Nursing and Population Health: Role of APRNs in Reducing Health Disparities, Study Guides, Projects, Research of Nursing

Download Nursing and Population Health: Role of APRNs in Reducing Health Disparities and more Study Guides, Projects, Research Nursing in PDF only on Docsity! 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: • 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 ( minorityhealth.hhs.gov/npa) was started by the Office of Minority Health 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 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. 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. 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, commi tment 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. “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? Anglo-American Cultural Values Selected Minority Values Personal control over environment Fate 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. 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 • 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 • 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 • 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 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. 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 is world health day. WHO’s goal is to build a better healthier future for all people over the world. There are now more than 7000 people working in 150 country offices, in six regional offices and at our headquarters in Geneva, Switzerland. 9. Be sure to review the articles: Angelini (2017) and Kurth (2017): What are said to be some of the noticed health effects of climate change? Can you speak to the “Call to Action” elements/content? Noticed health effects of climate change: (Kurth 2017) Climate change is due to human activity, Trigger global migration and local relocation due to sea level rise, More frequent weather events, Direct heat effects the elderly and vulnerable, Spread of vector-borne diseases, Increase in psychiatric and 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. 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. 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 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. 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. Outcomes are defined as an end result that follows some kind of healthcare profession, treatment, or intervention and may describe a patient’s condition or health status. Chapter 2 Page 24 Public health policy is the collected laws, regulations, and approaches taken to making decision. Public health policy issues include a wide range of topics including health care reform, insurance reform with an eye to individuals who are not covered by an employer or a group, and the prevention and control of communicable diseases. With a thorough assessment the primary goal of risk reduction is to prevent non and communicable diseases before it occurs so that outcomes can be controlled or managed. 6. Where is the intersection of: epidemiology, population health, public policy and social justice and vulnerable populations? Social inclusion agenda and policy provides an opportunity to reflect on the relationship between social inclusion and health internationally. All areas intersect with the inclusion of all people for the greatest health care 7. Are you able to define the key ethical terms and apply them to population health? For instance, ethics, fairness and social justice. * Ethics : (ANA) practices with compassion and respect. Is committed to patient, family, community, and population. Promotes, advocates for, and protects the rights, health, and safety of the patient. Establishes, maintains, and improves the ethical environment of the work setting that are conducive to safe quality health care. Advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. * Fairness : the state, condition, or quality of being fair, or free from bias or injustice; evenhandedness (closely tied to justice). ALL people have a right to EQUALprotection and equal access to public health. * Social justice : all human beings have the core entitlements essential to human fulfilment. The distribution of advantages and disadvantages within a society. fair and equitable treatment of people with direct implications for the improvement of the health of the public Chapter 5: Applying Evidence at the Population Level Exercise and Discussion Questions Exercise 5.1 Write a question using the PICOT format. (P) population (I) intervention (C) comparison (O) outcome (T) timeframe “Will a 6-week chronic disease self-management program increase the self-efficiency of insulin- dependent diabetic mentally ill patients in a state prison setting” (page 112) Exercise 5.2 Carry out a literature review for one of the PICOT questions you wrote in exercise 5.1 -Establish criteria for inclusion and exclusion of studies. In a clinical trial, the researchers must specify inclusion and exclusion criteria for participation in the study. Inclusion criteria are characteristics that the prospective subjects must have if they are to be included in the study, while exclusion criteria are those characteristics that disqualify prospective subjects from inclusion in the study. If a participant has an inclusion criterion, they are in; if they have an exclusion criteria, they are out. Inclusion and 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