NR222: Exam 2 Study Guide (Units 3, 4, and 5 Latest Update, Pass With A+)

NR222: Exam 2 Study Guide (Units 3, 4, and 5 Latest Update, Pass With A+).Health disparity  The second goal, eliminating health disparities, addressed the continuing problems of access to care; differences in treatment based on race, gender, and ability to pay; and related issues such as urban versus rural health, insurance coverage, Medicare and Medicaid reimbursement for care, and satisfaction with service delivery. (Edelman text book Unit 1 Foundations for Health Promotion Ch. 1 Objectives for Promotion and Prevention pg. 6)  Health disparities is an umbrella term that includes disparities in health care. It was defined by Healthy People 2020 as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage, and “health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender, age, mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion (U.S. Department of Health and Human Services, 2011)  Addressing health literacy and providing culturally sensitive health education are critical to reducing health disparities and achieving health equity. Health disparities are systematic, potentially avoidable health differences that adversely affect socially disadvantaged groups. Groups affected are those with characteristics such as race/ethnicity, skin color, religion, language, or nationality; socioeconomic resources or position; gender, sexual orientation, or gender identity; age; physical, mental, or emotional disability or illness; geography; political or other affiliation; or other characteristics that have been linked historically to discrimination or marginalization [(Braverman et al., 2011) Edelman text book Ch. 10 Health Education pg. 217]  Health Disparities and Health Care: Health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases, and related complications. On the other hand, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. [Fundamentals Ch. 9 Cultural Awareness Pg. 102] JM7/17  Poor access to health care is one social determinant of health that contributes to health disparities. Access to primary care is an important indicator of broader access to health care services. A patient who regularly visits a primary care provider is more likely to receive adequate preventive care than a patient who lacks such access. The 2013 National Healthcare Disparities Report (AHRQ, 2013a) revealed that African Americans, Asians, and Hispanics are less likely than non-Hispanic Whites to see a primary care provider regularly.  A similar disparity in access to care exists in other disadvantaged groups. Less care is available or accessible to people in low and middle- income groups compared with people in high-income groups. Uninsured people ages 0 to 64 are less likely to have a regular primary care provider than those with private or public insurance (AHRQ, 2013a). Research suggests that some subgroups of the LGBT community have more chronic health conditions & a higher prevalence & earlier onset of disabilities than heterosexuals  In addition to the poor access to health care, a large body of research shows that health care systems and health care providers can contribute significantly to the problem of health disparities. More than a decade ago, reports by the Institute of Medicine (IOM 2001, 2010) defined quality health care as care that is safe, effective, patient centered, timely, efficient, and equitable or without variation in outcomes as determined by stratified outcomes data. Although the U.S. health care system has improved in most of these areas since the IOM reports were published, the focus on the equity has lagged behind (Mutha et al., 2012). Inadequate resources, poor patient-provider communication, a lack of culturally competent care, fragmented delivery of care, and inadequate access to language services all compromise patient outcomes (NQF, 2012). As a result, many disparities in health care and health outcomes remain.  Disparities in access to care, quality of care, preventive health, health education, and available resources to enable self-management when patients are outside of the health care setting contribute to poor population health. Health disparities are also very costly. Recent analysis estimates that 30% of direct medical costs for Blacks, Hispanics, and Asian Americans are excess because of health inequities and that overall the economy loses an estimated $309 billion per year because of the direct and indirect costs of disparities Health equity The accomplishment of the highest level of health for all people. Health equity JM7/17  Attaining health equity requires valuing everyone equally with focused and ongoing societal efforts to deal with preventable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities  Although the diversity of the American population is one of the best assets for this country, one of the greatest challenges is reducing the disparity in health status of America’s racial and other health disparity populations. The U.S. Department of Health and Human Services (2011) and the Institute of Medicine (IOM, 2008) have well documented that racial and ethnic minorities, compared to Whites, have less access to health care, receive lower-quality health care, and have higher rates of illness, injury, and premature death. The issue of racial and ethnic health disparities has become one of the most urgent problems to plague the U.S. health care system.  Efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health. An individual’s ability to achieve good health could be affected because of race or ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic location. Folk healing Reflects belief, values, treatment of cultural group that are products of particular cultural development Nursing responsibilities when a client is using herbal remedies Education Being UnBias Ethnocentrism Practice of viewing other ways as inferior or unnatural Holism Incorporates family and support system in care Ethnocentric, emic, etic worldview Ethnocentric definition- views other ways as inferior, unnatural, or even barbaric, can serve as establishing and maintaining good working relationships with consumers of health care services JM7/17 Emic - pertaining to expressions, perceptions, beliefs, and practices that are specific to a given cultural system; an emic view of a cultural system is a description from the perspective of the participant in the system, rather than that of the observer. Etic worldview- involving analysis of cultural phenomena from the perspective of one who does not participate in the culture being studied How is the minority population changing? • The minority population is changing by becoming the majority. The influx of immigrants are causing the tables to turn. • , census data suggest, the U.S. 15-to-64 age group is expected to grow 42 percent. • By 2055, the U.S. will not have a single racial or ethnic majority. Much of this change has been (and will be) driven by immigration • African-American, Hispanic, Latino, Asian, Native American, and Alaska Native American adolescents are the fastest-growing segment in the U.S. population Unintentional injuries/suicide relating to emerging populations • Teenagers are most likely to commit suicide, due to their tendencies to be high risk takers. • Men die by suicide 3.5x more often than women. • Suicide is a major leading cause of death in adolescents 15 to 24 years of age (CDC, 2011) • Adolescents who believe that they have a homosexual or bisexual orientation often try to keep it hidden to avoid any associated stigma. This increases their vulnerability to depression and suicide. Cultural competence and considerations when caring for Native Americans, Hispanics, African Amer, Asian-Amer, Arab Americans, Jewish • Native Americans – In American Indian and Alaska Native populations, the infant mortality rate is 60% higher than in non-Hispanic Whites (OMH, 2014). In 2008 the infant mortality rate for African-American infants was more than twice the rate for non-Hispanic white infants. Native Americans encompass diverse tribal groups with differing practices, traditions, and ceremonies. Traditional Navajos do not touch the body after death. Care of the body in the large Navajo tribe includes cleansing the body, painting the deceased's face, dressing in clothing, and attaching an eagle feather to symbolize a return home. Mourners also have a ritual cleansing of their bodies. The dead are buried on the deceased's homeland JM7/17 • African Americans – African-Americans have the highest mortality rate of any racial and ethnic group for all cancers combined, contributing in part to a lower life expectancy for both African-American men and women. Care of the body after death depends on the AfricanAmerican's country of origin and degree of American acculturation. The presence of large extended family groups, including the church family, is common at time of death. The mourning period is relatively short, with a memorial service and a public viewing of the body or a wake before burial. Organ donation and autopsy are allowed. • Hispanics – Hispanic youths ages 2 to 19 are more likely to be overweight or obese than the non-Hispanic White or Black youths of the same age, which places them at a greater risk of developing a number of chronic diseases such as type 2 diabetes, high blood pressure, and asthma. Honoring family values and roles is essential in providing care and making decisions at the end of life. People in Hispanic and Mexican-American cultures often use special objects such as amulets or rosary beads, alternative healing practices (folk medicine), and prayer. Grief is expressed openly. Religious and spiritual rituals (predominantly Catholic) are essential at the end of life. Death is often believed to be the will of God • Asian Americans – Asian Americans generally have lower cancer rates than the nonHispanic white population, but they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Whites, or non-Hispanic Blacks. • Jewish- If the family practices Orthodox Judaism, determine if members from the Jewish Burial Society are coming to the facility before preparing the body. A family member often stays with the body until burial. Usually the burial occurs within 24 hours but not on the Sabbath. Some but not all types of Judaism avoid cremation, autopsy, and embalming • Arab Americans - , Arab women frequently do not have breast examinations, mammograms, and cervical cancer screening because of religious and cultural beliefs about modesty. Define/give examples of culture, acculturation, cultural competency, values, ethnicity, transcultural nursing  Culture is associated with norms, values, and traditions passed down through generations. It also has been perceived to be the same as ethnicity, race, nationality, and language. A more contemporary view of culture acknowledges its many other facets such as gender, sexual orientation, location, class, and immigration status.  acculturation Process of adapting to and adopting a new culture  Cultural competency is defined by the National Institutes of Health (2015) as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. Developing cultural competency allows systems, agencies, and groups of professionals to function effectively to understand the needs of groups accessing health information and health care and thus help eliminate health care disparities and ultimately health disparities.  Value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Inevitably you will work with patients and colleagues whose values differ from yours. To negotiate differences of value, it is JM7/17 important to be clear about your own values: what you value, why, and how you respect your own values even as you try to respect those of others whose values differ from yours.  