Addressing Health Disparities and Promoting Population Health, Exams of Nursing

Download Addressing Health Disparities and Promoting Population Health and more Exams Nursing in PDF only on Docsity! 1 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 2 ▪ 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: • 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. 5 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 https://ubcmj.med.ubc.ca/marginalization-in-health/) (online lesson wk 5) Singletone and Krause (2009) have identified the confounding variables that result in subpar health 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. 6 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”. 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); 7 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 attitude of openness and acceptance will do wonders. • 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 10 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. “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” 11 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? 12 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, 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, 15 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" 16 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. 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 17 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. 20 • 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 • 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. 21 • 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. 22 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 • 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. 25 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 26 4. Quality Education 5. Gender Equality 6. Clean Water and Sanitation 7. Affordable and Clean Energy 8. Decent work and Economic Growth 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. 27 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. 30 mental health issues as they feel the stress from climate change, Changes in food availability and cost- new and widespread malnutrition, As ecosystem-stress-induced changes occur health systems need to anticipate and plan for them, plans Nurses can lead local and regional adaptation efforts partnering with local decision makers in the identification of at-risk populations, the creation of emergency plans, and monitoring and in the clinical environment as well as in community health roles, nurses provide direct guidance to patients and families (George 2017) heat stress exposure, more extreme hurricanes and thunderstorms, extreme drought desertification and flood areas, more frequent dust storms and wildfires, increase prevalence, mortality, and morbidity of asthma and copd, reduced lung function and physical activity, thunderstorm asthma, increase prevalence and virulence of resp. infections. A Call to Action- (Kurth 2017) It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health, nurse is essential to every solution, The science, techniques, and interventions useful in patient-level health promotion are uniquely understood by nurses and midwives, These selfsame tools can inspire and illuminate health promotion of the planet and the critical systems on which human existence depends. (George 2017) Nurse scientists must contribute to the growing body of bench-to-bedside scientific evidence that documents the health impacts of climate change and evaluates the efficacy and effectiveness of interventions focused on reducing exposure or on reducing the health effects of unavoidable exposure, There is a need for nurses to help their patients develop adaptive strategies, which focus on modifying the built environment to respond to the negative impact of climate change that has already occurred, From a policy perspective, nurses might become involved in efforts to promote public transportation or increase urban tree canopy or may want to be involved in urban planning efforts to increase economic development and reduce economic disparities Climate change is expected to drive more extreme weather events, which have the potential to increase respiratory morbidity and mortality rates. Climate change produces several changes to the natural and built environments that may potentially increase infectious disease prevalence, morbidity, and mortality Climate changes may also influence the survival, reproduction, or distribution of allergens/pathogens (bacterial, viral, and fungal), vectors, hosts, and disease transmission. More frequent wildfires and dust storms can be anticipated due to increased drought and desertification resulting from climate change. “Call to action”- Nursing to assume a leadership role in addressing planetary health. Safeguarding human health requires a healthy planet. