Health Promotion in Minority Populations
Select an ethnic minority group that is represented in the United States (American Indian/Alaskan Native, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, or Pacific Islander). Using health information available from Healthy People, the CDC, and other relevant government websites, analyze the health status for this group.
In a paper of 1,000-1,250 words, compare and contrast the health status of your selected minority group to the national average. Include the following:
Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group?
What are the health disparities that exist for this group? What are the nutritional challenges for this group?
Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors.
What health promotion activities are often practiced by this group?
Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.
What cultural beliefs or practices must be considered when creating a care plan? What cultural theory or model would be best to support culturally competent health promotion for this population? Why?
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Health Promotion: Health and Wellness Across the Continuum
Read Chapter 3 in Health Promotion: Health and Wellness Across the Continuum.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php
Cultural Awareness
By Angel Falkner
Essential Questions
What is the global impact of health, wellness, and the delivery of care on emerging populations?
What nursing theories can be utilized when providing culturally competent care to patients?
What is the impact of race, culture, and ethnicity on individual and collective identity, and how does this influence beliefs regarding health?
What are some cultural factors that may affect care for emerging populations?
How do nurses work with individuals, families, communities, and social-cultural networks to influence health promotion?
Introduction
Cultural competence in nursing is an absolute necessity. As populations grow and become more diverse, understanding different cultures and their practices and respecting these differences is imperative to providing holistic care to patients in every health care setting. In order to educate patients effectively and empower them to promote their own health, the nurse must fully engage with them and become acclimated to their specific needs. This chapter will provide details on how to become culturally aware and apply cultural sensitivity to nursing care, particularly as a nurse educator. Health promotion education will encompass nutrition education and cultural aspects will be discussed.
Health Disparities
According to the Center for Disease Control (CDC) (2015a), health disparities are the preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by disadvantaged populations, (para. 1). Disadvantaged populations include a wide range of ethnicities. Ethnicity differs from race in that it encompasses ideas and practices of a group that shares commonalities of race, language, history, religion, and/or country or place of origin. Race involves ancestry and shared or common physical characteristics. In an effort to support the growing population of disadvantaged persons worldwide, the World Health Organization (WHO) has formulated the following goals centered on global awareness and improvement of health disparities.
Promoting development
Fostering health security
Strengthening health systems
Researching disparities, health risks, and effective solutions
Enhancing partnerships
Improving performance
Nurses are a crucial component to achieving these goals and must be keenly aware of the challenges such populations face. Emerging populations within the United States include:
Arab Americans
Asian Americans and Pacific Islanders
Black/African Americans
Latino/Hispanic Americans
Native Americans/Alaskan Natives
Homeless
Lesbian/Gay/Bisexual/Transgender/Questioning (LGBTQ)
Refugees
The federal government has recognized the challenges emerging populations face and has taken steps to promote and support health within these populations. The National Institute of Health (NIH), National Center on Minority Health and Health Disparities (NCMHD), the Office of Disease Prevention and Health Promotion (ODPHP), and the U.S. Department of Health and Human Services (HHS) have all collaborated to formulate plans to help decrease these disparities. Among the more prominently known and mentioned programs is Healthy People 2020. This initiative created by the ODPHP is composed of many goals all focused on health promotion in the United States, including the countrys emerging and disadvantaged populations.
Case Study
Mohammed immigrated to America from Saudi Arabia with his wife and two small children in 1995. Though they have lived and worked in America for more than 20 years, they have not yet acclimated to Western culture and do not feel truly at home. Because of the political climate, Mohammed has often felt a great deal of discrimination. Though it is not always blatant, the staring and whispers have been enough to make him feel incriminated. He and his family are devout Muslims, and his wife and daughter have often felt endangered in public wearing their hijabs. They have not sought much medical treatment out of fear of being harassed. Now, Mohammed is hospitalized with chest pain and is being informed he must undergo open heart surgery. He is nervous and feels that the whispers, laughing, and stares he receives from the hospital staff are about him, his family, and his culture. His nurse, Ben, admits to his manager that he does feel a bit uncomfortable caring for Mohammeds family because he is unfamiliar with their culture, and what he does know about Middle Eastern people comes from what he sees in the news media, most of which is associated with terrorism.
