Cultural Responsiveness Chapter 13

• These are study notes based on the provided text.

Cultural Responsiveness (Chapter 13)

• Cultural competence involves standards of practice for culturally competent nursing care.
• Cultural competence includes respecting and understanding the values and beliefs of a cultural group, allowing effective function in caring for its members.
• Cultural imposition involves imposing one's own beliefs on other people of their culture.
• Registered Nurses (RNs) ensure prevention of force on patients
• Microaggression refers to a comment or action that subtly and often unconsciously expresses a prejudiced attitude toward a marginalized group member, like a racial minority.
• Cultural stereotyping is a tendency to view individuals of a common culture background similarly based on preconceived notions of how they behave.
• Implicit bias is the unconscious collection of stereotypes and attitudes developed toward certain groups, affecting patient relationships and care decisions.

Concepts/Theories: Standards of Practice

• Standards of practice for culturally competent nursing care include:
• Social justice
• Critical reflection
• Knowledge of cultures
• Culturally competent practice
• Cultural competence in health care systems and organizations
• Patient advocacy and empowerment
• Multicultural workforce
• Education and training in culturally competent care
• Cross-cultural communication
• Cross-cultural leadership
• Policy development
• Evidence-based practice and research
• Cross-cultural perspectives on causes of illness

Population Trends in the US

• The US population is becoming more diverse.
• Minority groups have grown faster than the population as a whole in recent years.
• In 1970, minority groups made up 16% of the population, which increased to 38.7% by 2017.
• By 2060, minorities are projected to account for more than 56% of the total population.
• 2021 population estimates by race and ethnicity:
  • White: 58%
  • Hispanics/Latinos: 18%
  • Blacks/African American: 14%
  • Asian: 7%
  • American Indian & Alaska Natives: 1.5%
  • Other: 1.5%
• Men made up to 10% of registered nurses in the US

Communicable Disease and Environmental Health (Chapters 14, 26)

• Communicable diseases are defined and classified according to cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition.
• The CDC monitors communicable diseases in the US
  • Examples include gonorrhea, HIV, Lyme disease, TB, typhoid fever, measles, the plague, smallpox, and yellow fever.
• The emergence and reemergence of old and drug-resistant pathogens creates challenges in the US and worldwide.
• Vectorborne infectious screening is important for diseases like Lyme disease, Rocky Mountain spotted fever, and Zika.
• Epidemiology, environmental health, and herd immunity are defined.

Stages of Infection

• It is important to be able to control the infection.
• Latent Period:
  • Infectious agent invades a host and finds hospitable conditions to replicate.
  • Replication occurs before shedding.
• Communicable Period:
  • Begins before symptoms are present.
  • Follows the latent phase with no symptoms.
  • Begins with shedding of the agent, when a person becomes contagious.
• Incubation Period:
  • Time from invasion to the first appearance of disease symptoms.
  • May overlap with the communicable period.

Disease Occurrence

• Incidence is the rate of new cases of a disease in a population.
• Endemic: An infectious disease that occurs in a consistent or expected level within a specific geographic area.
• Outbreak: Unexpected increase infectious disease in a specific geographical area within a limited time.
• Epidemic: An unexpected increase in the occurrence of an infectious disease in a geographic area over an extended period of time
• Pandemic: A disease or an epidemic with steady occurance that covers a large geographic area or is evident worldwide

Chain of Transmission

• The six links in the chain of transmission include:
  • Infectious agents
  • Reservoirs
  • Portals of exit
  • Modes of transmission
  • Portals of entry
  • Host susceptibility
• Breaking the Chain of Transmission involves:
  • Controlling the agent through technology and medical science
  • Eradicating the nonhuman reservoir (water, food, milk, animals, insects, sewage)
  • Controlling the human reservoir by treating infected persons who have symptoms
• Quarantine-isolation during incubation periods
• Controlling portals of exit and entry by wearing masks, gloves, and condoms.
• Isolation of infected people
• Improving host resistance with vaccinations

Types of Immunity

• Natural immunity is innate resistance to specific antigens.
• Acquired immunity results from actual exposure through an infectious agent, such as through vaccines.
• Passive immunity is temporary resistance given through transfusions of plasma, immunoglobulins, antitoxins, or transplacental transfer.
• Primary vaccine failure is when vaccines fail to stimulate any response due to improper storage or administration.
• Secondary vaccine failure occurs with diminishing immunity after the initial immune response.

Herd Immunity

• Those who are not immune are still protected because a specific portion of the population has been vaccinated which only applies to those who are immune or evenly distributed.

Public Health Nurses & Communicable Diseases

• Reasons for emerging infectious diseases and public health control of infectious diseases categorized by public.
• Emerging infectious diseases include:
  • Infectious diseases are categorized as public due to potential to spread
  • Personal health conditions like diabetes and cancer
• Control involves reducing both incidence (new cases) and prevalence (existing cases).
• Elimination involves controlling a disease with a specified geographic area and reducing prevalence and incidence to near zero.
• Eradication involves reducing the worldwide incidence of a disease to zero, eliminating the need for further efforts.