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one's university, hospital, and or health system levels 10. How do you assess an area’s resources and its relationship to the health of a region? Community assessments of various kinds often require us to use statistics and other information relating to a certain area. Usually, that area is a city, a county, or even a state. After analysis, you can understand where the real needs are, tailor problem solutions to the areas where they’re really needed and divide resources so that they will be as effective as possible. By comparing the statistics and resources of several regions, you may be able to see why a health condition exists in one region and not in another. For example, a nearby industrial facility may be the difference between an area of high childhood asthma rates and one where the rates are low. The U.S. government has programs for pandemic preparedness that move from federal to state and local levels. Gauging the impact of a pandemic is difficult but researching past statistics about rates of infection and the numbers of people that seek medical care have assisted in preparation. Week 8 (Ch. 2) 1. Synthesize knowledge of population health to the role of political advocacy as an Advanced Practice Nurse. 31 Population health has been defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of an entire human population. Political advocacy goes hand and hand with population heath, for example- seat belt laws, no smoking areas, and allergy free schools. All of those things are population health issues that needed political advocacy to be implemented for the best health outcomes of the community. 32 Public Policy should always be based on evidence (From disease surveillance to the cost effectiveness of screening programs). Political advocacy as an Advanced Practice Nurse should focus on three key policy levers: NP scope-of- practice regulation, distribution of the NP workforce, and NP education. The American Public Health Association defines public health as the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries. Public health is provided by a variety of agencies, small and large, public and private. The CDC administers funding for many population-based prevention efforts (National Health Policy Forum [NHPF], 2010). State health departments are the agencies that most frequently get funding for programs associated with a specific disease or risk factor. Local health departments, such as city and county entities, can also be recipients of direct CDC funds. According to the NHPF (2010), most of the states (29; 58%) have established a decentralized public health organizational model, that is, local public health offices are independent of the state health department and are managed by local authorities. Six states have a centralized organization, in which all the local public health offices are managed from the state level, and 13 have a hybrid model. Two states, Hawaii and Rhode Island, do not have local public health agencies. The NHPF (2010) reports that there are 2794 local health departments in the United States, most of which serve counties (60%) and 9% serve multiple counties. Some health departments (18%) serve cities, towns, or townships. The American College of Physicians (2012) reports that in FY2010 to 2011, 40 states decreased their public health budgets. Of those, 29 had decreased their budgets for the second year in a row, and 15 had done it for a third year (2012). The HHS (2014) reported that the CDC will see a decrease of $432,461,000 in budget authority for FY2014 and operate with an overall budget of $6.665 billion. Program investments that are scheduled to realize an increase in funding are infectious diseases; global disease protection; preventing the leading causes of disability, disease, and death; health monitoring; and environmental and work hazard prevention. Additional funds were allotted for Vaccines for Children and the World Trade Center Health Program. Public health has finally become included in high-profile, tertiary care research centers. This includes the National Cancer Institute (NCI), the first and largest institute of the National Institutes of Health. The Cancer Control and Population Sciences division of the NCI is the bridge to public health research, practice, and policy. Through the NCI-designated cancer centers around the country, public health principles are the cornerstone of the departments within these centers that focus on community health, education, and the conducting of population-based research using community-based participatory approaches. An example is the NCI-designated University of New Mexico Cancer Center's Office of Community Partnerships and Cancer Health Disparities, which conducts community-based participatory research with Hispanic and Native American populations. Building on the accelerating pace of discoveries in human genetic variation, epigenetic, molecular, biochemical, and cellular technologies for cancer care and prevention, public health genomics (PHG) has evolved as a “multidisciplinary field concerned with the effective and responsible translation of genome based knowledge and technologies to improve population health” (Burke et al., 2006). PHG at the NCI promotes the integration of genomics and personalized medicine into public health cancer research, policy, and control. The work of Anita Kinney, PhD, RN, exemplifies the contributions nurse scientists are making in this area through her work combining behavioral science, genomics, and cancer prevention strategies. 