Check for Understanding
How can Ben provide culturally competent care for Mohammed and his family given his apprehensions?
Health Equality
Health equality is based on the premise that all individuals deserve high quality, easily accessible, and affordable health care regardless of ethnicity or race. Unfortunately, the socioeconomically disadvantaged have poor access to quality health care and ultimately have higher rates of illness and premature death (Egen, Beatty, Blackley, Brown, & Wykoff, 2017). Nurses have a duty to provide and advocate for quality care for persons from all backgrounds, in spite of personal bias. Acknowledgment of this inequality is essential to formulating a plan of action that leads to health equality. Equally imperative for the nurse to understand is the concept of health equity, which is the provision of resources necessary to live well to all individuals regardless of varying social determinants of health (SDOH) (Brennan Ramirez, Baker, & Metzler, 2008).
Nurses are in a unique position to advocate for patients needs. Nurses are often the first point of contact for patients and are able to form trusting relationships through which the nurse is able to glean important information regarding patients needs. In dealing with health inequity, nurses must utilize the power of assessment to identify patients at risk. Once these inequities have been identified, nurses can work together with the patient and interdisciplinary team to come up with a plan of care that helps the patient attain proper resources to meet his or her goals.
There are many frameworks or models within health care that guide nurses and the health care team in identifying and addressing patients cultural needs. The nurse utilizes these models in order to personalize the plan of care and provide individualized care that encompasses cultural needs. One such framework is Campinha-Bacotes (2011) model of cultural competence (see Figure 3.1).
Figure 3.1
Campinha Bacote Cultural Competence Model
Note. Adapted from Delivering patient-centered care in the midst of a cultural conflict: The role of cultural competence, by J. Campinha-Bacote, 2011, OJIN: The Online Journal of Issues in Nursing, 16. Copyright 2011 by OJIN: The Online Journal of Issues in Nursing.
The Campinha Bacote model involves the nurses inner reflection and self-journey in providing culturally competent nursing care; it also guides the nurse to provide culturally sensitive care by teaching nurses cultural skills (Campinha-Bacote, 2011).
Cultural skill is guided by Madeleine Leiningers culture care theory in which Leininger states that cultural assessment is the systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people being served, (Campinha-Bacote, 2011, para. 6).
This is done by asking culturally appropriate questions that help the nurse identify needs, such as:
When do you seek treatment from others when you are ill?
What do you fear most about your sickness or becoming ill?
What types of treatments are acceptable to you?
How do you feel your illness affects you in your daily life?
In addition, nurses must also take into consideration the patients SDOH. This includes the assessment of the patients social, economic, and physical environments that contribute to the patients level of risk. Assessing these determinants is a primary step in achieving cultural competence. These factors, which are directly related to the patients culture and belief system, have a significant impact on a patients overall health status. In essence, these needs are, at times, the basic necessities of life, such as stable housing and nutrition needs that must be addressed before other health concerns become the focus of care (Theiss & Regenstein, 2017).
Scenario
Sheila is a 41-year-old female patient being treated for hypertension. She goes to the nearby urgent care center for persistent headache, and the intake nurse discovers her blood pressure is 172/90. After thorough discussion and assessing for her SDOH, the nurse finds that Sheila has recently become homeless and cannot afford her medications. The nurse understands that resources need to be provided to meet Sheilas basic needs in order for her to remain compliant with her medical treatment regimen.
Figure 3.2
Social Determinants of Health
Cultural Awareness
Nurses have the unique opportunity to learn about many cultures and grow their cultural competency skills because of their frequent, if not daily, care of patients from different cultures (Rahimaghaee & Mozdbar, 2017). Culture is a pattern of traditions, beliefs, values, norms, symbols and meanings among a group of people, (Byrne, 2016, p. 114). There are many different cultures, all with varying values and beliefs.