ethnicity - Shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics  transcultural nursing - Distinct discipline developed by Leininger that focuses on the comparative study of cultures to understand similarities and differences among groups of people. Cultural knowledge, cultural skills, cultural encounters, cultural desire • cultural knowledge Obtaining knowledge of other cultures; gaining sensitivity to, respect for, and appreciation of differences. • cultural skills Communication, cultural assessment, and culturally competent care. • cultural encounters Engaging in cross-cultural interactions; refining intercultural 1311communication skills; gaining in-depth understanding of others and avoiding stereotypes; and managing cultural conflict. • Cultural desire: The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities. 1 st step to achieve cultural competence • Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. • Cultural competency is defined by the National Institutes of Health (2015) as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. Goals of health education The goal of health education is to help individuals, families, and communities achieve, through their own actions and initiative, optimal stages of health. Health education facilitates voluntary actions to promote health. Another important goal of health education is improving literacy. (Edelman Textbook Ch. 10 Health Education Goals pg. 217) Through health education, individuals can learn to make informed decisions about personal and family health practices and to use health services in the community. (Edelman Textbook Ch. 10 Health Education pg. 218) Patient education in Planning stage: After determining the nursing diagnoses that identify a patient’s learning needs, develop a teaching plan, determine goals and expected outcomes, and JM7/17 involve the patient in selecting learning experiences (see the Nursing Care Plan). Expected outcomes of an education plan are learning objectives. They guide the choice of teaching strategies and approaches with a patient. Patient participation ensures a more relevant, meaningful plan. (Potter. Fundamentals Ch. 25 Patient Education Goals and Outcomes Pg. 346) (Continued next paragraph). Goals and Outcomes. Goals of patient education identify what a patient needs to achieve to gain a better understanding of the information provided and better manage his or her illness (e.g., “achieves ostomy self-care”). Outcomes describe behaviors that identify a patient’s ability to do something on completion of teaching such as empties colostomy bag or administers an injection. When developing outcomes, conditions or time frames need to be realistic and meet he patient’s needs (e.g., “will identify the side effects of aspirin by discharge”). Consider conditions under which the patient or family will typically perform the behavior (e.g., will walk from bedroom to bathroom using crutches”). If possible, include the patient when establishing learning goals and outcomes and serve as a resource in setting the minimum criteria for success. (Potter. Fundamentals Ch. 25 Patient Education Goals and Outcomes pg. 346) Goals of health education The goal of health education is to help individuals, families, and communities achieve, through their own actions and initiative, optimal states of health. Another important goal of health education is improving health literacy. Health literacy is about communicating information clearly and understanding it correctly. It includes the ability to read, write, speak, listen, compute, and comprehend, and to apply those skills to health situations. The ability to communicate clearly with people from all literacy levels is an important component of personcentered quality and safety in health education. Health disparities are systematic, potentially avoidable health differences that adversely affect socially disadvantaged groups. Another goal of health education that may foster successful changes in health behavior is empowerment. People who believe that they can make a difference in health and who are involved in decision making are more likely to make changes. Two main objectives of health education and counseling are to change health behaviors and to improve health status. Steps in the teaching/learning process: identify examples The Joint Commission's Speak Up Initiatives helps patients understand their rights when receiving medical care (TJC, 2015b). The assumption is that patients who ask questions and are aware of their rights have a greater chance of getting the care they need when they need it. The program offers the following Speak Up tips to help patients become more involved in their treatment: • Speak up if you have questions or concerns. If you still do not understand, ask again. It is your body, and you have a right to know. • Pay attention to the care you get. Always make sure that you are getting the right treatments and medicines by the right health care professionals. Do not assume anything. JM7/17 • Educate yourself about your illness. Learn about the medical tests that are prescribed and your treatment plan. • Ask a trusted family member or friend to be your advocate (advisor or supporter). • Know which medicines you take and why you take them. Medication errors are the most common health care mistakes. • Use a hospital, clinic, surgery center, or other type of health care organization that has been checked out carefully. For example, TJC visits hospitals to see if they are meeting TJC quality standards. • Participate in all decisions about your treatment. You are the center of the health care team. In addition, patients are advised that they have a right to be informed about the care they will receive, obtain information about care in their 338preferred language, know the names of their caregivers, receive treatment for pain, receive an up-to-date list of current medications, and expect that they will be heard and treated with respect. Steps in the teaching/learning process: Identify examples (Box 10-6) STEPS IN THE TEACHING-LEARNING PROCESS (Textbook by Edelman Ch. 10 Health Education Pg. 222 in Teaching Plan.) 1. Assessment A. Learning Characteristics. B. Learning needs. 2. Development of expected learning outcomes. 3. Development of a teaching plan. A. Content. B. Teaching strategies, learning activities. 