NR503 FINAL EXAM STUDY GUIDE 2024 GRADED A

NR503 FINAL EXAM STUDY GUIDE Review primary, secondary, & tertiary prevention practices, screening, vulnerable populations, and the role of the nurse practitioner. Week 5 (Ch. 2) 1. Discriminate populations at risk for development of chronic health conditions while associating the role of the Advanced Practice Nurse in levels of promotion. Common risk factors: unhealthy diet, physical inactivity, and tobacco use Childhood risk: There is now extensive evidence from many countries that conditions before birth and in early childhood influence health in adult life. For example, low birth weight is now known to be associated with increased rates of high blood pressure, heart disease, stroke and diabetes. Risk accumulation: Ageing is an important marker of the accumulation of modifiable risks for chronic disease: the impact of risk factors increases over the life course. Underlying determinants: The underlying determinants of chronic diseases are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, population ageing, and the general policy environment. Poverty: Chronic diseases and poverty are interconnected in a vicious circle. At the same time, poverty and worsening of already existing poverty are caused by chronic diseases. The poor are more vulnerable for several reasons, including greater exposure to risks and decreased access to health services. Psychosocial stress also plays a role. Preventative health actions are often categorized in three levels: ● Primary prevention - aims to prevent disease or injury before it ever occurs. ▪ This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. ▪ Nurses play the part of educators that offer information and counseling to communities and populations that encourage positive health behaviors ▪ Examples include: ● legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) ● education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) ● immunization against infectious diseases. ● Secondary prevention - aims to reduce the impact of a disease or injury that has already occurred ▪ This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. ▪ Nurses work with these patients to reduce and manage controllable risks, modifying the individuals’ lifestyle choices and using early detection methods to catch diseases in their beginning stages when treatment may be more effective. ▪ Examples include: ● regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) ● daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes ● suitably modified work so injured or ill workers can return safely to their jobs. ● Tertiary prevention - aims to soften the impact of an ongoing illness or injury that has lasting effects ▪ This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. ▪ Nurses are tasked with helping individuals execute a care plan and make any additional behavior modifications necessary to improve conditions ▪ Examples include: lOMoAR cPSD| ● cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) ● support groups that allow members to share strategies for living well ● vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible. ● Members of minorities are overrepresented on the low tiers of the socioeconomic ladder. Poor economic achievement is also a common characteristic among populations at risk, such as the homeless, migrant workers, and refugees. However, the APN should be able to distinguish between cultural and socioeconomic class issues and not interpret behavior as having a cultural origin when the fact is based on socioeconomic class. A good resource for APNs is the Cross-Cultural Health Care Program (CCHCP), which has a plethora of materials to improve cultural competency among healthcare providers, including a training program for healthcare providers. In order to provide appropriate healthcare interventions, culture and all its variants must be addressed. (p28)APRNs may be able to access health information needed by working together with other sectors outside of health, such as housing, labor, education, and community-based or faith-based organizations that offer services to immigrant communities. This involves the collection, documentation, and use of data that can be used to monitor health inequalities in exposures, opportunities, and outcomes. Examples of social determinants that are related to health inequalities include poverty, educational level, racism, income, and poor housing. These inequalities can lead to poor quality of life, poor self-rated health, multiple morbidities, limited access to resources, premature death, and unnecessary risks and vulnerabilities. (p25) APRNs can best determine the effectiveness of an intervention and long-term impact by focusing on an accurate assessment and interpretation of data that are generated or collected using individual, population, and community health indicators. (p27)APRNs can work in partnership with community members to identify what community members see as relevant and important, build social capital, use outcome data to advocate for changes in policy, and then continue to work in partnership to identify strategies to intervene, monitor,and improve those outcomes (p40-41)APRNs have numerous resources they can access to improve quality and timely access to quality healthcare and decrease health disparities. The National Partnership for Action (NPA) to End Health Disparities ( to mobilize individuals and groups to work to improve quality and eliminate health disparities. The National Priorities includes key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end-of-life care, care coordination, patient safety, and population health. The Quality Alliance Steering Committee is another partnership of healthcare leaders who work to improve healthcare quality and costs. Various strategies to bridge the gaps in healthcare quality are available at the national level and may be applied or considered at the state, regional, or local level in collaboration with stakeholders as a means of decreasing health disparities. (p43) APRNs are better prepared to develop effective interventions to eliminate or reduce health disparities. Such strategies may include advocating better health insurance coverage for poor and immigrant populations; ensuring that sufficient services exist in underserved areas; assessing the interaction among social environments, genetics, and population health; encouraging minority participation in research studies with community-based participatory research and specifically with practice-based research networks; using linguistically and culturally appropriate communication and written handouts; promoting and facilitating community partnerships; and implementing strategies to encourage people from minority populations to become healthcare professionals 2. Compare and contrast variables that differentiate those categorized at being at risk for marginalization of health care. Definition: when an individual or group is put into a position of less power or isolation within society because of discrimination ฀ Limits their opportunities and means for survival. When an individual is marginalized, they are unable to access the same services and resources as other people and it becomes very difficult to have a voice in society. Marginalization – major cause of vulnerability, which refers to exposure to a range of possible harms, and being unable to deal