2. Social Determinants of Health- Community Nursing

Culturally and linguistically appropriate services (CLAS)

Promote development of a healthcare workforce that can respond effectively to the needs of a diverse client population

Promote ongoing improvement and accountability for culturally appropriate care

CLAS standards include...

providing language assistance and information to a client in their preferred language

Congruency between culture and health care is essential to...

well-being of the client. Link between health beliefs and practices is influenced by an individual's culture

cultural compentence

an attitude of openness to, respect for, and curiosity about different cultural values and traditions, and ideally includes a broader critical analysis of power relations affecting health disparities

cultural humility

an acknowledgment that everyone's views are culturally influenced, that our own are not inherently better than those of our clients, and that our clients can teach us

cultural accomodation

supporting and facilitating the client's use of cultural practices that are beneficial to the client's health

cultural repatterning

assisting the client to modify cultural practices that are not beneficial to the client's health

cultural brokering

advocating, mediating, negotiating, and intervening between the client's culture and health care culture on behalf of the client

cultural competence requires ongoing self-assessment between

healthcare organizations such as hospitals and visiting nurses agencies

environmental control

How the environment affects the individual

time orientation

Focuses more on the past, present, or future

social organization

Describes significance of individual members of a family or the family as a whole

Whether a person believes is the cause of impaired health will...

affect actions the individual will take to treat or prevent disease

biomedical beliefs

identifying a cause for every effect on the body, body functions like a machine

naturalistic beliefs

illness relate the individual as a part of nature or creation

magico-religious beliefs

illness link health to supernatural forces, or good and evil

cultural assessment parameters

-ethnic background

-religious preferences

-family structure

-language and literacy needs

-communication needs

-education

-cultural values

-food patterns

-health practices

-use of folk or spiritual healers and alternative healing techniques

first step of data collection

Collection of self-identifying data about the client's ethnic background, religious preference, family structure, food patterns, and health practices

second step of data collection

Nurse should pose questions that address the client's perceptions of their health needs

third step of data collection

Identification of how cultural factors can affect the effectiveness of nursing interventions

using interpreters

Cultural sensitivity

Respect

Properties of culture

Cross-cultural or transcultural nursing

Cultural safety

Cultural humility

Ethnocentrism

Interpreters

Give people culturally appropriate care!

neighborhood and built environment

assessing air, land, water, crime, violence, transportation, health food access

toxins

lead, pesticides, mercury, solvents, asbestos, and radon

air pollution

carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke

water pollution

wastes, erosion after mining or timbering, and run-off from chemicals added to the soil

contamination

food and food products with bacteria, pesticides, radiation, and medication

latency

state of existing but not yet being developed or manifest

Exposed to a toxin but no manifestation of disease

between exposure and illness can be very long (e.g., even decades)

I PREPARE

method of determining current and past environmental exposures

I: investigate

potential exposures

P: present work

Exposures, use of personal protective equipment, location of safety data sheets (SDSs), hazardous materials brought home from work on clothing, trends

R: residence

Age of home, heating, recent remodeling, chemical storage, water

P: past work

Exposures, farm work, military, volunteer, seasonal, length of work

A: activities

Hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines

R: referrals and resources

-Environmental Protection Agency

-National Library of Medicine - Toxnet Programs

-Agency for Toxic Substances and Disease Registry

-Association of Occupational and Environmental Clinics

-Occupational Safety and Health Administration

-EnviRN website

-Local Health Department

-Environmental Agency

-Poison Control Center

E: educate

Risk reduction, prevention, follow-up

exposure pathways

helps illustrate that proximity to a contaminant is not the deciding factor in determining its effect on humans

source of contamination

used to describe what the contaminants are and from where they originate

easy to identify (e.g., mercury coming from a former thermometer factory site)

source of contamination can come from...

point or non-point

point

one specific identified source

tanker truck carrying gasoline that crashed and spilled its contents into a pond

nonpoint

many diffuse sources

gasoline drips on parking lots and roads from thousands of cars

Environmental media and transport mechanism

include groundwater, surface water (lakes, ponds, rivers), air, surface soil, subsurface soil, sediment, and biota (plants and animals).

environmental media

the contaminant is in helps determine who is exposed and how they are exposed

transport mechanism

describe how the contaminant moves from the source to the point of exposure to people

point of exposure

where people come in contact with the contaminated medium, which may include food or another item

(home, a playground, a lake, a business, a cloud of diesel fumes, an abandoned lot, a fish to be eaten, or a park)

route of exposure

how the contaminant enters the body

(Environmental contaminants enter the body primarily by ingestion, inhalation, or skin contact)

Children have pica behaviors!!

receptor population

the population of people who are likely to be exposed

When thinking about populations, it is also important to think about what?

whether people are currently being exposed, whether people were exposed in the past, and whether people will continue to be exposed in the future.

toxicology

The study of the adverse effects of chemicals on people, animals, and the environment

exposure estimate

Estimated amount of contaminant that comes in direct contact with the body from inhalation, ingestion, dermal contact, or injection

bioavailability

The amount of a substance that is absorbed or becomes available at the site of physiologic activity

biomonitoring

Process of measuring contaminants in blood or urine to determine whether a person has been exposed to a contaminant and how much exposure he or she has received

proximity

how close you are to the toxin

interventions for exposure pathway

Break the exposure pathway

Health improvement, how many

Community satisfaction

Environmental justice

Cost and benefit

Sustainability

what to do if children are playing in an area with contaminated dirt or soil?

