NR503 IFINAL IEXAM ISTUDY IGUIDE
Review Iprimary, Isecondary, I& Itertiary Iprevention Ipractices, Iscreening, Ivulnerable Ipopulations, Iand Ithe Irole Iof Ithe Inurse Ipractitioner.
Week I5 I(Ch. I2)
1. Discriminate Ipopulations Iat Irisk Ifor Idevelopment Iof Ichronic Ihealth Iconditions Iwhile Iassociating Ithe Irole Iof Ithe
IAdvancedIPractice INurse Iin Ilevels Iof Ipromotion.
Common Irisk Ifactors: Iunhealthy Idiet, Iphysical Iinactivity, Iand Itobacco Iuse
Childhood Irisk: IThere Iis Inow Iextensive Ievidence Ifrom Imany Icountries Ithat Iconditions Ibefore Ibirth Iand Iin Iearly Ichildhood
Iinfluence Ihealth Iin Iadult Ilife. IFor Iexample, Ilow Ibirth Iweight Iis Inow Iknown Ito Ibe Iassociated Iwith Iincreased Irates Iof Ihigh Iblood
Ipressure, IheartIdisease, Istroke Iand Idiabetes.
Risk Iaccumulation: IAgeing Iis Ian Iimportant Imarker Iof Ithe Iaccumulation Iof Imodifiable Irisks Ifor Ichronic Idisease: Ithe Iimpact Iof Irisk
Ifactors Iincreases Iover Ithe Ilife Icourse.
Underlying Ideterminants: IThe Iunderlying Ideterminants Iof Ichronic Idiseases Iare Ia Ireflection Iof Ithe Imajor Iforces Idriving Isocial,
Ieconomic Iand Icultural Ichange I– Iglobalization, Iurbanization, Ipopulation Iageing, Iand Ithe Igeneral Ipolicy Ienvironment.
Poverty: IChronic Idiseases Iand Ipoverty Iare Iinterconnected Iin Ia Ivicious Icircle. IAt Ithe Isame Itime, Ipoverty Iand Iworsening Iof Ialready
Iexisting Ipoverty Iare Icaused Iby Ichronic Idiseases. IThe Ipoor Iare Imore Ivulnerable Ifor Iseveral Ireasons, Iincluding Igreater Iexposure Ito Irisks
Iand Idecreased Iaccess Ito Ihealth Iservices. IPsychosocial Istress Ialso Iplays Ia Irole.
Preventative Ihealth Iactions Iare Ioften Icategorized Iin Ithree Ilevels:
• Primary Iprevention I- Iaims Ito Iprevent Idisease Ior Iinjury Ibefore Iit Iever Ioccurs.
▪ This Iis Idone Iby Ipreventing Iexposures Ito Ihazards Ithat Icause Idisease Ior Iinjury, Ialtering Iunhealthy
IorIunsafe Ibehaviors Ithat Ican Ilead Ito Idisease Ior Iinjury, Iand Iincreasing Iresistance Ito Idisease Ior
Iinjury
should Iexposure Ioccur.
▪ Nurses Iplay Ithe Ipart Iof Ieducators Ithat Ioffer Iinformation Iand Icounseling Ito Icommunities
IandIpopulations Ithat Iencourage Ipositive Ihealth Ibehaviors
▪ Examples Iinclude:
• legislation Iand Ienforcement Ito Iban Ior Icontrol Ithe Iuse Iof Ihazardous Iproducts I(e.g.
Iasbestos) Ior Ito Imandate Isafe Iand Ihealthy Ipractices I(e.g. Iuse Iof Iseatbelts Iand Ibike
Ihelmets)
• education Iabout Ihealthy Iand Isafe Ihabits I(e.g. Ieating Iwell, Iexercising Iregularly,
InotIsmoking)
• immunization Iagainst Iinfectious Idiseases.
• Secondary Iprevention I- Iaims Ito Ireduce Ithe Iimpact Iof Ia Idisease Ior Iinjury Ithat Ihas Ialready Ioccurred
▪ This Iis Idone Iby Idetecting Iand Itreating Idisease Ior Iinjury Ias Isoon Ias Ipossible Ito Ihalt Ior Islow
Iits Iprogress, Iencouraging Ipersonal Istrategies Ito Iprevent Ireinjury Ior Irecurrence, Iand
Iimplementing
programs Ito Ireturn Ipeople Ito Itheir Ioriginal Ihealth Iand Ifunction Ito Iprevent Ilong-term Iproblems.