with them adequately. ● Variables: social class, race, homelessness, substance abuse, prison/offending, mental health problems, HIV positive ● Women are more likely to be marginalized than men, because of their gender. This is evident through the social, economic, and power imbalances that exist between men and women. For example, more women than men live in poverty, and men continue to have more secure, full-time jobs and higher income than their female counterparts. lOMoAR cPSD| ● A woman can also be marginalized because on her HIV status, or HIV risk. She may experience even more stigma if she is also a part of other marginalized groups in relation to her race or sexual orientation. For example, a woman is gay and an immigrant may also experience homophobia and racism. Those at risk for marginalization of health care include those without shelter in rural or urban areas, those living in remote parts of the country, families of lower socioeconomic status, disabled persons, recent immigrants and refugees, Indigenous populations, and seniors. Adequately identifying and gaining access to vulnerable communities are essential steps for the health system in order to recognize and address their unique health needs. Four dimensions that capture the principal determinants of health marginalization: residential instability, material deprivation, ethnic concentration, and dependency. (FYI: I couldn’t find this information in the text but I found it here communication. These include low health literacy, cultural barriers, and low English proficiency. The healthcare system is often confusing for individuals who are proficient in English but are not familiar with healthcare knowledge and terminology. One can imagine the synergistic effect of having low health literacy in addition to having inadequate English skills. The confluence can hinder optimal utilization of the healthcare system. (p28)Social determinants of health and inequalities data are areas that APRNs can also use to inform and guide their practice to develop socioculturally appropriate interventions. Social determinants that lead to health inequalities are recognized situations related to where people are born, grow up, work, live, and the systems of care available to them to deal with illness and disease….. Examples of social determinants that are related to health inequalities include poverty, educational level, racism, income, and poor housing. These inequalities can lead to poor quality of life, poor self-rated health, multiple morbidities, limited access to resources, premature death, and unnecessary risks and vulnerabilities. (p37) Disparities/inequity to be assessed by the following: • Race/ethnicity • Gender • Socioeconomic status • Disability status • LGBT status • Geography (p40) It is widely recognized now that the social determinants of health, such as housing, education, access to public transportation, access to safe water, access to fresh food, and the built environment, are all related to a population’s health. In addition to ethnicity, other characteristics also contribute to the presence of disparities or the achievement of good health such as gender, sexual orientation, geographic location, working environment, cognitive, sensory, or physical disability, and socioeconomic status. 3. How does culture influence the decisions a provider may make when selecting an intervention? Learning about one’s culture and assessing epidemiological patterns of health and illness across the life span facilitates the nurse practitioner's ability to focus on health initiatives and formulate plans of care leading to behavioral change and sustainable quality health and lifestyle outcomes. Religion, culture, beliefs, and ethnic customs can influence how pts understand health concepts, how they take care of their health, and how they make decisions related to their health. Without proper training, clinicians may deliver medical advice without understanding how health beliefs and cultural practices influence the way that advice is received. Asking about pts’s religions, cultures, and ethnic customs can help clinicians engage pts so that, together, they can devise treatment plans that are consistent with the pt’s values. Several models have emerged to assist healthcare providers to meet the challenge of providing culturally relevant care. Campinha-Bacote (2002) views cultural competence as an ongoing learning process as the providers continuously strive to achieve the best outcomes for patients, families, and populations. Culture is, "the practices, beliefs, values, and norms which can be learned or shared, and which guide the actions and decisions of each person in the group”. lOMoAR cPSD| Healthcare is not a “one-size-fits-all” profession. It is important to be sensitive to ways in which culture and faith impact patients’ healthcare experiences. One good place to start with all patients is to let them know that you want to make them comfortable and ask them what they need. An Health and disease denotes can vary from culture to culture. Therefore, there is a wide spectrum of what are considered appropriate interventions. Thus, culture influences the decisions a provider may make when selecting an intervention based on the cultures' perceptions of disease causation, symptomatology, and pathology. Care is provided with sensitivity and is based on the cultural uniqueness of clients. although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include. Although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include ● communication (verbal and nonverbal); ● personal space; ● social organization; ● time perception; ● environmental control; and ● biological variations. Several models have emerged to assist healthcare providers to meet the challenge of providing culturally relevant care. Macro-scale influences: Broad understandings of illness, suffering and healing, Social roles and the bureaucratic and economic context of health care services Micro-scale influences: Face-to-face interaction at front-lines, Successful and failed communication (week 5 lesson) The very essence of what health and disease denotes can vary from culture to culture. Therefore, there is a wide spectrum of what are considered appropriate interventions, which may not be compatible with Western medicine. Based on the cultures' perceptions of disease causation, symptomatology, and pathology, appropriate interventions may diverge from Western medicine's approach (Gesler & Kearns, 2002). The textbook provides many examples of the beliefs of direct cultures and the influence they play in healthcare. There are some long-standing health disparities in minorities. Minority health is often viewed as a variant form of Anglo-Protestant culture, with the scientific foundation and the principles of cause and effect as the basis of our healthcare. Cultural competence in nursing consists of four principles. ● Care is designed for the specific client. ● Care is based on the uniqueness of the person's culture and includes cultural norms and values. ● Care includes self-employment strategies to facilitate client decision making to improve health behaviors. ● Care is provided with sensitivity and is based on the cultural uniqueness of clients. 