2. Appraise ethical and legal principles to the provision of care by the Advanced Practice Nurse. Professional ethics is the study of how personal moral norms apply or conflict with the promises and duties of one's profession. Society demands that professionals be held to a separate moral standard of conduct because the choices professionals make affect other people's lives more than their own. Nursing's foundational documents make each nurse's advocacy and health policy responsibilities clear. Although some may think that advocacy and health policy are an ethical ideal, they are rather a nonnegotiable moral obligation embedded in the nursing role. The ANA Code of Ethics for Nurses states: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the 35 Would it not end up threatening the very foundations of a free society (because the foundation of a republic lies in the honesty of its processes)? What are the differences between normal legislative wrangling and abuse of power? What does it mean when political parties refuse to participate in the legislative process and/or use blatant scare tactics? What is legitimate dissent, and what is a refusal to accept democratic outcomes unless you happen to agree with them? Without civil disobedience, we would still have the Jim Crow laws. And without respect for the law, a society degenerates into either despotism or anarchy. When people ask whether it is wrong to lie about something (e.g., the number of people affected by a particular disease) to get funding for research and/or treatment of patients with a particular disease, in a word the answer is yes. It is wrong. 36 Why is lying wrong? It's wrong because it undermines the foundation of any relationship: trust. In like manner, lying to further a political agenda is wrong not only because it undermines trust, but also because it fosters further dishonesty. Judging by the amount of political dishonesty reported in the media, one is led to the conclusion that there is a lot of lying going on! Adding to it, telling more lies to further our own agenda, will only make matters worse. 4. What influence do you as a provider have regarding public policy? What ethical obligation do you believe you have? Nurses’ influence in health polices protects patient safety by voting, using media advocacy as a strategic to apply pressure to advance a social or public policy initiative. Nurses’ influence in health polices protects patient safety, increases quality of care, form strategic alliance with other likeminded organizations with similar interest, locally, nurses can become politically active by assuming leadership positions in the healthcare system or contacting elected officials about legislation affecting the industry. At the state and federal level, nurses can get involved in policy and politics by joining a professional nursing organization. Nursing advocacy is not limited to clinical settings. Nurses are expert health care providers who are well positioned to advocate for policies and practices that promote and encourage health. Three types of nursing advocacy influence policy, population health, and the profession of nursing: issue advocacy, community and public health advocacy, and professional advocacy. Chapter 14 Nursing's foundational documents make each nurse's advocacy and health policy responsibilities clear. Although some may think that advocacy and health policy are an ethical ideal, they are rather a nonnegotiable moral obligation embedded in the nursing role. The ANA Code of Ethics for Nurses states: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient”. Chapter 15 Page 140 Nurses who value their moral agency are familiar with the principles of bioethics which commit them, all things being equal, to: (1) respect the autonomy of individuals, (2) act so as to benefit (beneficence), (3) not harm (nonmaleficence), and (4) give individuals their due (justice). Other principles include keeping promises (fidelity) and responsiveness to vulnerability. A commitment to social justice and the common good has long characterized the profession of nursing. Chapter 15 Politics, defined as “any activity concerned with the acquisition of power, gaining one's own ends,” is not just for elected officials (Politics, n.d.). Politics are alive and well in every aspect of health care, from the operating room of a small community hospital to the board room of a multibillion-dollar pharmaceutical company. Every day, health care administrators make decisions that impact both nurses and the populations of patients they serve. Nurses are in key positions to influence hospital decision makers and to share the realities of the day-to-day care of patients. Nurses have the greatest influence when they are well-informed, open-minded, collaborative, and willing to do what is right even if there is a personal cost. Working though challenging issues is not easy. Using the Ethics Inventory to evaluate our personal approach to ethical issues is a good step toward improving our moral sensibility and moral valuing. Asking ourselves the question, “What counts as a good response?” can make us more aware of how we promote the common good and dignity of others. Do we maximize good and reduce harm for our patients? Do we act with virtue in difficult situations by speaking up when it may not be popular to do so? Do we act justly and/or advocate for justice in our work environments? Are we responsive to the vulnerabilities of others? Nurses are the most trusted of all professionals. Given our sheer numbers, think about the impact we could have if we shared one common voice to improve the care of the vulnerable. 37 5. How is risk reduction, assessment, and outcomes related to public health policy? Helping patients understand risk factors and take personal responsibility for lifestyle changes prevents disease, decreases risks, and promotes health that leads to improved outcomes, reduced costs, and an overall healthy population status. Risk reduction is the health protection when individuals participate in behaviors that enable them to react to actual or potential threats. Assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status. 