▪ Nurses Iwork Iwith Ithese Ipatients Ito Ireduce Iand Imanage Icontrollable Irisks, Imodifying
Ithe Iindividuals’ Ilifestyle Ichoices Iand Iusing Iearly Idetection Imethods Ito Icatch Idiseases Iin
ItheirIbeginning Istages Iwhen Itreatment Imay Ibe Imore Ieffective.
▪ Examples Iinclude:
• regular Iexams Iand Iscreening Itests Ito Idetect Idisease Iin Iits Iearliest Istages
I(e.g.Imammograms Ito Idetect Ibreast Icancer)
• daily, Ilow-dose Iaspirins Iand/or Idiet Iand Iexercise Iprograms Ito Iprevent Ifurther Iheart
IattacksIor Istrokes
• suitably Imodified Iwork Iso Iinjured Ior Iill Iworkers Ican Ireturn Isafely Ito Itheir Ijobs.
• Tertiary Iprevention I- Iaims Ito Isoften Ithe Iimpact Iof Ian Iongoing Iillness Ior Iinjury Ithat Ihas Ilasting Ieffects
▪ This Iis Idone Iby Ihelping Ipeople Imanage Ilong-term, Ioften-complex Ihealth Iproblems Iand
IinjuriesI(e.g. Ichronic Idiseases, Ipermanent Iimpairments) Iin Iorder Ito Iimprove Ias Imuch Ias
Ipossible Itheir
ability Ito Ifunction, Itheir Iquality Iof Ilife Iand Itheir Ilife Iexpectancy.
▪ Nurses Iare Itasked Iwith Ihelping Iindividuals Iexecute Ia Icare Iplan Iand Imake Iany Iadditional
IbehaviorImodifications Inecessary Ito Iimprove Iconditions
▪ Examples Iinclude:
• cardiac Ior Istroke Irehabilitation Iprograms, Ichronic Idisease Imanagement Iprograms I(e.g.
IforIdiabetes, Iarthritis, Idepression, Ietc.)
• support Igroups Ithat Iallow Imembers Ito Ishare Istrategies Ifor Iliving Iwell
• vocational Irehabilitation Iprograms Ito Iretrain Iworkers Ifor Inew Ijobs Iwhen Ithey
IhaveIrecovered Ias Imuch Ias Ipossible.
, •
Members Iof Iminorities Iare Ioverrepresented Ion Ithe Ilow Itiers Iof Ithe Isocioeconomic Iladder. IPoor Ieconomic Iachievement Iis Ialso Ia
common Icharacteristic Iamong Ipopulations Iat Irisk, Isuch Ias Ithe Ihomeless, Imigrant Iworkers, Iand Irefugees. IHowever, Ithe IAPN Ishould
Ibe Iable Ito Idistinguish Ibetween Icultural Iand Isocioeconomic Iclass Iissues Iand Inot Iinterpret Ibehavior Ias Ihaving Ia Icultural Iorigin Iwhen
Ithe IfactIis Ibased I on Isocioeconomic Iclass. IA Igood Iresource Ifor IAPNs Iis Ithe ICross-Cultural IHealth ICare IProgram I(CCHCP), Iwhich
I has Ia Iplethora Iof Imaterials Ito Iimprove Icultural Icompetency Iamong Ihealthcare Iproviders, Iincluding Ia Itraining Iprogram Ifor Ihealthcare
Iproviders. IIn Iorder Ito Iprovide Iappropriate Ihealthcare Iinterventions, Iculture Iand Iall Iits Ivariants Imust Ibe Iaddressed.
(p28)APRNs Imay Ibe Iable Ito Iaccess Ihealth Iinformation Ineeded Iby Iworking Itogether Iwith Iother Isectors Ioutside Iof Ihealth, Isuch Ias
Ihousing, Ilabor, Ieducation, Iand Icommunity-based Ior Ifaith-based Iorganizations Ithat Ioffer Iservices Ito Iimmigrant Icommunities. IThis
Iinvolves Ithe Icollection, Idocumentation, Iand Iuse Iof Idata Ithat Ican Ibe Iused Ito Imonitor Ihealth Iinequalities Iin Iexposures, Iopportunities,
IandIoutcomes. IExamples Iof Isocial Ideterminants Ithat Iare Irelated Ito Ihealth Iinequalities Iinclude Ipoverty, Ieducational Ilevel, Iracism,
Iincome, Iand Ipoor Ihousing. IThese Iinequalities Ican Ilead Ito
poor Iquality Iof Ilife, Ipoor Iself-rated Ihealth, Imultiple Imorbidities, Ilimited Iaccess Ito Iresources, Ipremature Ideath, Iand Iunnecessary Irisks
Iand Ivulnerabilities.