4. Explain how culture impacts provider attitudes? Does it? How will you assess your own attitudes about various cultures/races/groups? Bias can occur. Patients of color may be kept waiting longer for assessment or treatment than their White counterparts, or providers may spend more time with White patients than with patients of color. Racial/ethnic bias in attitudes, such as feeling that White people are nicer than Black people, whether conscious or not, can lead to prejudicial behavior, such as providers taking more time with White patients than Black patients and therefore learning more about the White patients’ needs and concerns. Assess your current level of cultural competence (what knowledge, skills, and resources can you build on? Where are the gaps?) One can take a test to learn more about one’s own bias. Demonstrating awareness of a patient’s culture can promote trust, better health care, lead to higher rates of acceptance of diagnoses and improve treatment adherence. Health professionals may view clients or patients who are culturally different from themselves as unintelligent or of differing intelligence, irresponsible, or disinterested in their health By assessing community, aggregate, family, and individual factors and conditions that have a strong influence on health, APRNs are better equipped to deliver effective and evidence-based care. Identifying population-level healthcare needs and healthcare disparities can help to improve equality in health outcomes at all levels. attitude of openness and acceptance will do wonders. lOMoAR cPSD| The APN will assess their own attitudes by cultural awareness, cultural humility, cultural knowledge, cultural skill and cultural desire. Without this reflection and evaluation of our world cultural beliefs and practices, the nurse will be influenced subconsciously. Cultural Awareness Self-examination of one's own prejudices and biases toward other cultures. An in-depth exploration of one's own cultural/ethnic background. Cultural Humility A lifelong commitment to self-evaluation and self-critiques, redressing the power of imbalances in the patient- physician dynamic, developing mutually. Beneficial relationships. Cultural Knowledge Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism. Cultural Skill Ability to collect culturally relevant data regarding the client's health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner. Cultural Desire Motivation of the healthcare provider to "want" to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commitment and passion to caring, regardless of conflict. The APN must be cognizant of his or her own cultural beliefs and the attitudes he she inherently has about other cultures. Without this reflection and evaluation of our world cultural beliefs and practices, the nurse will be influenced subconsciously. Culture can impact provider attitudes if the provider is not cognizant of their own beliefs. Culture does impacts providers attitudes. This is because providers are forced to learn cultural competence (which is the ability of the practitioner to bridge cultural gaps in caring and to work with cultural difference, enabling the family and patient to receive meaningful and supportive care). Cultural competence consists of the following principles; • Care is designed for the specific client. • Care is based on the uniqueness of the person's culture and includes cultural norms and values. • Care includes self-employment strategies to facilitate client decision making to improve health behaviors. • Care is provided with sensitivity and is based on the cultural uniqueness of clients. Assess own attitude: • communication (verbal and nonverbal); • personal space; • social organization; • time perception; • environmental control; and • biological variations. (wk 5 lesson) A good resource for APNs is the Cross-Cultural Health Care Program (CCHCP), which has a plethora of materials to improve cultural competency among healthcare providers, including a training program for healthcare providers. In order to provide appropriate healthcare interventions, culture and all its variants must be addressed. The APN must be cognizant of his or her own cultural beliefs and the attitudes he she inherently has about other cultures (Williamson, 2007) Without this reflection and evaluation of our world cultural beliefs and practices, the nurse will be influenced subconsciously. 5. Review the terms for this week and apply them to population health; for instance: cultural competence, cultural awareness, norms, values, Kleinman Explanatory Model, socioeconomic status, disparities, minorities, food dessert. Cultural competence: Respect for, and understanding of, diverse ethnic and cultural groups, their histories, traditions, beliefs, and value systems. Care is designed for the specific client. Care is based on the uniqueness of the person's culture and includes cultural norms and values. Care includes self-employment strategies to facilitate client decision making to improve health behaviors. Care is provided with sensitivity and is based on the cultural uniqueness of clients. Care is designed for the specific client. Care is based on the uniqueness of the person's culture and includes cultural norms and values. Care includes self-employment strategies to facilitate client decision making to improve health behaviors. Care is provided with sensitivity and is based on the cultural uniqueness of clients. lOMoAR cPSD| “Dynamic, fluid, continuous process whereby an individual, system or health care agency find meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they render care” The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Respect for, and understanding of, diverse ethnic and cultural groups, their histories, traditions, beliefs, and value systems Cultural competence in nursing consists of four principles. o Care is designed for the specific client. o Care is based on the uniqueness of the person's culture and includes cultural norms and values. o Care includes self-employment strategies to facilitate client decision making to improve health behaviors. o Care is provided with sensitivity and is based on the cultural uniqueness of clients. Cultural Awareness: Self-examination of one's own prejudices and biases toward other cultures. An in-depth exploration of one's own cultural/ethnic background. The ability and willingness to objectively examine the values, beliefs, traditions and perceptions within our own and other cultures Norms: Something that is usual, typical, or standard. a standard or pattern, especially of social behavior, that is typical or expected of a group. Customary rules of behavior that govern our interactions with others. Something that is usual, typical, or standard within a population. Cultural norms are the standards we live by. They are the shared expectations and rules that guide the behavior of people within social groups. Cultural norms are learned and reinforced from parents, friends, teachers, and others while growing up in a society. Cultural norms are the standards we live by. They are the shared expectations and rules that guide behavior of people within social groups. Cultural norms are learned and reinforced from parents, friends, teachers and others while growing up in a society. Norms often differ across cultures, contributing to cross-cultural misunderstandings. Value: The degree of importance of something. a person's principles or standards of behavior; one's judgment of what is important in life. Personal principles or