Environmental Health Assessment

• Upstream thinking involves promoting health for the entire population.
• Ask critical questions about where people work and live, and make the community aware of the environmental effects.

Disease Prevention

• Primary prevention means preventing transmission of infectious diseases and preventing pathology to a person exposed to infection through immunizations.
• Secondary prevention means early detection and treatment of infectious diseases, includes reporting diseases, investigating contacts, and notifying partners.
• Tertiary prevention cares for people with infectious diseases to ensure cure and quality of life.
• Ensuring antimicrobial treatments are completed to avoid increasing pathogen resistance.

Healthy Homes

• Focus on healthy homes, water quality, food safety, and waste management.
• Healthy Homes: The availability of shelter and its safety, structural strength, cleanliness, location, and indoor air quality.
  • Indoor living health concerns relate to radon, carbon monoxide, molds and dust, secondhand smoke, cooking vapors, lead paint, and rodents.
  • Housing health problems: fire hazards, lack of accommodations, illnesses from overcrowding, psychological effects
  • Injuries from collapsed structures
  • Exposure to deaths from inadequate indoor heating and cooling
• Sick housing syndrome
• Consider homelessness and unsafe neighborhoods by ensuring houses are environmentally safe.

Water Quality concerns

• Availability, volume, mineral content levels, toxic chemical pollution, and pathogenic microorganism levels.
• Problems include droughts, dousing reservoirs with chemicals, contaminating aquifers with pesticides and fertilizers, leaching lead from water pipes, and more.
• Ability to purify water for human use

Food Saftey

• Focuses on providing food that is free from harmful herbicides, pesticides, and bacteria.
• Considers availability, accessibility, and relative cost.
• Food safety concerns include malnutrition, bacterial food poisoning, food adulteration, disrupted food chains, and carcinogenic chemical food additives.

Waste Management

• Handling of waste materials resulting from industry, municipal processes, and human consumption and efforts to minimize waste production.
• Problems: non-biodegradable plastics, inefficient recycling programs, unlicensed waste dumps, inadequate sewage systems, unsafe dumping of industrial toxins.
• Effects: housing needs for elderly, occupational risks, high unemployment rates, droughts, long term hearing loss

Disaster Preparedness (Chapters 29)

• Shelter in place, evacuation, staging area, and first responder protocols

Disaster Definitions

• Disaster: Any event causing destruction, death, or injury that affects a community's ability to respond with available resources.
• Mass casualty is considered 100+ people involved
• Multiple casualty is considered 2-99 people involved
• Casualty is classified as a direct or indirect victim, displaced persons, and refugees

Types of Diasters

• Disasters may be natural, manmade, or a combination of both.
• Disaster frequency, predictability, mitigation and phases are all vital

National Incident Management System (NIMS)

• A systematic and proactive way for agencies to prevent, protect against, respond to, recover from, and prevent the effects of disasters.
• Know phases of community response to a disaster

Disaster Triage

• Disaster triage focuses on maximizing the number of survivors.
• Colors in disaster triage:
  • Green (walking wounded)
  • Yellow (systemic but not life-threatening)
  • Red (life-threatening but can be stabilized)
  • Black (deceased or injuries too extensive to save)
• Staging area: on-site incident command station
• The American Red Cross is chartered by Congress

US Department of Homeland Security (DHS)

• Prevent terrorism and enhance security
• Secure and manage US borders
• Enforce and administer immigration laws
• Safeguard and secure cyberspace
• Ensure resilience in disasters
• Know the different types of victims in a disaster

Home Health

• Includes a wide range of healthcare services provided to people in their homes to help them through an illness or injury
• Hospice focuses on caring for people facing a terminal illness with the goal of no longer curing it.
• The balanced budget act of 1997 switched to a fixed amount of money based on client cost.

Palliative Treatment

• Does not suspect someone will die within 6 months, treatment continues

Home Health Concepts

• Hospice services include improving end-of-life care, relieving suffering, supporting patients/families, and providing grief support.
• Hospice care includes pain control and symptom management, medication dosages, and emotional support.
• Home health: reimbursement home health care: 65 years or older, under care of physician
• Hospice: over 65, certified by MD or NP terminally ill with life expectancy 6 months or less

Home Services

• Patients must meet certain conditions to qualify for home healthcare services.

Home Visits

• Steps for conducting a home visit include:
  • Visit preparation
  • Establishing a trusted relationship
  • Reviewing referral form
  • Initial telephone contact
  • Assessing the environment
  • Improving communication
  • Building trust
  • Ensuring patient safety.
• The nurse will document all information, and create a plan for the patient which also includes the next visit

Caregivers

• Formal caregivers are professional or care professionals providing in-home healthcare and personal services.
• Informal caregivers include family that provide education provided by a home health nurse.

Outcome and Assessment Information Set (OASIS)

• Is a data set that determines Medicare pay rate and measures outcomes of adult home care patients to monitor outcome.
• Includes: Sociodemographic, environmental, support system, health status, and functional status attributes of an adult patient