(p25) IAPRNs Ican Ibest Idetermine Ithe Ieffectiveness Iof Ian Iintervention Iand Ilong-term Iimpact Iby Ifocusing Ion Ian Iaccurate Iassessment
IandIinterpretation Iof Idata Ithat Iare Igenerated Ior Icollected Iusing Iindividual, Ipopulation, Iand Icommunity Ihealth Iindicators.
(p27)APRNs Ican Iwork Iin Ipartnership Iwith Icommunity Imembers Ito Iidentify Iwhat Icommunity Imembers Isee Ias Irelevant Iand
Iimportant, Ibuild Isocial Icapital, Iuse Ioutcome Idata Ito Iadvocate Ifor Ichanges Iin Ipolicy, Iand Ithen Icontinue Ito Iwork Iin Ipartnership Ito
Iidentify IstrategiesIto Iintervene, Imonitor,and Iimprove Ithose Ioutcomes
(p40-41)APRNs Ihave Inumerous Iresources Ithey Ican Iaccess Ito Iimprove Iquality Iand Itimely Iaccess Ito Iquality Ihealthcare Iand Idecrease
Ihealth Idisparities. IThe INational IPartnership Ifor IAction I(NPA) Ito IEnd IHealth IDisparities I( Iminorityhealth.hhs.gov/npa) Iwas Istarted
IbyIthe IOffice Iof IMinority IHealth
to Imobilize Iindividuals Iand Igroups Ito Iwork Ito Iimprove Iquality Iand Ieliminate Ihealth Idisparities. IThe INational IPriorities Iincludes Ikey
Iprivate Iand Ipublic Istakeholders Iwho Ihave Iagreed Ito Iwork Ion Imajor Ihealth Ipriorities Iof Ipatients Iand Ifamilies, Ipalliative Iand Iend-of-
lifeIcare, Icare Icoordination, Ipatient Isafety, Iand Ipopulation Ihealth. IThe IQuality IAlliance ISteering ICommittee Iis Ianother Ipartnership
Iof Ihealthcare Ileaders Iwho Iwork Ito Iimprove Ihealthcare Iquality Iand Icosts. IVarious Istrategies Ito Ibridge Ithe Igaps Iin Ihealthcare Iquality
Iare Iavailable Iat Ithe Inational Ilevel Iand Imay Ibe Iapplied Ior Iconsidered Iat Ithe Istate, Iregional, Ior Ilocal Ilevel Iin Icollaboration Iwith
IstakeholdersIas Ia Imeans Iof Idecreasing Ihealth Idisparities.
(p43) IAPRNs Iare Ibetter Iprepared Ito Idevelop Ieffective Iinterventions Ito Ieliminate Ior Ireduce Ihealth Idisparities. ISuch Istrategies
ImayIinclude Iadvocating Ibetter Ihealth Iinsurance Icoverage
for Ipoor Iand Iimmigrant Ipopulations; Iensuring Ithat Isufficient Iservices Iexist Iin
Iunderserved Iareas; Iassessing Ithe Iinteraction Iamong Isocial Ienvironments, Igenetics,
and Ipopulation Ihealth; Iencouraging Iminority Iparticipation Iin Iresearch Istudies Iwith Icommunity-based Iparticipatory Iresearch Iand
Ispecifically Iwith Ipractice-based Iresearch Inetworks; Iusing Ilinguistically Iand Iculturally Iappropriate Icommunication Iand Iwritten
Ihandouts; Ipromoting Iand Ifacilitating Icommunity Ipartnerships; Iand Iimplementing Istrategies Ito Iencourage Ipeople Ifrom Iminority
Ipopulations Ito Ibecome Ihealthcare Iprofessionals
2. Compare Iand Icontrast Ivariables Ithat Idifferentiate Ithose Icategorized Iat Ibeing Iat Irisk Ifor Imarginalization Iof Ihealth Icare.
Definition: Iwhen Ian Iindividual Ior Igroup Iis Iput Iinto Ia Iposition Iof Iless Ipower Ior Iisolation Iwithin Isociety Ibecause Iof Idiscrimination I
ILimits Itheir Iopportunities Iand Imeans Ifor Isurvival. IWhen Ian Iindividual Iis Imarginalized, Ithey Iare Iunable Ito Iaccess Ithe Isame Iservices Iand
Iresources Ias Iother Ipeople Iand Iit Ibecomes Ivery Idifficult Ito Ihave Ia Ivoice Iin Isociety.
Marginalization I– Imajor Icause Iof Ivulnerability, Iwhich Irefers Ito Iexposure Ito Ia Irange Iof Ipossible Iharms, Iand Ibeing Iunable Ito Ideal Iwith
Ithem Iadequately.