standards of behavior; one's judgment of what is important in life The commonly held standards of what is acceptable or unacceptable, important or unimportant, right or wrong, workable or unworkable, etc., in a community or society. Something is held to deserve; the importance, worth, or usefulness of something within a population. Cultural values are beliefs of a person or social group in which they have an emotional investment (either for or against something). Core principles and ideals upon which an entire community exists. This is made up of several parts: customs, which are traditions and rituals; values, which are beliefs; and culture, which is all of a group's guiding values. APRNs must understand cultural values and work with the patient to not go against the values while developing care interventions Kleinman Explanatory Model: Gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Proposes that individuals and groups can have vastly different notions of health and disease. Instead of simply asking patients, “Where does it hurt,” the physicians should focus on eliciting the patient’s answers to “Why,” “When,” “How,” and “What Next.” Kleinman suggests the following questions to learn how your patient sees his or her illness: 1. What do you think caused your problem? 2. Why do you think it started when it did? 3. What do you think your sickness does to you? 4. How severe is your sickness? 5. Do you think it will last a long time, or will it be better soon in your opinion? 6. What are the chief problems your sickness has caused for you? 7. What do you fear most about your sickness? 8. What kind of treatment do you think you should receive? 9. What are the most important results you hope to get from treatment? 10. What do you call your problem? Socioeconomic status: Social standing or class of an individual or group. An economic and sociological combined total measure of a person's work experience and of an individual's or family's economic and social position in relation to others, based on income, lOMoAR cPSD| education, and occupation. Examinations of socioeconomic status often reveal inequities in access to resources, plus issues related to privilege, power and control Disparities: Health disparities can be defined as the differences identified in incidence or prevalence of factors. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, gender, sexual identity (LGBT), age, disability, socioeconomic status, low health literacy, cultural barriers, and low English proficiency, and geographic location all contribute to an individual’s ability to achieve good health. Numerous dimensions of disparities (or differences) related to health that can adversely affect groups of people because of specific characteristics or obstacles. ● Determinants of health cause disparities (environment, housing, education, access to transportation, safe water, fresh food) ● Ethnicity and other characteristics also contribute to the ● presences of disparities (or achievement of good health) o Gender o Sexual orientation o Geographic location o Working environment o Cognitive, sensory, physical disabilities o Socioeconomic status ** Population health will focus on disparities in the hopes to bridge the gap and locate methods and interventions to reach populations with numerous health disparities. Other disparities that America is facing include; low health literacy, cultural barriers, inability to read and understand english (results in subpar health communication). APRNs have access to resources to decrease health disparities… ● The National Partnership for Action (NPA) to End Health Disparities o Mobilizes individuals and groups to work to improve quality and elimination of health disparities ● The national Priorities partnership o Key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end of life care, carae coordination, patient safety, and population health. ● The quality alliance steering committee o Work to improve healthcare quality and costs ● Office of Minority Health and Health Disparities (OMHD) house within the CDC o Resources may be used by the APRN to obtain data that demonstrate how minority population compare with the US population as a whole Health disparities are deplorable, and effective strategies to reverse the trend is needed. A multidimensional approach is needed and a history of institutionalized racism and individual racism that is embedded in every aspect of life of ethnic minorities must be recognized and addressed. APRNs can health by: ● Cultural competency training ● Communication improvement between patients and providers ● Improve community relations ● Adherence to nondiscriminatory health policies is also necessary ● Advocating better health insurance for the poor or immigrants ● Ensuring enough services exists in underserved areas ● Using Genetics Minorities: A group of people who are different from the larger group in a country, area, etc. A part of a population differing from others in some characteristics and often subjected to differential treatment. Can cause health disparities. Possess ethnic, religious, or linguistic characteristics differing from those of the rest of the population. Show, if only implicitly, a sense of solidarity directed towards preserving their distinctive collective identity. lOMoAR cPSD| Anglo-American Cultural Values Selected Minority Values Personal control over environment Fate Change Tradition Time dominates Human interaction dominates Human equality Hierarchy, rank, status Individualism, privacy Group welfare Self-help Birthright and inheritance Competition Cooperation Future orientation Past orientation Action goal: work orientation "Being" orientation Informality Formality Directness, openess, honesty Indirectness, ritual "face" Practicality, efficiency Idealism, theory Materialism Spiritualism, detachment Food Dessert: Food deserts describes neighborhoods and communities in parts of the country especially one with low-income residents, that have limited access to affordable and nutritious foods such as fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is largely due to a lack of grocery stores, farmers’ markets, and healthy food providers. A part of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is largely due to a lack of grocery stores, farmers’ markets, and healthy food providers Cultural humility: A lifelong commitment to self-evaluation and self-critiques, redressing the power of imbalances in the patient- physician dynamic, developing mutually. Beneficial relationships. Cultural knowledge: Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism. Cultural skill: Ability to collect culturally relevant data regarding the client's health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner. Cultural desire: Motivation of the healthcare provider to "want" to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commitment and passion to caring, regardless of conflict. Ethnicity: "the aggregate of cultural practices, social influences, religious pursuits, and racial characteristics shaping the distinctive identity of community" Race: a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings) Nationality: country of birth, or the ancestors' country of birth. Accommodation: To create an environment that accommodates health practice and ritual from other cultures within a plan of care. lOMoAR cPSD| Acculturation: Degree two which an individual from one culture has given up the traits of that culture and adopted the traits of the dominant cultural in which they now reside Assimilation: The social, economic, and political integration of a cultural group into a mainstream society to which it may have emigrated. 