NSG505 EXAM 2

Campinha-Bacote's Process of Cultural Competence (model assumptions)

• health professionals do not assume they are already culturally competent

• cultural competence is viewed as an ongoing process

• there is a direct relationship between cultural competence of health professionals and ability to provide culturally responsive care

Components of Campinha-Bacote's Process of Cultural Competence

• cultural awareness

• cultural knowledge

• cultural skill

• cultural encounters

• cultural desire

cultural awareness (Campinha-Bacote's Process of Cultural Competence)

• self-examination and reflection

• exploration of own culture

• recognition of personal biases and assumptions

cultural knowledge (Campinha-Bacote's Process of Cultural Competence)

• general educational foundation about diverse cultures

• learning about individual family and/or aggregate health related beliefs and values

cultural skill (Campinha-Bacote's Process of Cultural Competence)

- ability to perform a culturally based health assessment

cultural encounters (Campinha-Bacote's Process of Cultural Competence)

- directly engaging in cross-cultural interactions

cultural desire (Campinha-Bacote's Process of Cultural Competence)

• desire to engage in the ongoing process to be culturally competent

• involves the concept of caring

• involves being open and willing to learn

Role of the PHN in Campinha-Bacote's Process of Cultural Competence

• develop a culture of self awareness

• cultivate cultural sensitivity

• assess the population's culture

• show respect and patience

• consider culturally derived health practices

Ethnocentrism

a preference for one's own culture and belief that one's culture of origin is the best approach to life

Ethnorelativism

seeing all behavior in a cultural context

Enculturation

the process of learning one's culture

culture

systems of values, beliefs, norms, shared traditions, foods that all guide people's lives; makes them diverse

• Determines some of our behaviors/outcomes 0 Informs basis of roles and norms

race

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

ethnicity

people with common origins and a shared culture and identity

Cultural Relativism

recognizing and respecting alternative viewpoints and understanding values, beliefs, and practices within their cultural context

Ecology

the study of the interactions and relationships between living organisms and their environments

Sustainability

• Protecting the environment and promoting healthy habits within the populations that we sustain and live in

• Think about strategies that are socially desirable, economically feasible, ecologically viable

Upstream Focus

• address the root causes that influence health at the institutional and system level rather than looking solely at healthy lifestyle issues

• taking an upstream approach to asthma prevention by working with legislators to strengthen ambient air quality polices

• laws and regulations

• social justice

• education systems

• health care systems

• social system

Environmental Justice

the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies

Precautionary Principle

In the absence of clear data to indicate the safety of an action/material for human use, it should not be used

Environmental Health Risks in the Home Environment

bleach tastes bad

Where Can Lead Be Coming From?

• lead based (chipping, peeling, etc) paint (houses built before 1978)

• water

• soil

• toys

• jewelry

• imported ceramics

• air

Indoor Asthma Triggers

• 2nd hand smoke

• mold

• dust mites

• pets

• pests

• volatile organic compounds (VOCs) (perfumes, cleaning products, etc)

Minimizing Indoor Asthma Triggers

• wash bedding regularly

• dust covers

• vacuum regularly

• washable plush toys

• keep pets outside (uhhh)

• keep pets outside of bedrooms of kids with asthma

• pets off furniture

• pet cages away from air vents

• wash hands after playing with pet

• limit use of perfumes/aerosols/VOCs

• fix leaky plumbing

• use exhaust fans

• vent dryers outside

Integrated Pest Management

an approach to minimize use of harmful pesticides

• dry them out (reduce water sources)

• starve them out (reduce food sources)

• keep them out (reduce entry and shelter)

• proper use of the least toxic pesticides

Barriers to Effective Communication

• Selective Perception

• Filtering

• Emotional Influence

• Language Barrier

• Language of Nursing

Selective Perception

• Individuals interpret a message through their own perceptions, which are influenced by their own experience, interests, values, motivations, and expectations.