• Variables: Isocial Iclass, Irace, Ihomelessness, Isubstance Iabuse, Iprison/offending, Imental Ihealth Iproblems, IHIV Ipositive
• Women Iare Imore Ilikely Ito Ibe Imarginalized Ithan Imen, Ibecause Iof Itheir Igender. IThis Iis Ievident Ithrough Ithe
Isocial, Ieconomic, Iand Ipower Iimbalances Ithat Iexist Ibetween Imen Iand Iwomen. IFor Iexample, Imore Iwomen Ithan
Imen Ilive Iin
poverty, Iand Imen Icontinue Ito Ihave Imore Isecure, Ifull-time Ijobs Iand Ihigher Iincome Ithan Itheir Ifemale Icounterparts.
• A Iwoman Ican Ialso Ibe Imarginalized Ibecause Ion Iher IHIV Istatus, Ior IHIV Irisk. IShe Imay Iexperience Ieven Imore Istigma
IifIshe Iis Ialso Ia Ipart Iof Iother Imarginalized Igroups Iin Irelation Ito Iher Irace Ior Isexual Iorientation. IFor Iexample, Ia
Iwoman Iis Igay Iand Ian Iimmigrant Imay Ialso Iexperience Ihomophobia Iand Iracism.
Those Iat Irisk Ifor Imarginalization Iof Ihealth Icare Iinclude Ithose Iwithout Ishelter Iin Irural Ior Iurban Iareas, Ithose Iliving Iin Iremote Iparts Iof
ItheIcountry, Ifamilies Iof Ilower Isocioeconomic Istatus, Idisabled Ipersons, Irecent Iimmigrants Iand Irefugees, IIndigenous Ipopulations, Iand
Iseniors. IAdequately Iidentifying Iand Igaining Iaccess Ito Ivulnerable Icommunities Iare Iessential Isteps Ifor Ithe Ihealth Isystem Iin Iorder Ito
Irecognize Iand Iaddress Itheir Iunique Ihealth Ineeds.
, Four Idimensions Ithat Icapture Ithe Iprincipal Ideterminants Iof Ihealth Imarginalization: Iresidential Iinstability, Imaterial Ideprivation, Iethnic
Iconcentration, Iand Idependency.
(FYI: II Icouldn’t Ifind Ithis Iinformation Iin Ithe Itext Ibut II Ifound Iit Ihere Ihttps://ubcmj.med.ubc.ca/marginalization-in-
health/)I(online Ilesson Iwk I5) ISingletone Iand IKrause I(2009) Ihave Iidentified Ithe Iconfounding Ivariables Ithat Iresult Iin
Isubpar Ihealth
communication. IThese Iinclude Ilow Ihealth Iliteracy, Icultural Ibarriers, Iand Ilow IEnglish Iproficiency. IThe Ihealthcare Isystem Iis Ioften
Iconfusing Ifor Iindividuals Iwho Iare Iproficient Iin IEnglish Ibut Iare Inot Ifamiliar Iwith Ihealthcare Iknowledge Iand Iterminology. IOne Ican
Iimagine Ithe Isynergistic Ieffect Iof Ihaving Ilow Ihealth Iliteracy Iin Iaddition Ito Ihaving Iinadequate IEnglish Iskills. IThe Iconfluence Ican Ihinder
Ioptimal Iutilization Iof Ithe Ihealthcare Isystem.
(p28)Social Ideterminants Iof Ihealth Iand Iinequalities Idata Iare Iareas Ithat IAPRNs
can Ialso Iuse Ito Iinform Iand Iguide Itheir Ipractice Ito Idevelop Isocioculturally
IappropriateIinterventions. ISocial Ideterminants Ithat Ilead Ito Ihealth Iinequalities Iare
recognized Isituations Irelated Ito Iwhere Ipeople Iare Iborn, Igrow Iup, Iwork, Ilive,
and Ithe Isystems Iof Icare Iavailable Ito Ithem Ito Ideal Iwith Iillness Iand Idisease….. IExamples Iof
Isocial Ideterminants Ithat Iare Irelated Ito Ihealth Iinequalities Iinclude Ipoverty, Ieducational
Ilevel, Iracism, Iincome, Iand Ipoor Ihousing. IThese Iinequalities Ican Ilead Ito
poor Iquality Iof Ilife, Ipoor Iself-rated Ihealth, Imultiple Imorbidities, Ilimited Iaccess Ito
Iresources, Ipremature Ideath, Iand Iunnecessary Irisks Iand Ivulnerabilities.