Values are the beliefs that serve as standards that ultimately influence behavior and thought processes within the cultural group. These beliefs often have heavy influence on perception of health in many ways, including health promotion, health maintenance, when to seek care and treatment, and what types of treatments are acceptable. Value orientation differs in that the collective values of a society shape its overall personality. It is the nurses responsibility to understand that some cultural beliefs may incorporate health practices that are considered unsafe or unhealthy to other cultures that do not share the same beliefs.
A controversial example of this is the practice of female genital mutilation. Female genital mutilation, also known as female genital circumcision, is a practice in which the external female genitalia is partially or totally removed for nonmedical purposes (World Health Organization [WHO], 2018). This practice is seen in countries within the Middle East as well as Africa and parts of Southeast Asia.
The controversy for Western society, as well as other developed countries, lies in the many risks this practice poses to a womans health, in addition to the practice being viewed as a violation of human rights (Momoh, Olufade, & Redman-Pinard, 2016). In light of this cultural practice, the nurse must remain sensitive when addressing patients who may have undergone this practice. This includes avoiding the term mutilation, as this might be considered disrespectful to women who have had the procedure and consider it to be a normal part of their culture and not a form of mutilation or cruelty (Momoh et al., 2016).
The nurse must also take child protection issues into account and advocate for patient safety if a minor is at risk for undergoing this procedure. Other controversial practices include refusal of blood or blood products, male circumcision, and beliefs surrounding death and dying. Each culture has different views on different aspects of health that need to be respected, regardless of personal feelings surrounding the practice.
Cultural Competence
What does it mean to be culturally competent? As nurses, caring for all persons regardless of ethnicity, socioeconomic background, race, or culture, is expected. To provide patients with basic nursing care, nurses must have the ability to suspend personal biases and fully respect patients in spite of differences. Providing culturally competent care is a major element in helping to eliminate outstanding health disparities worldwide. Cultural competency does not mean becoming an expert on every culture encountered, but it does mean that nurses should recognize what they do and do not know in order to provide appropriate care.
Cultural competency means being aware of differences related to culture and adjusting plans of care accordingly as well as remaining sensitive and respectful of choices patients may make based on their culture. Campinha Bacotes cultural competence model is a nursing theory that aids nurses in this process. Becoming culturally competent is considered a continual process that requires continuous education, self-awareness, and evaluation in order to provide holistic, culturally competent nursing care (Campinha-Bacote, 2011). With the influx of immigrants into the United States and the rise in ethnic minorities, nurses will be faced with the issue of culturally competent care on a daily basis. Cultural competence is just one component of providing integrated health care, which includes treating the patient in a holistic way that addresses all of their psychosocial and physical health care needs.
Within different cultural traditions, there are varying healing systems that are specific to maintaining and restoring health; they are traditional and nontraditional care systems (see Table 3.1). Traditional care systems embody more of the health care modalities seen in Western medicine, such as seeking medical attention from a licensed professional.
Nontraditional systems take a more natural approach, utilizing herbs and traditional practices for healing versus modern medicine modalities of care (Gale, 2014). There is a growing acceptance of the use of complementary alternative medicine (CAM) within the United States, which uses a combination of traditional treatments with alternative therapies such as massage, aromatherapy, or acupuncture (Lavretsky, 2017).
Table 3.1
Traditional and Nontraditional Healing Systems
Criteria
Traditional
Nontraditional
Care Philosophy
Curative
Carative (not necessarily treatment for a total cure)
Approach
Specializations depending on ailment
Holistic and individualized
Setting
Professional, including clinics and offices
Homes and community centers
Treatments
Pharmaceuticals, advanced technological treatments, and use of modern medicine
Herbs, charms, amulets, massage therapy, and meditation
Providers
Licensed professional
Healers, shaman, spiritualists, priests, and medicine man
Support
Ancillary staff at hospital or professional care setting/facility
Family and friends
Payment
Insurance, self-pay
Negotiable
Health Philosophy
Influenced by scientific methods, definitions, and research
Continuous search for balance
Note. Adapted from Complementary and Alternative Healthcare: Is it Evidence-Based?, by S. Tabish, 2008, International Journal of Health Sciences, 2, V-IX. Copyright 2008 by the International Journal of Health Sciences.
