Week 6

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West Coast University, Orange County *

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Medicine

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Feb 20, 2024

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Chapter 3 US and Global Health Care Introduction  Despite the fact that health care costs in the U.S. are the highest in the world, the indicators of health are not the best worldwide  This chapter describes a health care system in transition as it struggles to meet evolving global and domestic challenges  Nurses play a pivotal role in meeting these needs o Several of the most destructive health conditions can be prevented through changes in lifestyle, health screenings, and/or immunizations Forces Stimulating Change in US Health Care System  Demographic Trends o In 2020 the US was the 3 rd most populated country in the world  Population growth of the world  increased fertility & decreased mortality rates (for both genders in all age groups)  Aging Baby boomer generation  increasing average age  Change in largest minority group  Hispanics now outnumber African Americans as the largest minority group  New infectious diseases emerging  With the expectation of COVID-19 new treatments for infectious diseases have resulted in steady declines in mortality among children, as long as parents participate in immunization programs  Social and Economic trends o Changing lifestyles  more people combing traditional, complementary, and alternative therapies o Growing appreciation of the life quality of life o Changing composition of families and living patterns o Changing household incomes o Revised definition of quality health care  health is seen as an irreplaceable commodity  Health workforce trends o Not enough primary-care providers o Move to contain costs & move to community-based care  Though 54% of RNs still work in hospital o Current nursing shortage  By 2026, it is expected to be 438,100 new nursing positions o Need to increase number of minority nurses to help decrease health disparities  In 2020, minority nurses represented about 30.1% of the RN population  Technological Trends o Positive effects  Electronic Health Records (EHRs) – telehealth!  24-hour availability of records  Coordination of referrals & facilitation of interprofessional care in chronic disease management, etc. o Negative Effects  High-tech equipment is expensive & quickly become outdated Current Health Care Systems in the United States  The challenge remains: ability of individuals to obtain health insurance  Cost – Expensive o The largest share of health care expenditures goes to pay for acute care (less towards PH) o Other increasingly high costs of health care include prescription drugs, technology, and care for chronic and degenerative diseases o Affordable Care Act – INCREASED ACCESS  Law enacted on March 23, 2010, more individuals have been able to purchase health insurance as employers have shifted more of the cost of health insurance to the employee  Affordable care act helped reduce the number of uninsured from 48 million before it passed to 27.6 million in 2016

 Access – Ongoing problem o Two-Class System:  Private = those with insurance or who can personally pay for health care  Public = those who depend on public health o Rising number of uninsured (working poor who do not qualify for public funds (either make too much money or are undocumented immigrants)  Safety net the federally funded community health centers, which are primarily located in medically under severed areas  Quality – Ground-breaking report! o Institute of Medicine (IOM) report: To Err is Human: building a safer health system (IOM 200) indicated the 98,000 deaths a year could be attributed to preventable medical errors  Laws passed, barring nurses from working more than 12 hours a day, 60 hours a week Organization of the Current Health Care System  In general, the American health care system is divided into two components  1. Private or Personal Care o Primary care is the first level of the private health care system  Providing accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs o Managed Care (MC) – HMOs & PPOs  Attempts to control cost of care by requiring families to choose a care provider from the MC network & not allowing access to other services without their providers permission  MC Model introduced into Medicare & Medicaid  Medicare part D was added to cover prescriptions  2. Public Health o Mandated through laws that are developed at the national, state, or local level  At the local level, health districts provide care that is mandated by state and federal regulations  Ex. A law mandating immunizations for all children entering kindergarten and a law requiring constant monitoring of the local water supply and food service inspections The Federal, State, and Local System  Federal o US Department of Health and Human Services (HHS) – the agency most heavily involved with the health and welfare concerns of U.S. Citizens  US Public Health service – a major component of the HHS o Department of Homeland Security  Has a mission to ensure a homeland that is safe, secure, and resilient against terrorism and other hazards  Through programs like Community Emergency Response Team (CERT)  Trains people to be better prepared to respond to emergency situations in their communities  State o State health departments  Functions: Disaster prevention or response, establishing health codes, licensing facilities and personnel, and regulating the insurance industry, etc.  Local o Local health departments  Have direct responsibility to citizens in its community or jurisdiction  Services and programs offered by local health departments vary depending on the state and local health codes that must be followed, the needs of the community, and available funding and other resources Factors Influencing the Healthcare systems of the future  Consumers – want lower costs and high-quality health care without limits and with improved ability to choose providers of their choice  Employers (Purchasers) – want to be able to obtain reasonably priced basic health care plans for their employees  Health Care Systems – want a better balance between consumer and purchaser demands  Legislation – concerning access and quality continues to be enacted

Overview of Global Health & Nursing  Global health is about achieving better health outcomes for vulnerable populations and communities around the world  Understanding global health and factors that contribute to certain health problems better prepares nurses to develop interventions that are culturally congruent, culturally responsive, and culturally acceptable to the target group  The vision of the International Council of Nurses (ICN)’s leadership for change program is that nursing is to take a leadership role in helping achieve better health for all Promoting Healthy/Preventing Disease: Year 2030 Objectives  Healthy People 2030 o Framework with measurable health indicators o Builds on the accomplishments for Healthy People 2020 o Objectives assist nurses in having data to show that PH and nurses are changing practice  How can nurses make a difference? o By filling the gap between personal care and PH thru their skills in assessment, health promotion & disease and injury prevention, knowledge of community resources & community involvement TEST  Healthcare in the US  factors influencing, expensive, issues with access to healthcare  Managed Care  Kaiser System, hard to go out of network  Demographic trends in US healthcare system  Affordable care act  made healthcare more accessible