6. What are the social determinants of health? How does a provider integrate knowledge of these social determinants of health into their practice? Why are they important? Social determinants of health are economic and social conditions that influence the health of people and communities. They the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, housing, education, neighborhood, physical environment, employment, social support networks, access to public transportation, access to safe water, access to fresh food, as well as access to health care. They must be considered when interpreting epidemiological data on health disparities. In addition to ethnicity, other characteristics also contribute to the presence of disparities or the achievement of good health such as gender, sexual orientation, geographic location, working environment, cognitive, sensory, or physical disability, and socioeconomic status. Advocate for minority groups by: Monitor for potential differences among groups to recognize why and where population disparities are occurring; work in partnership with others to develop creative strategies to reduce the disparities and improve health equities, Review the literature and other resources for strategies that work in other parts of the county that could be considered at the state, regional, or local level, collaborate with local stakeholders, and create community partnerships. The outcomes identified in the objectives of Healthy People 2020 are intended to improve the health of all groups of people and bridge those gaps. Healthy People 2020 will assess health disparities in U.S. populations in future years by tracking morbidity and mortality outcomes in relation to factors found to be associated with disparities. Current census data indicate that many culturally diverse patient populations, as well as low-income families of whatever race or ethnicity, tend to be in poorer health than other Americans. Providers can make use of data from Social determinants of health and inequalities to inform and guide their practice to develop sociocultural appropriate interventions. Demographic factors can be monitored through HP2020 (Race and ethnicity, Gender, Sexual identity and orientation, Disability status or special healthcare needs, & Geographic location <rural and urban>). This is important bc addressing social determinants of health is a primary approach to achieving health equity. Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care. APRNs can use this information from social determinants of health to advocate improved health policy and additional resources, or to develop innovative interventions. 7. Apply social justice theory to the provision of care; what does social justice mean when applied to health care? Social Justice Theory- addresses the availability of equal access to healthcare to all individuals and speaks to equal quality of care without prejudice. NPs should incorporate social justice and the ANA Ethical Statements to guide practice. Social justice is the view that everyone deserves equal rights and opportunities —this includes the right to good health. These inequities are the result of policies and practices that create an unequal distribution of money, power and resources among communities based on race, class, gender, place and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health AND equity. Social justice is the view that everyone deserves equal rights and opportunities and this includes the right to good health. In the context of health and health care, social justice means believing that everyone ought to be able to avoid preventable disease and escape premature death. often, gross inequities causes some group of people succumb to disease and death disproportionately, while others’ advantages protect them, due to disparities in health care provision, political persecution, social strife, racial discrimination, and a plethora of other factors. 8. What data sources are used to assess determinants of health? • Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool. • Surveillance and service provision data • Housing and labor data lOMoAR cPSD| • Policy data • gender equity data • Cross Cultural Health Care Program (CCHCP) • The National Partnership for Action (NPA) to End Health Disparities • The National Priorities Partnership • The Quality Alliance Steering Committee • the Association of American Medical Colleges • The State of Health Equity Research: Closing Knowledge Gaps to Address Inequities • Another resource available to APRNs can be found at Quick Health Data Online • The CDC, WHO and Healthy People 2020 also provide useful information on determinants of health. Week 6 (Ch. 3) 1. Construct intervention plans related to a chronic health problem that integrates awareness of genetic implications. 2. Integrate risk / screening as it applies to genetics? Gathering three generations of family history will help determine a patient’s risk for developing cancer. For example, if there is a family history of breast cancer this patient has a higher risk for developing breast cancer. The FNP should counsel the patient on risk factors and way to reduce their risk of developing cancer, making lifestyle choices. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies Risk terminology ● Absolute risk is the probability of an event, such as illness, injury, or death ● Absolute risk gives no indication of how its magnitude compares with others. ● The odds ratio closely approximates the relative risk if the disease is rare. ● Odds ratio and the relative risk are used to assess the strength of association between risk factor and outcome. ● Attributable risk is used to make risk-based decisions for individuals. ● Population-attributable risk measures are used to form public health decisions Genetics is the study of individual genes and their impact on relatively rare single gene disorders. Family history of diseases sometimes put a person at higher risk for having a health condition. It is important for people to understand their genetics so they know what diseases they are at risk for. Screening can be done to high risk populations to help diagnose an illness early enough to prevent a poor outcome. For example. Colonoscopies are recommended for individuals 50 and over. However, if a person has a family history of colon cancer. They may be urged to start screenings earlier. 3. What is genetic risk assessment? How is it determined? A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge, they need to make appropriate screening, prevention and lifestyle management decisions. This is not a test for cancer: it is a test that can tell you if a higher risk for breast, ovarian or colorectal cancer runs in your family. Family history is a valuable tool. Genetic (inherited) factors can contribute to the development of many diseases, and those at risk can often be identified early if information is collected, shared, and interpreted correctly. Conducting an accurate family history for three generations can reveal a wealth of information on which to base prevention strategies. If the information collected is used to counsel individuals on how to decrease risk with lifestyle modifications (before the patient has the disease) then the utilization of the family history would be considered a primary intervention. For example, if the family history identifies an increased risk for breast cancer, the patient is counseled to modify lifestyle choices to minimize risk. