106 week 3 fundementals

Social Determinants and Health Disparities

• Health Disparities Framework

  • Concept: Intersectionality
  • Model examining marginalized groups and their access to care
  • Focuses on disparities between those with resources (the haves) and those without (the have-nots)

• Access to Healthcare

  • Factors: Money, transportation, knowledge, medical background, information
  • Implications: Limited access affects the level of care received by individuals without resources.

• Minimizing Disparities

  • Goals: To reduce the gap between those with healthcare access and those without.
  • Strategies: Increase presence of community centers and mobile healthcare units.

Social Determinants of Health

• Non-medical conditions affecting health outcomes
• Important to consider the intersection of oppression and cultural competence in nursing care.
  • Self-awareness of biases and attitudes toward patients
  • Successful patient care involves knowledge, skills, and a respectful attitude towards patients, regardless of perceived social status.

Understanding Intersectionality in Healthcare

• Contextual Patient Examples

  • 25-year-old Unhoused Hispanic Woman
  • Lives in transitional housing; limitations in managing diabetes due to lack of stable living conditions.
  • 85-year-old African American Retired Nurse
  • Knowledgeable but faces barriers to healthcare access due to rural living.
  • 32-year-old Lesbian Executive in San Francisco
  • Navigates identity conflicts in a supportive community but may face biases due to personal background.
  • Undocumented Eastern European Woman with a Disabled Child
  • Dual stress: caring for a child with disabilities while fearing deportation.

• Considerations in Cultural Competency

  • Recognize variations in health behavior and access to care.
  • Adapt healthcare approaches based on historical, cultural, and personal contexts of patients.

Cultural Competency in Care

• Defining Cultural Competence

  • Dynamic and fluid concept that evolves over time based on personal and patient histories.
  • Importance of understanding racial identity, ethnic culture, acculturation, and assimilation in patient contexts.

• Cultural Respect

  • Respecting patients' and families' individuality in care.
  • Acknowledging the interplay between culture and illness perception.

Models of Cultural Awareness

• Core Components of the Compina Bacobi Model
  • Cultural awareness: Self-examination of beliefs.
  • Cultural knowledge: Gathering information about the patient’s background.
  • Cultural skill: Communicating effectively and performing culturally-informed assessments.
  • Cultural encounter: Engaging appropriately with patients from diverse backgrounds.
  • Cultural desire: Willingness to provide high-quality care and learn about diverse cultures.

Using the LEARN Model for Patient Communication

• L: Listen to the patient’s concerns and experiences.
• E: Explain your understanding of the patient’s problems and needs.
• A: Acknowledge potential cultural differences.
• R: Recommend actions collectively with the patient’s input.
• N: Negotiate a care plan that respects both medical and cultural needs.

Assessing Cultural Competence

• Recognize continuous development of cultural competence:

  • Focus on education regarding diverse patient backgrounds.
  • Assessment findings, health literacy, and cultural beliefs are crucial for effective care.

• Language Barriers

  • Importance of providing information in languages understood by patients.
  • Utilize translation services to ensure accurate communication.

Stress and its Impact on Patient Care

• Physiological Response to Stress

  • General Adaptation Syndrome (GAS) has three stages:
  1. Alarm Stage: Activation of the sympathetic nervous system, release of stress hormones resulting in increased heart rate, blood pressure, and alertness, while appetite decreases and immune response is impaired.
  2. Resistance Stage: Body attempts to stabilize after initial stress; if successful, homeostasis is regained.
  3. Exhaustion Stage: Prolonged stress leads to physical breakdown and health issues such as hypertension and sleep disorders.

• Appraisal of Stress

  • Primary appraisal: Initial assessment of stressor's significance.
  • Secondary appraisal: Assessment of coping resources and options.

Coping Strategies for Nurses and Patients

• Nursing Considerations

  • Equip patients with healthy coping skills (exercise, relaxation techniques).
  • Assess for signs of stress and maladaptive responses such as denial, regression, or displacement.
  • Legal and ethical responsibility to ensure patient safety amid crises.

• Promoting Stress Management Techniques

  • Mindfulness: Encourage being present in the moment.
  • Guided imagery and progressive muscle relaxation: Techniques to reduce stress and anxiety.
  • Assertiveness training: Empower patients to communicate needs effectively.

Addressing Crises in Patient Care

• Types of Crises:

  • Developmental/Maturational Crisis: Issues related to life cycle transitions (e.g., aging, becoming a parent).
  • Situational Crisis: Events external to the individual (e.g., job loss, natural disasters).
  • Adventitious Crisis: Major social changes or events (e.g., pandemics, acts of violence).

• Intervention Strategies

  • Collaborative approach with interdisciplinary teams to manage stress and crises effectively.
  • Use assessment tools to gather comprehensive patient information to guide care planning and interventions.

Conclusion and Practical Applications

• Continuous Learning and Adapting

  • Cultural competence in nursing is a lifelong journey; recognize that every interaction is an opportunity for growth and learning.
  • Effective patient care requires being aware of and addressing both cultural factors and stress management strategies.

• Creating Supportive Environments

  • Encourage staff team-building activities to prevent burnout and promote resilience.
  • Implement policies that foster understanding, acceptance, and respect for diverse patient backgrounds.