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Chapter 7 Culture of Populations in Communities Introduction  The US population is becoming increasingly diverse  Nurse & client often come from different cultural background and may not recognize or understand their differences o Can lead to different understandings of communication, behaviors, and plans for care  Nurses must be able to provide culturally competent care o Such nursing care helps improve health outcomes and reduce health care costs Cultural Competence  A combination of culturally congruent behaviors, practice attitudes, and policies that allows nurses to work effectively in cross- culture situations  It is important for nurses to develop cultural competence by examining how their own personal belief’s & decisions are relative of his/her culture  Purnell Theory & Model for Culturally Competent Health Care o Compromised of 11 major assumptions o No culture is better than any other, they are just different o Each person has the right to be respected for his or her uniqueness and cultural heritage Culture, Race and Ethnicity  Culture – a set of beliefs, values, and assumptions about life that are widely help among a group of people and that are transmitted across generations  Race – a biological designation whereby group members share features (ex. Skin color, bone structure, genetic traits such as blood groupings)  Ethnicity – shared feeling of peoplehood among a group of individuals Cultural Diversity  Refers to the degree of variation that is represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time  Also includes the awareness of the presence of differences among the members of a social group or unit Social Determinants of Health  The circumstance in which all people are born, grow, live, work, and age that shape health o The 5 areas of social determinants: 1. Economic Instability; 2. Education; 3. Social Environment; 4. Health & health care; 5. Physical environment  Social determinants can disproportionally affect ethnically or culturally diverse groups; these determinants are shaped by money, power, education, and other resources  Nursing judgement o Nurses should be able to distinguish between cultural and socioeconomic class issues and not interpret behavior as having cultural origin when in fact it is based on socioeconomic class Immigrant Health Issues  44.7 million immigrants living in the US (2018) o 1 in 7 US residents is foreign born  Foreign born refers to all residents who were not a US citizen at birth, regardless of their current legal or citizen status  Approximately 1/3 of immigrants are insures  Poor health outcome factors o Fear of immigration reinforcement often prevents seeking healthcare o Live in low-income and segregated neighborhoods o Work in low-wage occupations o Unsafe working situations (i.e. exposure to toxic chemicals)

Types of Foreign-Born  Legal immigrant – not a citizen but allowed to both live and work in the US also known as lawful permanent resident  Refugees – admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views  Nonimmigrants – admitted to the United States for a limited duration and specific purpose (ex. Students, tourists)  Unauthorized Immigrant – may have crossed the border illegally or legal permission expired eligible only for emergency medical services Factors to consider for providing health care for immigrants  Financial constraints (uninsured)  Language barriers  Difference in social, religious, and cultural between the immigrant and the health care provider  Providers’ lack of knowledge about high-risk diseases in the specific immigrant groups for whom they care  Traditional healing or folk health care practices that may be unfamiliar to their US health care providers  When working with immigrant populations, consider how your own background, beliefs, and knowledge may be significantly different from those of the people receiving care Developing Cultural Competence  Two Principals o Maintain a broad, objective, and open attitude toward individuals and their cultures o Avoid seeing all individuals alike  Implement these concepts/dimensions of cultural competence o Cultural Preservation – meant that the nurse supports & facilitates the use of scientifically supported cultural practices from a person’s culture among with those from the biomedical health care system (Ex. Acupuncture & acupressure) o Cultural accommodation – negation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans o Cultural Skill – the effective integration of cultural knowledge and awareness to meet client needs o Cultural repatterning – working with clients to make changes in health practices when the clients’ cultural behaviors are harmful or decrease their well-being Inhibitors to Developing Cultural Competence  Stereotyping/prejudice/racism  Ethnocentrism – the belief that one’s own group or culture is superior to others  Cultural Imposition – the process of imposing ones values on others  Cultural Conflict – perceived threat that may arise from a misunderstanding of expectations between clients and nurses when neither is aware of their cultural differences  Cultural blindness – when differences between cultures are ignored and persons act as though these differences do not exist Clinical Nursing Assessment  During initial contact with client, nurses should perform a general cultural assessment & ask about the following o Ethnic background o Religious preference o Family patterns o Cultural values o Language o Education o Politics o Health practice

Five Principals of a Culturally Competent Organizational Model  Valuing diversity  Conducting cultural assessment  Understanding the dynamics of difference  Institutionalizing cultural knowledge  Adapting to diversity o Nurses can play a leading role in developing culturally competent organizations one patient at a time, as changes in one part of the world affect people everywhere TEST  Cultural accommodation  Cultural imposition  Cultural Repatterning  Cultural Skill  Cultural Blindness  Ethnocentrism Chapter 11 TEST  Epidemic  Measles  Salmonella  Agents of Bioterrorism  Understand Disease Development and Spectrum Chapter 12 TEST  Levels of prevention  How to interpret the TST (SKIN TEST)  All about HIV  Chlamydia  Gonorrhea  Hep B  All 3 stages of syphilis  HSV 2  HPV Chapter 4 TEST  3 branches of government  The governmental role in US healthcare Chapter 6 TEST  Ethical decision-making framework  Callahan’s 4 standards  The following ethical principles: deontology, utilitarianism, virtue ethics, advocacy  What are nurses’ responsibilities regarding advocacy and ethics  How to apply ethical decision making  Ethic of care and caring related to nursing

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