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies (Spector et al., 2009). Many experts recommend that genetic testing for cancer risk should be strongly considered when all three of the following criteria are met: The person being tested has a personal or family history that suggests an inherited cancer risk condition, The test results can be adequately interpreted (that is, they can clearly tell whether a specific genetic change is present or absent), & The results provide information that will help guide a person’s future medical care. ● Genetic risk is the contribution our genes play in the chance we have of developing certain illnesses or diseases. Genes are not the only deciding factor for whether or not we will develop certain diseases and their influence varies depending on the disease lOMoAR cPSD| ● Etiological theory and empirical evidence indicate that large numbers of environmental and genetic factors contribute to common diseases. genetics can provide probabilistic information about risk. Current genetic discoveries may already furnish enough information to make incremental improvements in clinical risk assessments of adults ● Genetics may provide a window into clinical heterogeneity: genetic information may be useful in understanding differences in the timing of onset, rate of progression, persistence, comorbidity, and response to treatment. ● . At the population level, genetics can help to identify groups susceptible to developing a particular health problem. ● Genetics can contribute to composite risk assessments that identify high- and low-risk segments of the population. Background genetic risk information can, in turn, inform investigations of other risk factors or of prevention ● A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge they need to make appropriate screening, prevention and lifestyle management decisions. Genetic testing analyzes your DNA to detect specific, inheritable, disease-related gene mutations that may increase the risk of certain cancers. It provides you with an in-depth cancer risk assessment. 4. Explore and integrate genetic terminology, for example: Genomics, pharmacogenomics, genetic epidemiology. Also, refer to HP2020. ● Genomics- The study of all genes in the human genome as well as their interaction with other genes, the individual’s environment, and the influence of cultural and psychosocial factors. ● Genetics- The study of individual genes and their impact on relatively rare single gene disorders. ● Pharmacogenomics- The study of how genes affect a person's response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person's genetic makeup. One of the additional responsibilities when possessing prescriptive authority is the necessity of having a thorough knowledge of pharmacogenomics. It has been acknowledged that the effect of medications has a range of therapeutic and nontherapeutic responses. Age, weight, ethnic background, and physiologic impairments associated with disease processes were often concomitant with these variations. Due to the recent genomic research, it is now acknowledged that genetic variations can affect mediation efficacy, toxicity, and drug interaction outside of the drugs themselves ● Genetic Epidemiology- The link of epidemiology and genetics. Focuses on the risk of developing the disease, in populations that have a genetic basis, and is now recognized as a component of risk analysis. This chance of developing a disease, in the absence of other risk factors, gives credence to the potential of a genetic etiology ● Healthy People 2020- genomics plays a role in nine of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes and Alzheimer’s disease. In addition, over 1,000 genetic tests were developed to facilitate diagnosis. ● Pedigree: A graphic illustration of a family health history for three generations 5. What are the components of a genetic risk assessment? A genetic evaluation includes: ● Medical history: A detailed review of your personal and family medical history and a counseling session is completed to determine your risk of developing cancer, the appropriate medical management, and if genetic testing is recommended to help clarify your cancer risk. ● Testing: Genetic testing is analysis of a person’s genes (usually through a blood sample) to determine if you have a change in a gene, called a mutation, that increases the risk for cancer. A small blood sample is analyzed, looking for a change or mutation in the gene. Insurance companies typically cover the cost of testing if you have a personal or family history that is concerning for a hereditary cancer. Cost and insurance coverage for testing are discussed during your evaluation. ● Counseling: Following the testing, you’ll receive comprehensive counseling based on your test results and family history. For those who are found to have a gene mutation or are at a higher risk of cancer, options for next steps are discussed. ● Next steps: If you have a gene mutation and a higher risk of cancer, we’ll discuss your prevention options, which can include surveillance or prevention tactics. A patient’s choice is strictly a personal decision. Genetic counseling and testing provide the tools you need to make informed decisions. ● Family Risk: If you test positive for a mutation, we encourage your other family members to be tested as well. The information from genetic counseling and testing enables family members to make decisions that could save their lives. It also can tell family members that they do not have the mutated gene. People with a personal or family history of any of the following genetic risk factors should consider genetic testing ● pre-menopausal breast cancer (under age 50) ● ovarian cancer at any age, especially if there are also cases of breast cancer in the family lOMoAR cPSD| ● male breast cancer ● both breast and ovarian cancer in the same person ● two primary breast cancers in an individual ● two or more breast cancers in a family, one under age 50 ● a previously identified mutation in the family ● ethnic background (Ashkenazi Jewish) ● colorectal cancer diagnosed before age 50 ● a history of colon, endometrial and other cancers (including ovarian, stomach, kidney, brain) in the family ● history of multiple colon polyps (greater than 20 altogether) ● history of childhood or rare type of cancers in the family The benefit of doing early on allows for more frequent screening tools at a younger age, preventative surgery can be performed, and treatment plans can also be made. Risk assessment constitutes an essential component of genetic counseling and testing, and the genetic risk should be estimated as accurately as possible for individual and family decision making. All relevant information retrieved from population studies and pedigree and genetic testing enhances the accuracy of the assessment of an individual's genetic risk. Risk assessment is an essential part of genetic testing and counseling, and should be calculated as accurately as possible to enable both the