• This perceptual screen leads to possible distortion or misinterpretation of the meaning from the sender's original intent.

• Nurses can overcome this barrier by using teach back to ask clients to voice their understanding of the message they just received from the nurse

Filtering

• manipulation of information by the sender in order to make it seem more favorable to the receiver

• dont sugar coat

Emotional Influence

- How a person feels at the time a message is sent or received influences the meaning

Language Barrier

• People interpret the meaning of words differently, depending on many variables, such as age, education, cultural background, and primary spoken language

• For example, an adolescent might understand the term "lit" to mean that something is good or exciting, whereas an 80 year-old person might understand the word refers to lighting

Language of Nursing

• The context of health care provides nurses with a unique vocabulary that may not be understood by clients, family, and community members.

• chill out with the jargon and abbreviations

Health Literacy

• understanding and completing complex daily medical regimens

• plan necessary lifestyle changes

• make informed health-related decisions

• know when to access health care

• address health issues in the community

Principles of Effecting Positive Change

• participation

• resistance to change

• proper timing

• interdependence

• flexibility

• self-understanding

participation (Principle of Effecting Positive Change)

people affected by change should participate in all parts of the change process

resistance to change (Principle of Effecting Positive Change)

• expect it

• understand challenges/barriers and encourage participation

proper timing (Principle of Effecting Positive Change)

Where and when does this particular activity make sense and will have the most engagement for implementing change

independence (Principle of Effecting Positive Change)

• change does not happen in a vacuum

• how will this change impact other parts of the system or individual's life?

flexibility (Principle of Effecting Positive Change)

be ready to adapt

self-understanding (Principle of Effecting Positive Change)

PHNs must understand our role in effecting change

Health Belief Model

the model predicts the likelihood a person will engage in health promoting behaviors based on:

• perceived benefits vs barriers

• perceived threats

• self-efficacy

• cues to action

components of the health belief model

modifying variables

• perceived benefit vs barriers

• perceived threat (consists of perceived seriousness and perceived susceptibility)

• self-efficacy (confidence in being able to perform the health behavior)

- cues to action (ex: health care referrals and recommendations, media attention)

- modifying variables + cues to action directly influence the likelihood of engaging in health-promoting behavior

Transtheoretical Model (Stages of Change)

- addresses change by anticipating relapses and recognizing those as opportunities to better plan for how to sustain the needed change in future attempts

consists of the following stages

• pre-contemplation

• contemplation

• preparation

• action

• maintenance

pre-contemplation stage (Transtheoretical Model)

• the person isn't considering changing their health behavior

• Not interested in making changes at this time; doesn't see it as an issue, "feels fine", not a concern

• No plan to make a change

contemplation stage (Transtheoretical Model)

• starts to notice that it may be an issue, but may not be ready to make that change yet

• Knows issue is there, it is a little worrying, but has so much going on that they can't imagine making the change

• The client may say, "I know I should probably try to quit smoking, but I am really stressed right now and can't think about it."

preparation stage (Transtheoretical Model)

• recognizes change may be helpful; starting to actively think about what change would look like for them in their life

• Preparing for the change, know it is an issue and is looking/thinking of ways to start that

• Start asking questions, engaging with family and friends who have done this change; looking for opportunities to talk about it

• Has not made the change yet

• All talk no action

action stage (Transtheoretical Model)

• The beginning of the behavioral change.

• The client sets a date to quit smoking, begins using a nicotine patch or medication, and finds replacement behaviors for smoking (e.g., using breath mints, exercising during usual smoking breaks).

• The client knows that this attempt may not be successful the first time and should be encouraged to acknowledge and plan for this.

maintenance stage (Transtheoretical Model)

• The behavior has been changed.

• The smoker has stopped smoking, but now needs to be vigilant in avoiding a relapse.

• The client needs a support system and rewards to encourage maintenance.