(p37) IDisparities/inequity Ito Ibe Iassessed Iby Ithe Ifollowing:
• Race/ethnicity
• Gender
• Socioeconomic Istatus
• Disability Istatus
• LGBT Istatus
• Geography
(p40) IIt Iis Iwidely Irecognized Inow Ithat Ithe Isocial Ideterminants Iof
health, Isuch Ias Ihousing, Ieducation, Iaccess Ito Ipublic Itransportation, Iaccess Ito
Isafe Iwater, Iaccess Ito Ifresh Ifood, Iand Ithe Ibuilt Ienvironment, Iare Iall Irelated Ito Ia
Ipopulation’s Ihealth. IIn Iaddition Ito Iethnicity, Iother Icharacteristics Ialso
IcontributeIto Ithe Ipresence Iof Idisparities Ior Ithe Iachievement Iof Igood Ihealth
Isuch Ias
gender, Isexual Iorientation, Igeographic Ilocation, Iworking Ienvironment,
Icognitive,Isensory, Ior Iphysical Idisability, Iand Isocioeconomic Istatus.
3. How Idoes Iculture Iinfluence Ithe Idecisions Ia Iprovider Imay Imake Iwhen Iselecting Ian Iintervention?
Learning Iabout Ione’s Iculture Iand Iassessing Iepidemiological Ipatterns Iof Ihealth Iand Iillness Iacross Ithe Ilife Ispan Ifacilitates Ithe Inurse
Ipractitioner's Iability Ito Ifocus Ion Ihealth Iinitiatives Iand Iformulate Iplans Iof Icare Ileading Ito Ibehavioral Ichange Iand Isustainable Iquality
Ihealth Iand Ilifestyle Ioutcomes. IReligion, Iculture, Ibeliefs, Iand Iethnic Icustoms Ican Iinfluence Ihow Ipts Iunderstand Ihealth Iconcepts, Ihow
Ithey Itake Icare Iof Itheir Ihealth, Iand Ihow Ithey Imake Idecisions Irelated Ito Itheir Ihealth. IWithout Iproper Itraining, Iclinicians Imay Ideliver
Imedical Iadvice Iwithout Iunderstanding Ihow Ihealth Ibeliefs Iand Icultural Ipractices Iinfluence Ithe Iway Ithat Iadvice Iis Ireceived. IAsking
IaboutIpts’s Ireligions, Icultures, Iand Iethnic Icustoms Ican Ihelp Iclinicians Iengage Ipts Iso Ithat, Itogether, Ithey Ican Idevise Itreatment Iplans
Ithat Iare Iconsistent Iwith Ithe Ipt’s Ivalues.
Several Imodels Ihave Iemerged Ito Iassist Ihealthcare Iproviders Ito Imeet Ithe Ichallenge Iof Iproviding Iculturally Irelevant Icare. ICampinha-
IBacote I(2002) Iviews Icultural Icompetence Ias Ian Iongoing Ilearning Iprocess Ias Ithe Iproviders Icontinuously Istrive Ito Iachieve Ithe Ibest
Ioutcomes Ifor Ipatients, Ifamilies, Iand Ipopulations.
Culture Iis, I"the Ipractices, Ibeliefs, Ivalues, Iand Inorms Iwhich Ican Ibe Ilearned Ior Ishared, Iand Iwhich Iguide Ithe Iactions Iand Idecisions Iof Ieach
Iperson Iin Ithe Igroup”.
Health Iand Idisease Idenotes Ican Ivary Ifrom Iculture Ito Iculture. ITherefore, Ithere Iis Ia Iwide Ispectrum Iof Iwhat Iare Iconsidered Iappropriate
Iinterventions. IThus, Iculture Iinfluences Ithe Idecisions Ia Iprovider Imay Imake Iwhen Iselecting Ian Iintervention Ibased Ion Ithe Icultures'
Iperceptions Iof Idisease Icausation, Isymptomatology, Iand Ipathology.
Care Iis Iprovided Iwith Isensitivity Iand Iis Ibased Ion Ithe Icultural Iuniqueness Iof Iclients.
although Icultures Idiffer, Ithey Iall Ihave Ithe Isame Ibasic Iorganizing Ifactors Ithat Imust Ibe Iassessed Iin Iorder Ito Iprovide Icare Ifor Iculturally
Idiverse Ipatients. IThese Ifactors Iinclude. IAlthough Icultures Idiffer, Ithey Iall Ihave Ithe Isame Ibasic Iorganizing Ifactors Ithat Imust Ibe
IassessedIin Iorder Ito Iprovide Icare Ifor Iculturally Idiverse Ipatients. IThese Ifactors Iinclude
• communication I(verbal Iand Inonverbal);
Review Iprimary, Isecondary, I& Itertiary Iprevention Ipractices, Iscreening, Ivulnerable Ipopulations, Iand Ithe Irole Iof Ithe Inurse Ipractitioner.
