: intrinsic rightness or wrongness

decision-making: rule based & absolute

strengths: respects individual rights & autonomy

weaknesses: can be rigid & ignore practical outcomes

examples: respecting a patient’s refusal of treatment

virtue ethics

-emphasizes a person’s moral character & virtues rather than focusing on rules or outcomes

key concepts

virtues: traits or qualities such as honesty, compassion, courage, and integrity

moral character: ethical actions stem from a person’s character & virtuous habits, not from adherence to rules or concerns for consequences

practical wisdom: the ability to balance virtues in context & make decisions that promote human flourishing

caring ethics

-emphasizes the relational nature of ethics & moral significance of caring in human relationships. it centers on empathy, compassion, & well being of others

key concepts:

relational ethics: moral decisions arise from the context of relationships & interconnectedness rather than abstract principles

responsiveness: caring involves attentiveness to the needs & vulnerabilities of others & acting to meet those needs

context-specific: ethical decisions depend on the specific dynamics of each relationship rather than applying universal rules

feminist ethics

-emphasizes equality, justice & addressing power imbalances, particularly those rooted in gender & social inequities. It challenges traditional ethical frameworks for failing to address the lived experiences of marginalized groups

key concepts:

power dynamics: examines how societal structures & institutions create & perpetuate oppression & inequality

intersectionality: recognizes the interconnected nature of social categorization such as race, gender & socioeconomic status in shaping experiences & vulnerabilities

relational autonomy: emphasizes the autonomy is influenced by relationships & societal factors rather than being entirely individual

virtue ethics focus, core question, strengths, limitations

focus: moral character & virtues

core question: what kind of person should i be

strengths: encourages personal growth & integrity

limitations: may lack specific guidance for action

caring ethics focus, core question, strengths, limitations

focus: relational connections & empathy

core questions: how can i best care this person

strengths: prioritize relationships & emotional well-being

limitations: may overlook justice or autonomy

feminist ethics focus, core question, strengths, limitations

focus: addressing power imbalances & systematic inequities

core question: how can i promote justice & equality

strengths: challenges systematic injustices & promotes equity

limitations: can be seen as overly broad or political

nonmaleficence

-the obligation to not harm

beneficence

-duty to actively promote the well-being of others

justice

-refers to the fairness in the distribution of resources, care & treatment

ANA code of ethics

-foundational document that outlines the ethical obligations & duties of every nurse. It serves as a guide for ethical practice & decision making

ANA code of ethics (nine provisions)

1-3 focus on nurses’ commitment to patients

4-6 highlight accountability, responsibility, & maintain professional competence

7-9 address the nurse’s role in advancing the profession, community health & global health

public health code of ethics

-provides ethical guidance specific to public health practice. it emphasizes the protection & promotion of community health while addressing social determinants of health & equity

public health code of ethics (core values)

equity: ensuring fair access to resources & opportunities for all, especially marginalized populations

interdependence: recognizing the interconnectedness of individuals & communities in achieving health

-justice promoting policies & practices that reduce health disparities

ANA code of ethics focus, core principles, application, example

focus: patient-centered, individual rights

core principles: autonomy, beneficence, nonmaleficence, justice

application: guides clinical decision making & bedside care

example: advocating for individual patient’s rights & safety

public health ethics focus, core principles, application, example

focus: population centered, social justice

core principles: equity, interdependence, advocacy

application: informs policies, resource allocation &community interventions

examples: implementing vaccination programs that ensure equitable access

applying ethics of advocacy

-empowering communities to participate in decision making

-addressing social determinants of health by promoting access to resources like housing, education, and healthcare

-promoting equity by challenging systematic barriers to health

-collaborating with skateholders to implement ethical policies & programs

current health care systems in the united states

-cost

-access

-quality

HMO

-health maintenance organizations

-don’t offer coverage out of network

-only exception is medical emergencies

PPO

-preferred provider organization

-can visit outside of network

-however, if visiting an out of network the cost may increase

-for physicians PPOs offer greater reimbursement rates

factors affecting resource allocation in health care

-the uninsured

-poor americans

-access to health services

^medicaid

^safety net providers

^affordable health care act

-rationing health care

^american health benefit exchange

trends in health care spending

-must consider past and current health care spending

-past decisions reflect the values and beliefs held by society and policy makers that undergrid policy making

-largest portion of health care expenses were for hospital care and physician services (2028)

paying health care organizations

-retrospective reimbursement

-prospective reimbursement

paying health care practitioners

-fee for service

-preferred provider

-capitation

-reimbursement for nursing services

economic and the future of the nursing practice

-plan for the future changes in health care

-effect changes in health care system

-continue to focus on improving the overall health of the nation

-nursing leadership

10 guidlines for providing culturally competent care

1. knowledge of cultures

2. education and training in culturally competent care

3. critical reflection

4. cross cultural communication

5. cultural competent practice

6. cultural competence in health care and organizations

7. patient advocacy and empowerment

8. multicultural workforce

9. cross cultural leadership

10. evidence based practice and research

legal immigrant

-not a citizen but allowed to live and work in the united states also known as lawful permanent residents

refugees

-admitted outside the usual quota restrictions based on fear of persecution due to race, religion, nationality, social group, or political views

nonimmigrants

-admitted to the united states for limited duration and specific purpose (stuent, tourist)

unauthorized immigrant

-may have crossed the boarder illegally or legal permission expired, eligible only for emergency services

skill for working with immigrant populations

1. self awareness

2. identify the client’s preferred or native language

3. learn the health seeking behaviors for your immigrant client and their family

4. get to know the community where the immigrant client lives, read about the culture of your client

5. get to know some of the traditional practices and remedies used by families and communities

6. learn how cultural subgroups explain illnesses or events

7. try to see things from the point of view from the client, family, and community and accommodate rather than squash the client’s view

8. 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