4. Implementation of the teaching plan. 5. Evaluation of expected outcomes. A. Achievement of learning outcomes. B. Evaluation of the teaching process. The process of generating a teaching plan helps the nurse recognize and use methods of learning that involve the individual as an active participant. The plan includes a list of specific actions or abilities that the person may perform at intervals during and at the end of the educational intervention. Teaching plans help nurses clarify these outcomes. Preparing a teaching plan involves the steps of the teaching-learning process outlined in Box 10-6. (Textbook by Edelman Ch. 10 Health Education Pg. 222 in Teaching Plan.) Examples: (From Textbook by Edelman Ch. 10 Health Education Pg. 223 in Teaching Plan.) Assessment of a learner can be accomplished by answering the following five questions: (Identify learning needs)  What are the characteristics and learning capabilities of the individual JM7/17  What are the learner’s needs for health promotion, risk reduction, or health problems?  What does the person already know and what skills can the person already perform that are relevant to the health needs?  Is the learner motivated to change any unhealthy behaviors?  What are the barriers to and facilitators of health behavior change? Development of expected learning outcomes. (Determine the expected learning outcomes of a health education intervention) The nurse answers the following questions:  What broad public health and social goals guide the proposed educational program?  What are the participant’s learning goals?  What does the learned need to know, do, and believe to progress through the behavior change process? Program goals: The program goals of a health education project reflect the desire to facilitate improvement in some health problem or social living condition. Program goals are broad statements on long-range expected accomplishments that provide direction; they do not have to be stated in measurable terms (Miller & Stoeckel, 2011) Learning goals: Learning goals are best established when the student and the nurse work together. These goals reflect the health behavior or health status change that the person will have achieved by the end of an educational intervention. Learning goals relate to the program goals. Learning objectives: Learning objectives indicate the steps to be taken by the individual toward meeting the learning goal and may involve the development of knowledge, skill, or change in attitude. Objectives are most useful when stated in behavioral terms and when they contain these components: the learner and a precise action verb that indicates what the learner will be able to do; the conditions under which the task is performed; and the level of performance expected (Bastable & Doody, 2008). Learning objectives guide the selection of content and methods and help narrow the focus of a teaching plan to more achievable steps; they also aid in setting standards of performance and suggesting evaluation strategies. The Development of the Teaching Plan, Content To select appropriate content for a health education program. The nurse considers what information, skills, and attitudes need to be taught and the level of learning to be achieved. Content is divided into three domains: Cognitive, psychomotor, and affective. Cognitive learning refers to the development of new facts or concepts and building on or applying knowledge to new situations. Example: Patient Dan will correctly select food choices based on this diabetic meal plan (measurable). Psychomotor learning involves developing physical skills from simple to complex actions. Example: Patient Dan will demonstrate proper technique and dosage when giving an insulin injection to himself. (measurable) JM7/17 Affective learning alludes to the recognition of values, religious and spiritual beliefs, family interaction patterns and relationships, and personal attitudes that affect decisions and problemsolving progress. Example: Patient Dan will verbalize the importance of checking his blood glucose level before each meal and at bedtime. (measurable) To learn or change a health behavior, a person may need to acquire new information, practice some physical techniques, and clarify the ways in which the new behavior may affect relationships with others. The nurse’s role is to select a combination of content from the three domains that is appropriate to meet the behavioral objective. To find samples of content for a teaching plan, the nurse researches resource materials, such as books, teaching guides, journal articles, pamphlets, and flyers created by nonprofit agencies and professional organizations. The nurse is careful about giving students materials with technical vocabulary that is too complex for the audience. Implementing the teaching Table 10-2 (pg. 224 Edelman Ch. 10 Health Education) Domain of Learning: Cognitive (thinking). Teaching strategies – Lecture, One-to-one instruction, Discussion, Discovery, Audiovisual or printed materials, Computer-assisted instruction. Domain of Learning: Affective (feeling). Teaching strategies – Role modeling, Discussion, Role playing, Simulation gaming. Domain of Learning: Psychomotor (acting). Teaching strategies – Demonstration, Practice, Mental imaging. Evaluation of expected outcomes Examples of desired outcomes for the following learning domains: Cognitive (thinking) – Describes and/or explains information relevant to the behavior change. Affective (feeling) – Expresses positive feeling, attitudes, values toward changing the behavior. Psychomotor (acting) – Demonstrates performance of skills related to the behavior change. Evaluating the teaching – learning process. The teacher can evaluate the learning, or measure achievement of learning objectives, in all domains using written or oral testing, demonstrations, observation, self-reports, and self-monitoring. Teaching methods for one domain may overlap those for another domain. Teaching is directed toward one or more of three learning domains: Cognitive, psychomotor, and affective. Examples of appropriate teaching strategies for each domain and the expected JM7/17 outcomes in relation to behavior change are summarized in Table 10-2 page 224. (Edelman. Ch. 10 Health Edu. Pg. 224 & pg. 225)