• If the client relapses, the PHN and others can help the client learn from this and begin their preparation and action stages again until longer periods of maintenance are achieved.

Types of Change

evolutionary
- gradual change over time

revolutionary
- rapid, abrupt change with little warning

planned
- purposeful, designed change efforts

Defining Family

A family refers to a group of individuals whose behaviors, actions, health conditions, and interrelationships impact the health of the group and the individuals

Universal Family Characteristics

every family is a small social system

• families are interdependent

• family boundaries

• energy exchange

• adaptive behavior

• goal oriented behavior

families go through life cycles

• expansion vs contraction

• family development tasks

family culture

• shared values

• roles

• distribution of power

family structure and function

• provide affection and security

• instill identity

• promote affiliation

• provide socialization

• establish controls

Anticipatory Guidance: Care of Families

• In general, family health visits are designed to educate, provide anticipatory guidance, and focus on health promotion or prevention.

• different levels/considerations of anticipatory guidance are needed at different stages of the family life cycle (this mainly revolves around childbearing and parental aging)

Family Health Practice Guidelines

• Work with the family collectively.

• Start where the family is.

• Adapt nursing interventions to fit the family

• Recognize the validity of family structural variations.

• Emphasize family strengths.

Traits Associated with Healthy Family Functioning

• healthy communication among family members

• enhancement of family member development

• effective structuring of family role relationships

• active coping effort

• healthy environment and lifestyle

• regular links with the broader community

steps when making the home health visit

• build rapport

• use acute observational skills

• help family focus/move towards goal

• review important points and highlight strengths

• plan for next visit

Interactional Framework (family home visit)

• Family as a unit of interacting personalities

• emphasis on communication, roles, conflict, coping patterns, and decision-making processes

• neglects interactions with the external environment

• how the family interacts with each other

structural-functional framework (family home visit)

family as a social system relating to other social systems in the external environment

developmental framework (family home visit)

• life-cycle perspective

• examination of members' changing roles and tasks in each progressive life-cycle stage

• integrates elements of interconnectional and structural-functional frameworks

4M framework

for older adults

• medications

• mentations

• mobility

• what matters

ecomap

• An eco-map shows the connections between a family and the other systems in the ecologic environment.

• It visually depicts dynamic family-environment interactions. A central circle represents the family or family member with smaller peripheral circles indicative of people and systems significantly relating to the central circle.

• Connecting lines between the central circle and smaller ones depict the strength of relationships.

Genogram

• The genogram diagrams the family's genealogy, relationships, and complex family patterns.

• The PHN can formulate hypotheses about a family over a significant period of time and across generations.

• Completing the genogram with the family encourages family expression, which can reveal family behavior and problems

• The genogram has been useful in linking health outcomes to preventive strategies based on potential health risks and guiding clinical and public health interventions

Home Health Nursing Caregiving Wheel

- a model to promote self-management within a family

hub
- promoting self management

spokes

• solving

• teaching

• mobilizing

• collaborating

• strengthening

rim
- detecting

- Car at bottom symbolizes locating, "finding the family" we're working with

disaster

any natural or manmade event that causes a level of destruction or emotional trauma exceeding the abilities of those affected to recover from without community assistance

natural disaster

A natural disaster is caused by natural events, such as earthquakes and tsunamis

manmade disaster

A manmade disaster is caused by human activity, such as mass shootings, the bombing of significant landmarks in major cities, or the riots in major cities after a sociopolitical event

multiple-casualty incident

If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident

mass-casualty incident

Although multiple-casualty incidents may strain the health care systems of small or midsized communities, a mass casualty incident—often involving many casualties—can completely overwhelm the health care resources of even large cities
- 100+ victims

Phases of a Disaster

• Pre-disaster

• Impact

• Heroic

• Honeymoon

• Disillusionment

• Reconstruction

Pre-disaster phase

• warning signs

• uncertainty

Impact phase of disaster

• the "oh shit" phase

• intense emotional reaction

Heroic phase of disaster

• Intense excitement and concern for survival.