Week I5 I(Ch. I2)
1. Discriminate Ipopulations Iat Irisk Ifor Idevelopment Iof Ichronic Ihealth Iconditions Iwhile Iassociating Ithe Irole Iof Ithe
IAdvancedIPractice INurse Iin Ilevels Iof Ipromotion.
Common Irisk Ifactors: Iunhealthy Idiet, Iphysical Iinactivity, Iand Itobacco Iuse
Childhood Irisk: IThere Iis Inow Iextensive Ievidence Ifrom Imany Icountries Ithat Iconditions Ibefore Ibirth Iand Iin Iearly Ichildhood
Iinfluence Ihealth Iin Iadult Ilife. IFor Iexample, Ilow Ibirth Iweight Iis Inow Iknown Ito Ibe Iassociated Iwith Iincreased Irates Iof Ihigh Iblood
Ipressure, IheartIdisease, Istroke Iand Idiabetes.
Risk Iaccumulation: IAgeing Iis Ian Iimportant Imarker Iof Ithe Iaccumulation Iof Imodifiable Irisks Ifor Ichronic Idisease: Ithe Iimpact Iof Irisk
Ifactors Iincreases Iover Ithe Ilife Icourse.
Underlying Ideterminants: IThe Iunderlying Ideterminants Iof Ichronic Idiseases Iare Ia Ireflection Iof Ithe Imajor Iforces Idriving Isocial,
Ieconomic Iand Icultural Ichange I– Iglobalization, Iurbanization, Ipopulation Iageing, Iand Ithe Igeneral Ipolicy Ienvironment.
Poverty: IChronic Idiseases Iand Ipoverty Iare Iinterconnected Iin Ia Ivicious Icircle. IAt Ithe Isame Itime, Ipoverty Iand Iworsening Iof Ialready
Iexisting Ipoverty Iare Icaused Iby Ichronic Idiseases. IThe Ipoor Iare Imore Ivulnerable Ifor Iseveral Ireasons, Iincluding Igreater Iexposure Ito Irisks
Iand Idecreased Iaccess Ito Ihealth Iservices. IPsychosocial Istress Ialso Iplays Ia Irole.
Preventative Ihealth Iactions Iare Ioften Icategorized Iin Ithree Ilevels:
• Primary Iprevention I- Iaims Ito Iprevent Idisease Ior Iinjury Ibefore Iit Iever Ioccurs.
▪ This Iis Idone Iby Ipreventing Iexposures Ito Ihazards Ithat Icause Idisease Ior Iinjury, Ialtering Iunhealthy
IorIunsafe Ibehaviors Ithat Ican Ilead Ito Idisease Ior Iinjury, Iand Iincreasing Iresistance Ito Idisease Ior
Iinjury
should Iexposure Ioccur.
▪ Nurses Iplay Ithe Ipart Iof Ieducators Ithat Ioffer Iinformation Iand Icounseling Ito Icommunities
IandIpopulations Ithat Iencourage Ipositive Ihealth Ibehaviors
▪ Examples Iinclude:
• legislation Iand Ienforcement Ito Iban Ior Icontrol Ithe Iuse Iof Ihazardous Iproducts I(e.g.
Iasbestos) Ior Ito Imandate Isafe Iand Ihealthy Ipractices I(e.g. Iuse Iof Iseatbelts Iand Ibike
Ihelmets)
• education Iabout Ihealthy Iand Isafe Ihabits I(e.g. Ieating Iwell, Iexercising Iregularly,
InotIsmoking)
• immunization Iagainst Iinfectious Idiseases.
• Secondary Iprevention I- Iaims Ito Ireduce Ithe Iimpact Iof Ia Idisease Ior Iinjury Ithat Ihas Ialready Ioccurred
▪ This Iis Idone Iby Idetecting Iand Itreating Idisease Ior Iinjury Ias Isoon Ias Ipossible Ito Ihalt Ior Islow
Iits Iprogress, Iencouraging Ipersonal Istrategies Ito Iprevent Ireinjury Ior Irecurrence, Iand
Iimplementing
programs Ito Ireturn Ipeople Ito Itheir Ioriginal Ihealth Iand Ifunction Ito Iprevent Ilong-term Iproblems.