Transcultural Nursing
Madeleine Leininger (1991) developed the culture care theory, which recognizes the importance of cultural care in nursing. This is the fundamental basis for transcultural nursing, which is the study of cultural competence and how to apply it to patient care on a daily basis. The theory helps nurses understand elements that influence the patients well-being such as religion, culture, and economic factors. This theory also highlights the importance of human caring in all patient interactions and that caring is the true basis of nursing care. The nurse acknowledges and respects cultural differences and formulates a plan of care that is specific to the patients individualized cultural needs (de Oliveira Carvalho, Santiago da Rocha, & de Souza Rocha, 2015). The concepts that are central to this theory and guide the nurses care are as follows.
Cultural preservation is the nurses ability to retain and respect the patients cultural practices and traditions while providing nursing care.
Cultural accommodation involves the nurse going above and beyond to accommodate a patients specific cultural needs.
Cultural repatterning is the gentle suggestion of modifying certain cultural practices that could cause harm or interrupt the current medical treatments being provided.
The nurse utilizes these skills to provide appropriate, culturally sensitive nursing care to the patient (de Oliveira Carvalho et al, 2015). The sunrise model (see Figure 3.3) illustrates how the elements involved in cultural care affect one another as well as the nurses actions and care, all of which contribute to the individuals health. At the center of the model is the healthy, balanced patient. The patients health is directly influenced by a variety of factors, including social, religious, economic, and cultural; collectively these are referred to as the patients cultural care worldview. The nurse considers all elements within the patients worldview and understands that they each play an important role in affecting the patients health. Below the healthy, balanced patient, the model shows the different ways in which the patient may seek restoring health, including folk care, nursing care, and professional systems. Below this are the elements of cultural care that the nurse utilizes in order to provide culturally congruent nursing care to the patient.
Figure 3.3
Leiningers Sunrise Model
Note. Adapted from The Sunrise Model: A Contribution to the Teaching of Nursing Consultation in Collective Health, by L. Pereira de Melo, 2013, in American Journal of Nursing Research, 1(1), 20-23. Copyright 2013 by the Science and Education Publishing.
Patient Care and Safety
Safe nursing practice begins with thorough assessment. In order to provide safe care to multicultural patients, proper cultural assessment is a necessity. As previously described, each culture may have their own set of values and beliefs that could affect their plan of care. This also includes family dynamics, such as the decision maker within the family. This is important when discussing course of treatment, as it may be considered rude to discuss these details without a particular family member present. Taking detailed notes on family history is also crucial. Factors such as divorce, involvement of extended family members, power of attorney, end-of-life wishes, paternity, adoption, child custody, and familial violence all play important roles in the patients individualized plan of care. The nurse should take all of these elements into consideration and perform an adequate assessment to gather such details, customizing the patients plan of care to accommodate his or her needs.
When addressing the needs of emerging populations and immigrants, another topic that should be investigated is access to resources. The patient may be new to the area and/or country and may and may not have an awareness of local custom or approaches to navigate complex systems such as the health care system. In addition, they could simply lack the foundational knowledge, or prior experience necessary to access medical services. Education with interpretive services should be made available to ensure a basic understanding of the information being delivered. Collaboration with interdisciplinary team members ensures effective patient management as well as smooth transition of care.