40 exclusion criteria may include factors such as age, sex, race, ethnicity, type and stage of disease, the subject’s previous treatment history, and the presence or absence of other medical, psychosocial, or emotional conditions. -Synthesize and appraise information of the literary review using table 5.3. Example table for literature review and synthesis for evidence-based practice (page 118) Title of Article Authors with Credential s Question Study Design Level of Evidence Description of Sample Measures Result Exercise 5.3 Determine whether or not you have enough evidence to change current practice using a PICOT question. -Will you need to conduct a study to in order to test the effectiveness of the intervention? Yes, unless there is enough unbiased evidence provided from previous studies -If you need to conduct a study, describe the method that you would use to evaluate effectives of the intervention. Several models are available to facilitate and implement evidence-based practice. These models are; Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model, John Hopkins Nursing Model, Chronic Care Model, Iowa Model of Evidence-Based Practice to Promote Quality of Care (page 129) -Describe what outcomes of interest you will need to identify in your study. In probability theory, an outcome is a possible result of an experiment. Each possible outcome of an experiment is unique, and different outcomes are mutually exclusive (only one outcome will occur on each trial of the experiment). All of the possible outcomes of an experiment form the elements of a sample space. Exercise 5.4 Describe how you will incorporate this change into practice. Chapter 5 Summary The use of research evidence to guide practice can lead to the implementation of the interventions that will improve population outcomes, but this is a complex process. The ability to identify clinical problems and issues, ask clinical questions in a form that allows study, conduct a search of the literature, appraise and synthesize the available evidence, and successfully integrate knowledge into practice requires specialized skills and knowledge. This process can be challenging and time-consuming. Researches have identified many barriers to evidence-based practice, including lack of belief by practicing nurses that research can make a real difference. APRNs are uniquely situated to influence care through their roles as leaders, educators, and clinical experts. This chapter described some of the basic skills needed to integrate and synthesize information in order to design intervention that are based on evidence to improve population outcomes. APRNs need to use their specialized knowledge and advanced practice roles to identify the barriers to evidence-based practice in order to build capacity to adopt change. They also require the ability to involve individuals, teams and organizations in the process. By adopting a culture of evidence-based practice in the work environment, APRNS have the opportunity to facilitate change that can lead to improvement of quality of care. (page 132-133) Kleinman Explanatory Model- consists of three sectors: The popular sector, the professional sector, and the folk sector. The model can be used to determine how individuals make decisions. Socioeconomic Status- (SES) is 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, education, and occupation. 41 Disparities- Although the term disparitiesis often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups. 42 Minorities- Minority, a culturally, ethnically, or racially distinct group that coexists with but is subordinate to a more dominant group. As the term is used in the social sciences, this subordinacy is the chief defining characteristic of a minoritygroup. As such, minoritystatus does not necessarily correlate to population Food Desert- an urban area in which it is difficult to buy affordable or good-quality fresh food. Determinant of Health- The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health fall under several broad categories: ● Policy making ● Social factors ● Health services ● Individual behavior ● Biology and genetics It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health. Social determinants of health- · Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods · Social norms and attitudes, such as discrimination · Exposure to crime, violence, and social disorder, such as the presence of trash · Social support and social interactions · Exposure to mass media and emerging technologies, such as the Internet or cell phones · Socioeconomic conditions, such as concentrated poverty · Quality schools · Transportation options · Public safety · Residential segregation. They are important because they play a huge part on how a person is treated an how prone they are to have a certain condition. Social justice implies that there is a fair and equitable distribution of benefits and burdens in a society Data Sources used to assess determinants of health include: Chronic Disease Indicators, Interactive Atlas of Heart Disease and Stroke, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, National Environmental Public Health Tracking Network, and The Social Vulnerability Index. Individuals with a high risk of a disease may have genetic testing to determine the best course of acting for acquiring that disease. 