clinician and the patient (or his/her family) to make decisions. An individual's genetic risk refers to the probability of the individual carrying a specific disease-associated mutation, or of being affected with a specific genetic disorder. The calculation of genetic risk should incorporate all available information at a particular point in time, such as the results of genetic testing (mutations, polymorphic markers); the presence of an independent risk factor derived from genetic test results; genetic test results on either or both parents, siblings, and close relatives (the probability of carrying a particular mutation or mutations often differs considerably among families and even among individuals within the same family); the ethnic background of each parent; an overall mutation rate for each ethnicity; and, if possible, the frequency of mutation in the population. Risk assessment should be looked at as an ongoing process of analysis of estimates. Risk assessment should be looked at as an ongoing process of analysis of estimates. A good example of genetic risk variation between ethnic groups has been described for cystic fibrosis. Cystic fibrosis is caused by mutations in the cystic fibrosis transmembrane conductance regulator gene . The disease-allele distribution of the CFTR gene varies greatly among different ethnic groups, leading to different inputs when calculating risk of disease. When looking at the genetic risk for a determined population, attention should be brought to the possible misrepresentation of experimental data such as the allelic bias introduced by migrating populations, the study settings that established the genetic association (moment of diagnosis of a certain condition in a population and time of the genetic study), environmental factors, misclassification of outcome. Generally, genetic risk assessment has been largely focused on the evaluation of risk in Mendelian disorders, where a disease-causing mutation in a single gene has high penetrance, producing an observable, often profound effect on phenotype. 6. Can you discuss the interplay between genetics and the environment, how do they influence one another? Do they? Genetics and the environment are still in the beginning phases of exploring the possibilities. Attributable risk descriptors are often utilized to express the combination of genetic susceptibility enhanced by environmental risk factors. An example given between genetics and the environment is illustrated by PKU, a known autosomal recessive disease that prevents the metabolism of phenylalanine. Once phenylalanine is ingested the body is unable to metabolize and hyper-phenylalanine occurs which destroy brain matter. Once this was researched it was noted by limiting phenylalanine in the diet decreased the risk for developing mental retardation. The environment and genetics to influence one another as provided with the example above. All traits depend both on genetic and environmental factors. Heredity and environment interact to produce their effects. This means that the way genes act depends on the environment in which they act. In the same way, the effects of environment depend on the genes with which they work. For example, people vary in height. Although height is highly heritable , environmental variables can have a large impact. For example, Japanese-Americans are on the average taller and heavier than their second cousins who grew up in Japan, reflecting the effect of environmental variables, especially dietary differences. Phenylketonuria (PKU) is an excellent example of environmental modification of a genetically controlled effect. PKU is a form of mental retardation that results from toxic (~damaging) effects of abnormal breakdown of the essential amino acid, phenylalanine, which is found in all protein. The enzyme that breaks down phenylalanine is defective, so it accumulates and breaks down abnormally. So in PKU, a single gene can dramatically affect behavior: it is clearly a genetically influenced process. Genes alone do not determine our futures—environmental factors and chance also play important roles. Genetic variants that have evolved in one set of circumstances to be beneficial or neutral can be quite detrimental in other conditions. For example, many aspects lOMoAR cPSD| of our metabolism evolved under conditions where calories were hard to come by. Now, in the environments of rich nations where calories are all too easy to acquire, these genetic factors contribute to obesity and other detrimental health effects. Sometimes, sensitivity to environmental risk factors for a disease are inherited rather than the disease itself being inherited. Individuals with different genotypes are affected differently by exposure to the same environmental factors, and thus gene–environment interactions can result in different disease phenotypes. For example, sunlight exposure has a stronger influence on skin cancer risk in fair-skinned humans than in individuals with darker skin. 7. What is the Genetics Nondiscrimination Act? The Genetic Information Nondiscrimination Act (GINA) of 2008 protects Americans from discrimination based on their genetic information in both health insurance (Title I) and employment (Title II). GINA prohibits health insurers from discrimination based on the genetic information of enrollees. Specifically, health insurers may not use genetic information to make eligibility, coverage, underwriting or premium-setting decisions. Furthermore, health insurers may not request or require individuals or their family members to undergo genetic testing or to provide genetic information. As defined in the law, genetic information includes family medical history, manifest disease in family members, and information regarding individuals' and family members' genetic tests. It prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future, and it bars employers from using individuals' genetic information when making hiring, firing, job placement, or promotion decisions. Genetics Information Nondiscrimination Act (GINA) was passed to offer some protection against the potential misuse of genetic information. However, it is important to note this nondiscrimination law does ***NOT cover life insurance, disability insurance, and long-term care insurance or the Military Health Service, Indian Health Service, or United States Department of Veteran’s Affairs. GINA makes it against the law for health insures to request, require, or use genetic information to make decisions about: eligibility for health insurance, your premiums and contribution amounts or coverage terms. It is also against the law to deny or request the genetic test result, they also cannot consider it a pre-existing condition or require that you obtain a genetic test, they are not able to discriminate against you. Called Gina is a federal law from 2018 that protects individuals from genetic discrimination in health insurance and employment. Gina makes it against the law for health insurers to request, require, or use genetic information to make decisions about one’s eligibility for health insurance or insurance premium price. This means that health insurance companies cannot use the results of a direct-to-consumer genetic test (or any other genetic test) to deny coverage or require you to pay higher premiums....... Some of these companies request information about genetic testing as part of their application process, but others do not. Week 7 (Ch. 11) 1. Inspect the relationship between environment and global health. Global health is an extension of population health. In terms of geographic scale, diseases can affect people across geographic boundaries and specific population aggregates, such as mothers and children or those who have hepatitis or are HIV positive. Global health uses Global Health Initiative (GHI), Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) as a means for linking population health with health policy, the containment of infectious diseases, and the elimination of health disparities. Environmental health is the branch of public health concerned with monitoring or mitigating those factors in the environment that affect human health and disease. 