Vulnerable populations are groups of people who require special attention related to well-being and safety, including pregnant women, human fetuses, neonates, children, cognitively impaired, prisoners, students, employees, uninsured, seniors, immigrants, and the educationally disadvantaged (Samuel-Nakamura, Leads, Cobb, Nguyen Truax, & Schanche Hodge, 2017). Vulnerable populations warrant the protection and care of federal agencies as well as health care institutions in order to ensure safe, effective, appropriate, affordable, and accessible health care. Nurses should be aware of these populations and work together with the interdisciplinary health care team to provide resources to these patients in order to ensure that they receive adequate health care.
Health Literacy
Nurses have all had experiences in which they go to great lengths to educate a patient regarding a topic only to receive a very confused look or have a patients family member tell them the patient did not understand the information just communicated. Of course, this confusion can be caused from a number of communication issues, but the patients health literacy may not be a factor the nurse thinks to consider. In the nurses effort to expedite care and optimize time in an already stretched thin shift, the nurse might forget the need to slow down or speak in a way that is understandable to those who do not comprehend medical jargon. While medical professionals are capable of deciphering medical terms, even the most educated individual may not understand such terms. Moreover, patients may acknowledge and agree to the presented facts out of embarrassment or anxiety, leaving the nurse unaware that they did not understand. This issue comes with repercussions such as readmission and adverse health outcomes related to poor maintenance or neglected follow-up care (Johnson, 2015).
Figure 3.4
Health Literacy
Nurses must stay abreast of patients education needs, especially health literacy and the patients ability to fully understand recommendations and education provided. Comprehension is vital to enabling the patient to make informed decisions regarding their health care decisions. Crucial elements include the use of laymans terms when describing medical procedures or anatomy and the use of the teach back method in which the nurse asks the patient or caregiver/family to repeat what was just explained to them in their own words. In this way, the nurse can determine what they did or did not understand so that clarifications can be made (Tamura-Lis, 2013).
Also important to the education process is limiting yes or no questions. These types of questions do not allow for patients to speak freely, and most patients tend to answer simply and without seeking clarification. Instead, the nurse should use open-ended questions, such as, Can you tell me why it is important to check your blood sugars daily? This presents an opportunity for further discussion between the nurse and patient. Speaking slowly in concise sentences, sticking to only two or three topics at a time, and supplementing presented material with video media have all been proven to be effective delivery methods for providing patient education (Johnson, 2015).
Health Promotion
Nutrition is a central component to healthy living. Within much of Western civilization, foods are readily accessible and often highly processed and laden with extra calories, fat, and sugar. These foods can be less expensive than healthier options as well, making healthy choices less accessible for low-income families and individuals. Food is also a key element in daily social life as well, often taking center stage during celebrations, gatherings, and many events.
As a result, the United States, along with other countries around the world, faces a growing crisis of obesity and associated comorbidities. Obesity, diabetes, hypertension, heart disease, cancer, and stroke, along with other diseases, have all become more prominent and have a direct correlation to poor dietary intake (Patience, 2016). Nurses have always been an important proponent in promoting wellness. As nurses roles continue to grow and advance, it is important for them to be knowledgeable about patient education needs such as nutrition and activity. This section will explore these elements and details. In order to address the growing concern of obesity and overall health, the ODPHP has developed Healthy People 2020, in which a series of recommendations and implementation programs have been initiated to promote wellness.
Healthy People 2020
As part of a national effort to improve health, ODPHP created initiatives to improve prominent health issues in the United States. Addressing nutrition and obesity is one of the main initiatives because statistics show that nearly 1 in 3 adults is considered obese, and approximately 81.6% of adults do not get the recommended amount of daily activity (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). The ODPHPs overarching goal is to help persons within the United States live healthy, long lives and provide them the resources to avoid preventable diseases related to poor health. Indicators also point to an alarming number of Americans not consuming anywhere near the recommended amount of fruits and vegetables and a large proportion living sedentary lifestyles, all of which have been proven to increase the development of noncommunicable diseases (ODPHP, n.d.). Moreover, it is evident that American society has shifted from being a country of nutritional deficit-related diseases to one of noncommunicable diseases related to nutritional excess and overconsumption. Such a shift requires the attention of governmental bodies as well as health professionals who work closely within communities to promote and restore health in an ever-growing population with longer life expectancies.