▪ Nurses Iwork Iwith Ithese Ipatients Ito Ireduce Iand Imanage Icontrollable Irisks, Imodifying
Ithe Iindividuals’ Ilifestyle Ichoices Iand Iusing Iearly Idetection Imethods Ito Icatch Idiseases Iin
ItheirIbeginning Istages Iwhen Itreatment Imay Ibe Imore Ieffective.
▪ Examples Iinclude:
• regular Iexams Iand Iscreening Itests Ito Idetect Idisease Iin Iits Iearliest Istages
I(e.g.Imammograms Ito Idetect Ibreast Icancer)
• daily, Ilow-dose Iaspirins Iand/or Idiet Iand Iexercise Iprograms Ito Iprevent Ifurther Iheart
IattacksIor Istrokes
• suitably Imodified Iwork Iso Iinjured Ior Iill Iworkers Ican Ireturn Isafely Ito Itheir Ijobs.
• Tertiary Iprevention I- Iaims Ito Isoften Ithe Iimpact Iof Ian Iongoing Iillness Ior Iinjury Ithat Ihas Ilasting Ieffects
▪ This Iis Idone Iby Ihelping Ipeople Imanage Ilong-term, Ioften-complex Ihealth Iproblems Iand
IinjuriesI(e.g. Ichronic Idiseases, Ipermanent Iimpairments) Iin Iorder Ito Iimprove Ias Imuch Ias
Ipossible Itheir
ability Ito Ifunction, Itheir Iquality Iof Ilife Iand Itheir Ilife Iexpectancy.
▪ Nurses Iare Itasked Iwith Ihelping Iindividuals Iexecute Ia Icare Iplan Iand Imake Iany Iadditional
IbehaviorImodifications Inecessary Ito Iimprove Iconditions
▪ Examples Iinclude:
• cardiac Ior Istroke Irehabilitation Iprograms, Ichronic Idisease Imanagement Iprograms I(e.g.
IforIdiabetes, Iarthritis, Idepression, Ietc.)
• support Igroups Ithat Iallow Imembers Ito Ishare Istrategies Ifor Iliving Iwell
• vocational Irehabilitation Iprograms Ito Iretrain Iworkers Ifor Inew Ijobs Iwhen Ithey
IhaveIrecovered Ias Imuch Ias Ipossible.
, •
Members Iof Iminorities Iare Ioverrepresented Ion Ithe Ilow Itiers Iof Ithe Isocioeconomic Iladder. IPoor Ieconomic Iachievement Iis Ialso Ia
common Icharacteristic Iamong Ipopulations Iat Irisk, Isuch Ias Ithe Ihomeless, Imigrant Iworkers, Iand Irefugees. IHowever, Ithe IAPN Ishould
Ibe Iable Ito Idistinguish Ibetween Icultural Iand Isocioeconomic Iclass Iissues Iand Inot Iinterpret Ibehavior Ias Ihaving Ia Icultural Iorigin Iwhen
Ithe IfactIis Ibased I on Isocioeconomic Iclass. IA Igood Iresource Ifor IAPNs Iis Ithe ICross-Cultural IHealth ICare IProgram I(CCHCP), Iwhich
I has Ia Iplethora Iof Imaterials Ito Iimprove Icultural Icompetency Iamong Ihealthcare Iproviders, Iincluding Ia Itraining Iprogram Ifor Ihealthcare
Iproviders. IIn Iorder Ito Iprovide Iappropriate Ihealthcare Iinterventions, Iculture Iand Iall Iits Ivariants Imust Ibe Iaddressed.
(p28)APRNs Imay Ibe Iable Ito Iaccess Ihealth Iinformation Ineeded Iby Iworking Itogether Iwith Iother Isectors Ioutside Iof Ihealth, Isuch Ias
Ihousing, Ilabor, Ieducation, Iand Icommunity-based Ior Ifaith-based Iorganizations Ithat Ioffer Iservices Ito Iimmigrant Icommunities. IThis
Iinvolves Ithe Icollection, Idocumentation, Iand Iuse Iof Idata Ithat Ican Ibe Iused Ito Imonitor Ihealth Iinequalities Iin Iexposures, Iopportunities,
IandIoutcomes. IExamples Iof Isocial Ideterminants Ithat Iare Irelated Ito Ihealth Iinequalities Iinclude Ipoverty, Ieducational Ilevel, Iracism,
Iincome, Iand Ipoor Ihousing. IThese Iinequalities Ican Ilead Ito
poor Iquality Iof Ilife, Ipoor Iself-rated Ihealth, Imultiple Imorbidities, Ilimited Iaccess Ito Iresources, Ipremature Ideath, Iand Iunnecessary Irisks
Iand Ivulnerabilities.