2. Appraise global health problems considering the WHO SDG’s as well as related epidemiological data. The health goal (SDG3) is comprehensive: ‘to ensure healthy lives and promote well-being for all at all ages. ● 17 Goals 1. No poverty 2. Zero hunger 3. Good Health and Well- Being 4. Quality Education 5. Gender Equality 6. Clean Water and Sanitation 7. Affordable and Clean Energy 8. Decent work and Economic Growth lOMoAR cPSD| 9. Industry, Innovation, and Infrastructure 10. Reduced Inequalities 11. Sustainable Cities and Communities 12. Responsible Consumption and Production 13. Climate Action 14. Life Below Water 15. Life on Land 16. Peace, Justice and Strong Institutions 17. Partnership for the Goals ● Most significantly, the MDGs made huge strides in combatting HIV/AIDS and other treatable diseases such as malaria and tuberculosis. 3. Can you discuss the types of outbreaks at a population health level? Pandemic: a global epidemic of disease that spreads to more than one continent (WHO, 2009) Outbreak: the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, or time of year. An outbreak may only last for a matter of days or weeks, but may last for years (WHO, 2014). Quarantine: the separation and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill (CDC, 2014). Isolation: the separation of sick people with a contagious disease from those who are not ill (CDC, 2014) Disaster epidemiology: “Disaster epidemiology is defined as the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health, and behavioral health” (CDC, 2012). 4. How is the epidemiological triangle related to pandemics, outbreaks? The epidemiological triangle explains causation. Causative agent (those factors for which presence of absence cause disease— biological chemical, physical, nutritional), susceptible host (such things as age, gender, race immune status, genetics), and the environment (including diverse elements as water, food, neighborhood, pollution.). Helpful when explain acute diseases. The World Health Organization defines a pandemic as a global epidemic that spreads to more than one continent. 5. If you were to explain “disaster epidemiology” to a colleague or nursing student, what would you say? Disaster epidemiology: “Disaster epidemiology is defined as the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health, and behavioral health” (CDC, 2012). It is the use of epidemiology to assess the short and long term adverse health effects of disaster and to predict the consequences of future disasters; provides situational awareness. The main objectives of disaster epidemiology is prevent or reduce the number of deaths, illnesses, and injuries caused by disasters by providing timely and accurate health information for decision making. Improve prevention and mitigation strategies for future disasters by collecting information for future response preparation. 6. What is the WHO? What do the SDG’s (formerly MDG’S) mean? lOMoAR cPSD| World Health Organization (WHO) is an arm of the United Nations. It provides leadership to global health matters and technical support to countries, and monitors and assess health trends. Millennium Development Goals (MDG) transitioned to Sustainable Development Goals (SDG’s) represent an agreement among countries to achieve the MDGs by 2015 and “create an environment at the national and global levels alike- which is conductive to development and the elimination of poverty.” o 8 goals subdivided into 21 targets for achieving the goals. o The SDGs were adopted by the United Nations General Assembly in September 2015 and look to 2030. They are far broader in scope than the Millennium Development Goals (MDGs) which focused on a narrow set of disease-specific health targets for 2015. WHO’s primary role is to direct and coordinate international health within the United Nations system. Their main areas of work are health systems; health through the life-course; noncommunicable and communicable diseases; preparedness, surveillance and response; and corporate services. Working with 194 Member States, across six regions, and from more than 150 offices, WHO is an organization united in a shared commitment to achieve better health for everyone, everywhere. They strive to combat diseases – communicable diseases like influenza and HIV, and noncommunicable diseases like cancer and heart disease. The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected – often the key to success on one will involve tackling issues more commonly associated with another. 7. Connect social justice theory to the implications of outbreaks. Health equity and social justice is the framework for the analysis of strategies to address health disparities across socially, demographically, or geographically defined populations. Apply social justice and human rights principles in public health policies and programs, implement strategies to engage marginalized and vulnerable populations in making decisions that affect their health and well-being, critique policies with respect to impact on health equity and social justice, analyze distribution of resources to meet the health needs of marginalized vulnerable groups Health emergencies such as outbreaks, pose the potential for mass illness and death, often resulting in extreme scarcity of medical countermeasures, hospital beds, and other essential resources. Rarely will there be enough stockpiles or surge capacity to meet mass needs. For example, of implication of outbreaks and social justice is, the U.S. influenza preparedness plan anticipates marked shortages of vaccines, antiviral medications, and medical equipment. What does justice tell us about how to ration scarce, life-saving resources? In the context of influenza, the United States focuses on key personnel and sectors such as government, biomedical researchers, the pharmaceutical industry, health care professionals, and essential workers or first responders. These apparently neutral categories mask injustice. In each case, people gain access to life-saving technologies based on their often-high-status employment. This kind of health planning leaves out, by design, those who are unemployed or in “nonessential” jobs—a proxy for the displaced and devalued members of society. Consequently, public health planning based on pure utility, although understandable, fails to have enough regard for the disenfranchised in society. 8. What is the history of the World Health Organization? Diplomats met to form the United Nations in 1945 and spoke about setting up a global health organization. WHO’s constitution came into place on 4/7/48 which