45 The Sustainable Development Goals (SDGs) (or the Global Goals for Sustainable Development, the 17 Global Goals [1], the Global Goals [2] or simply the Goals[3]) are a collection of 17 global goals set by the United Nations General Assembly in 2015. The SDGs are part of Resolution 70/1 of the United Nations General Assembly [4]: "Transforming our World: the 2030 Agenda for Sustainable Development". That has been shortened to "2030 Agenda".[5] The goals are broad and interdependent, yet each has a separate list of targets to achieve. Achieving all 169 targets would signal accomplishing all 17 goals. The SDGs cover social and economic development issues including poverty, hunger, health, education, global warming, gender equality, water, sanitation, energy, urbanization, environment and social justice.[6] If individuals do not have equal access to healthcare, food, and other health factors, outbreaks could be more predominate due to poor health and lack of adequate medical services needed to treat the disease. Climate change can have increase effects on COPD, Asthma, and Respiratory infections. A Call to Action is meant to change planetary health through nursing. A Call to Action: It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one's university, hospital, and or health system levels. * Learning-and teaching-about planetary health is a key productive action. The collective changes possible with law and policy changes-in short, better governance-are necessary to limit further harm. * Communication about planetary health matters requires special care to keep emotions even keeled and avoid an apocalyptic focus. Just as gain-framed messages are demonstrably more effective in health prevention strategies for individuals, prevention in the planetary health domain can include emphasis on improved economies, jobs, population health, and social justice. * Finding common ground (leveraging beliefs, telling personal stories; see Figure S3) with an audience improves message receptivity. New research indicates "that it is possible to pre-emptively protect ('inoculate') public attitudes about climate change against real-world misinformation" (van der Linden, Leiserowitz, Rosenthal, & Maibach, 2017, p. 1). Nurses in educational, community, and clinical leadership roles can provide listeners with information about the nature of disinformation campaigns and why certain parties seek to confuse their audiences. This is the sort of health promotion ("inoculation") work in which nurses and midwives excel. * The formal and continuing education of nurses and midwives must keep pace with the changing conditions, evolving science, and higher levels of engagement from populations and patients in planetary health matters. Medical and public health curricula have made shifts to include climate change and health matters. Nursing curricula are arriving: the Global Consortium on Climate and Health Education (n.d.), a collaborative of nursing, public health, and medical schools formed in 2017, is developing interprofessional curricula on climate change and health. * Survey data show that Americans are concerned about global warming. A Yale survey in late 2016 shows the proportion of Americans "alarmed" about climate change has grown, and the proportion of "dismissives" has shrunk, such that alarmed individuals are now double the number of dismissive (see Figure S4; Yale Program on Climate Change Communication, 2016). * Green technology is an economic growth area. Economies based on wisely used, sustainable, and renewable sources of energy appear ready to thrive. Fossil fuel availability will peak then decline, creating potential market gaps for prepared leaders and nations to lead the green energy transition, enhancing the resiliency of cities, and making food and water systems sustainable. Embracing a planetary health mindset can challenge, renew, and unite us. 46 * Pay attention to what narratives and stories we tell ourselves: "If we don't transition quickly to a sustainable way of life, humanity is doomed!" or rather, "We are transitioning to a more sustainable and resilient way of life that will offer tremendous benefits to humanity" (Frumkin, 2017; Hunter, Frumkin, & Jha, 2017). Nurses are essential to every solution that will improve the health of the planet, with implications for the development and use of the global healthcare workforce, for research, and for practice. Nurses help plan and build resilient health systems, but in order to develop health beyond health care, nurses must move into expanded roles, working with other sectors and individuals, to support the development of resilient communities. The science, techniques, and interventions useful in patient-level health promotion are uniquely understood by nurses and midwives. These selfsame tools can inspire and illuminate health promotion of the planet and the critical systems on which human existence depends. Safeguarding human health requires a healthy planet. The changes we make as individuals are useful, though as trusted clinicians, scholars, and leaders, those changes also can inspire and educate others (Whitmee et al., 2015). The magnitude of our jewel of a planet's health crisis is enormous. But the timeliness, impact, and scale of the solutions that nurses and midwives will muster could evince the very best of our professional- and human-potential. You can assess an areas resources and its relationship to the health of the region by performing a community health assessment.