• everyone doing whatever they can

Honeymoon phase of disaster

• community cohesion

• ex: applauding of HCWs during covid

• high emotions

Disillusionment phase of disaster

• "oh shit" part two

• its gonna be a long night

• emotional lows

Reconstruction phase of disaster

• Involves adjusting to a new reality and continued rebuilding of the area

• Counseling is sometimes needed

• Those affected begin looking ahead.

Phases of Disaster Management

• Prevention & Mitigation

• Preparedness

• Response

• Recovery

Prevention & Mitigation Phase of Disaster Management

• Activities during this phase are focused on preventing future emergencies or minimizing their effects.

• The shaping of public policies and plans that either modify the causes of disasters or mitigate their effects on people, property, and infrastructure are critical activities during this phase.

• Mitigation activities take place before and after disaster emergencies.

Preparedness Phase of Disaster Management

• Disaster preparedness involves improving community and individual reaction and responses, so that the effects of a disaster are minimized.

• Disaster preparedness includes plans for communication, evacuation, rescue, victim care, and recovery

Response Phase of Disaster Management

• The response phase begins immediately after the onset of the disastrous event and during the emergency.

• Response is putting your preparedness plans into action immediately, with the goals of saving lives and preventing further injury or damage to property.

• Activities during the response phase include rescue, triage, on-site stabilization, transportation of injured, and treatment at local hospitals and clinics.

Recovery Phase of Disaster Management

• During the recovery phase, the community joins together to repair, rebuild, or relocate damaged homes and businesses, and restore health, social, and economic vitality to the community.

• There will be many opportunities during this phase to enhance prevention and increase preparedness, thus reducing future vulnerabilities.

• Both survivors and relief workers may experience psychological trauma and should be offered mental health services to support their recovery

Primary Prevention of disaster management

• Primary prevention of a disaster means keeping the disaster from ever happening by taking actions that completely eliminate its occurrence—or, if that is not possible, to minimize damage through primary prevention.

• ex: disaster drills

Secondary Prevention of disaster management

• Secondary disaster prevention focuses on the earliest possible detection and treatment.

• After a disaster, the local health department's PHNs work with the American Red Cross to coordinate and provide emergency assistance.

• Secondary prevention corresponds to immediate and effective response.

Tertiary Prevention of disaster management

• Tertiary disaster prevention involves reducing the amount and degree of disability or damage resulting from a disaster.

• This level involves rehabilitative work and can help a community recover and reduce the risk of further disasters.

Host-Agent-Environment Model applied to Disasters

• Host Factors*

• The host is the human being who experiences the disaster.

• Host factors that contribute to the likelihood of experiencing a disaster include age, general health, mobility, psychological factors, and socioeconomic factors.

• For instance, older residents of a mobile home community may be unable to evacuate independently in response to a tornado warning if they can no longer drive

Agent Factors

• The agent is the natural or technologic element that causes the disaster.

• For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs

Environmental Factors

• Environmental factors are those that could potentially contribute to or mitigate a disaster.

• Common environmental factors include a community's level of preparedness; the presence of industries that produce harmful chemicals or radiation; the presence of flood-prone rivers, lakes, or streams; above-average amount of rainfall or snowfall; above-or below-average high or low temperatures; proximity to fault lines, coastal waters, or volcanoes; and the presence or absence of political unrest.

Mass Casualty Triage (including Simple Triage and Rapid Treatment [START])

• victims grouped into 4 categories

• the injured who could be helped by immediate transportation (red)

• the injured with less severe injuries whose transport could be delayed (yellow)

• those with minor injuries not requiring urgent care (green)

• the deceased, or soon to be (black)

Phases of disaster management planning related to public health department

prior to event

• situational awareness

• assessment of med/surge capacity

• city wide planning meetings

• event specific clinical planning

• communication redundancy checks