While Healthy People 2020 targets several subjects related to overall health, the programs focus on nutrition involves helping individuals achieve optimum weight status by teaching them to eat well-balanced meals in order to avoid chronic illness development associated with obesity (ODPHP, n.d.). Central to the issue of nutrition are recommendations such as decreasing fats, sugars, salts, and alcohol as well as learning to incorporate nutrient dense foods. Objectives specific to nutrition include healthier food access, work- and school-related programs, combating obesity, food insecurity, and nutrient deficiencies. Their overarching goals for helping individuals attain wellness include the following.
Eliminate preventable disease.
Achieve health equity, and improve health of all groups.
Create social and physical environments that promote wellness.
Promote health development and healthy behaviors (ODPHP, n.d.).
The Healthy People website provides links and resources such as choosemyplate.gov, which provides easy to understand recommendations for dietary intake, including the recommended intake of whole grains, fruits, vegetables, carbohydrates, and fats (United States Department of Agriculture [USDA], n.d.). This valuable resource also provides information regarding the nutritional content of the different food groups and why they are essential to health. The website also has tools such as personalized food trackers to visualize typical daily intake and a body mass index (BMI) calculator to determine a baseline health status.
The Healthy People website delivers evidence-based studies, clinical advisories, as well as consumer advice, which is the resource most relevant to the general population. Within the topic of consumer advice, a collection of links is available, providing resources on a plethora of topics, including healthy snack tips for parents, heart health, shopping list tips, and eating healthy during pregnancy. These resources can help nurses to guide their patients in the health promotion and education process (ODPHP, n.d.). Though disease prevention and health promotion are ideal, the issue remains that health-related disparities are increasing in the United States and must be understood in order to create a plan of action for change in the future.
Initiatives for Emerging Populations
With respect to the goals for Healthy People 2020, the HHS developed specific health-related initiatives for individuals, including those within emerging populations. Each varying initiative is directed at achieving the following overall goals of helping individuals across the United States achieve wellness.
Increase the proportion of persons with medical insurance.
Increase the number of population-based data systems used to monitor Healthy People 2020 objectives that collect data on LGBTQ populations.
Increase the proportion of population-based Healthy People 2020 objectives for which national data are available by race and ethnicity.
Eliminate very low food security among children.
Increase the proportion of persons with diabetes who receive formal diabetes education.
Disease Processes and Nutrition
Nutrition can be a defining factor in attaining optimal or poor health. What is put into the body has a direct impact on its functioning capacity, and poor nutrition can lead to the development of a number of diseases. This chapter focuses briefly on six diseases that are directly linked to nutrition:
Obesity
Hypertension
Diabetes Mellitus (DM)
Heart Disease
Cancer
Stroke
It should be noted that four of these diseasesdiabetes, heart disease, stroke and cancerare some of the leading causes of death in the United States and, therefore, take precedence and require the most amount of attention for health promotion and education, especially from the nurses perspective (CDC, 2017a).
Obesity
Obesity is a prominent and growing concern in the United States, leading to a host of other diseases that result in poor patient outcomes (Lu, Dickin, & Dollahite, 2014). Genetics as well as hormonal imbalances play a causative role in the development of obesity; however, modifiable factors, such as dietary intake and physical activity, remain the driving forces of disease prevention (CDC, 2015c). Bearing all of this in mind, it is crucial to focus on encouraging lifestyle changes that involve proper dietary intake, weight loss and maintenance, increased physical activity, and mental health wellness, as appropriate, to help individuals live their best life.
Hypertension
Hypertension is the elevation in blood pressure greater than 140mmHg systolic and/or a diastolic greater than 90mmHg (American Heart Association, 2017). Multiple risk factors are involved in its development including obesity, DM, genetics, and familial tendency. Again, this disease process is related to the others described within the text, particularly obesity. While this disease can be placed under the umbrella of heart disease, its prominence warrants ind