placing a fence around the site to keep them away from the site is a reasonable and likely successful intervention

environmental epidemiology

help determine whether the environment is affecting people's health

aspects of environmental epidemiology

Aligns with Nightingale's Theory

Focuses on the incidence and prevalence

Exposures in environment

Cancer is a frequent concern

what is a challenge in environmental epidemiology?

it is nearly impossible to create an experimental study that is generally considered the most conclusive form of epidemiologic study

other environmental epidemiology challenges

Limited contaminant data

Multiple contaminant exposure

Latency time

Time intensive

Resource utilization

Confounding variables

environmental impact on children's health

Body system development

Breathing zone- closer to the ground

Nutritional intake proportion

Contaminant excretion- less able to break down contaminant

Behaviors and risk

Outdoor risk exposure

primary level of environmental health intervention

education, advocacy

Educate to reduce environmental hazards

secondary level of environmental health intervention

surveillance, screening, early detection

tertiary level of environmental health intervention

education to prevent complications, resources

ANA standard 18

Environmental Health: The registered nurse practices in a manner that advances environmental safety and health.

equity

As applied to healthcare, the notion that healthcare does not vary in quality because of gender, race, age, ethnicity, geographic location, or socioeconomic status

mulilateral

Agencies that use both governmental and nongovernmental resources (World Bank)

bilateral

Refers to two agencies that conduct business within one country

Nongovernmental Organization (NGO)

Agency that acquires resources to help others from private (vs. public) sources (American Heart Association)

health care access data collection

Availability verus access

general/specializaed providers/attitude

benefits/cost

Vulnerable verus underserved

Health literacy

Cultural beliefs/values

Geographic isolation

Communication

microeconomic theory

examines individual preference and finances, and how those actions affect cost of care and resource distribution

macroeconomic theory

focuses on aggregate behaviors, economic growth and employment

rationing/specific insurance plans

Some providers ration health care, and only offer services to individuals with certain coverage types

Government involvement in financing

Providing direct health care services, providing information and protection to the public, setting policies, and assisting providers and the public with finances

World Health Organization (WHO)

Daily report international disease

Antibiotics/vaccines world standards

Health care workforce/education/primary prevention

Environment/Sanitation

Infectious diseases

Maternal/child health

Veterans Health Administration (VHA)

Finances health services for active and retired military persons and dependents (within the US Department of Veteran Affairs)

US Department of Health and Human Services (DHHS)

Under the direction of the Secretary of Health

Funded through federal taxes

DHHS consists of:

Administration for Children and Families (ACF)

Administration for Community Living (ACL)

Centers for Medicare and Medicaid Services (CMS)

Agency for Healthcare Research and Quality (AHRQ)

Centers for Medicare and Medicaid Services (CMS)

Administers the HIPAA, disability insurance, Aid to Families with Dependent Children (AFDC), and SSI

Centers for Disease Control and Prevention

Works to prevent and control disease, injury, and disability both nationally and internationally

Food and Drug Administration (FDA)

Works to ensure food safety as well as the safety and effectiveness of medications

National Institute on Health (NIH)

Supports biomedical research and includes the National Institute of Nursing Research

medicare eligibility

Must be older than 65 years and receiving social security

Have been receiving disability benefits for 2 years

Have amyotrophic lateral sclerosis and receive disability and benefits

Kidney failure/maintenance dialysis

Kidney transplant

part A of medicare

hospital care, home care, hospice, limited skilled care

part B of medicare

health care provider services, outpatient care, home health, diagnostic services, physiotherapy, durable medical equipment, ambulance service, mental health, preventative services

part C of medicare

Medicare Advantage plan: combination of Part A and B, provided through a private insurance company

part D of medicare

prescription medication coverage

medicaid eligibility

Household size

Income- low socioeconomic status

Priority (children, pregnant women, individuals with a disability)

medicaid coverage

Inpatient/outpatient hospital care/ home health care

laboratory/radiology services/vaccines for children

Family planning/pregnancy-related care

Early and Periodic screening, diagnosis, and treatment (EPSDT) services for those younger than 21 years

patient protection and affordable care act

Helps make affordable health insurance

Decreases federal spending on health care

Dependents can remain on parent's insurance until age 26

Prohibits denial of benefits for pre existing coverage to children under age 19

Bans lifetime limits on benefit coverage

Covers preventive care services

state departments of health

obtain funding from state legislature and federal public health agencies

example of state departments of health

Women, Infants, and Children (WIC)

Children's Health Insurance Program (CHIP)

State Board of Nursing

WIC

Promotes nutrition for women, infants, and children up to age five who are of low socioeconomic status

CHIP

Offers expanded health coverage to uninsured children whose families do not qualify for medicaid

what does the state departments of health do?

Establishes public health policies

Supports local health departments

Administers Medicaid

Reports communicable diseases to the CDC

state board of nursing

Development and oversight of the state's nurse practice act

Licensure of registered and licensed practical nurses

Oversight of the state's schools of nursing

local health department

receives funds from the state level to implement community level programs

what does the local health department do?

Work closely with local officials, businesses, and stakeholders

Report notifiable communicable disease to state departments of health

Funded through local taxes with support from federal and state funds

Identify needs of local community

financing health care

Health maintenance organizations

Organized insurance

Public funding

Individual payment

nursing interventions for healthcare financing

Assess to identify barriers

Cognizance of current standards and organizations that influence care

Implement collaboration with health entities on all levels

Promote distributive justice in the use of health care resources

Promote equity in health care delivery

Apply healthcare economic principles

poverty

Federal poverty level

Food

Shelter

Transportation

Clothes

Medical care

neighborhood poverty

Poor housing

Low employment rates

Increased disease /morbidity

Increased mortality

Extreme poverty leads to inadequate housing/homelessness