(p25) IAPRNs Ican Ibest Idetermine Ithe Ieffectiveness Iof Ian Iintervention Iand Ilong-term Iimpact Iby Ifocusing Ion Ian Iaccurate Iassessment
IandIinterpretation Iof Idata Ithat Iare Igenerated Ior Icollected Iusing Iindividual, Ipopulation, Iand Icommunity Ihealth Iindicators.
(p27)APRNs Ican Iwork Iin Ipartnership Iwith Icommunity Imembers Ito Iidentify Iwhat Icommunity Imembers Isee Ias Irelevant Iand
Iimportant, Ibuild Isocial Icapital, Iuse Ioutcome Idata Ito Iadvocate Ifor Ichanges Iin Ipolicy, Iand Ithen Icontinue Ito Iwork Iin Ipartnership Ito
Iidentify IstrategiesIto Iintervene, Imonitor,and Iimprove Ithose Ioutcomes
(p40-41)APRNs Ihave Inumerous Iresources Ithey Ican Iaccess Ito Iimprove Iquality Iand Itimely Iaccess Ito Iquality Ihealthcare Iand Idecrease
Ihealth Idisparities. IThe INational IPartnership Ifor IAction I(NPA) Ito IEnd IHealth IDisparities I( Iminorityhealth.hhs.gov/npa) Iwas Istarted
IbyIthe IOffice Iof IMinority IHealth
to Imobilize Iindividuals Iand Igroups Ito Iwork Ito Iimprove Iquality Iand Ieliminate Ihealth Idisparities. IThe INational IPriorities Iincludes Ikey
Iprivate Iand Ipublic Istakeholders Iwho Ihave Iagreed Ito Iwork Ion Imajor Ihealth Ipriorities Iof Ipatients Iand Ifamilies, Ipalliative Iand Iend-of-
lifeIcare, Icare Icoordination, Ipatient Isafety, Iand Ipopulation Ihealth. IThe IQuality IAlliance ISteering ICommittee Iis Ianother Ipartnership
Iof Ihealthcare Ileaders Iwho Iwork Ito Iimprove Ihealthcare Iquality Iand Icosts. IVarious Istrategies Ito Ibridge Ithe Igaps Iin Ihealthcare Iquality
Iare Iavailable Iat Ithe Inational Ilevel Iand Imay Ibe Iapplied Ior Iconsidered Iat Ithe Istate, Iregional, Ior Ilocal Ilevel Iin Icollaboration Iwith
IstakeholdersIas Ia Imeans Iof Idecreasing Ihealth Idisparities.
(p43) IAPRNs Iare Ibetter Iprepared Ito Idevelop Ieffective Iinterventions Ito Ieliminate Ior Ireduce Ihealth Idisparities. ISuch Istrategies
ImayIinclude Iadvocating Ibetter Ihealth Iinsurance Icoverage
for Ipoor Iand Iimmigrant Ipopulations; Iensuring Ithat Isufficient Iservices Iexist Iin
Iunderserved Iareas; Iassessing Ithe Iinteraction Iamong Isocial Ienvironments, Igenetics,
and Ipopulation Ihealth; Iencouraging Iminority Iparticipation Iin Iresearch Istudies Iwith Icommunity-based Iparticipatory Iresearch Iand
Ispecifically Iwith Ipractice-based Iresearch Inetworks; Iusing Ilinguistically Iand Iculturally Iappropriate Icommunication Iand Iwritten
Ihandouts; Ipromoting Iand Ifacilitating Icommunity Ipartnerships; Iand Iimplementing Istrategies Ito Iencourage Ipeople Ifrom Iminority
Ipopulations Ito Ibecome Ihealthcare Iprofessionals
2. Compare Iand Icontrast Ivariables Ithat Idifferentiate Ithose Icategorized Iat Ibeing Iat Irisk Ifor Imarginalization Iof Ihealth Icare.
Definition: Iwhen Ian Iindividual Ior Igroup Iis Iput Iinto Ia Iposition Iof Iless Ipower Ior Iisolation Iwithin Isociety Ibecause Iof Idiscrimination I
ILimits Itheir Iopportunities Iand Imeans Ifor Isurvival. IWhen Ian Iindividual Iis Imarginalized, Ithey Iare Iunable Ito Iaccess Ithe Isame Iservices Iand
Iresources Ias Iother Ipeople Iand Iit Ibecomes Ivery Idifficult Ito Ihave Ia Ivoice Iin Isociety.
Marginalization I– Imajor Icause Iof Ivulnerability, Iwhich Irefers Ito Iexposure Ito Ia Irange Iof Ipossible Iharms, Iand Ibeing Iunable Ito Ideal Iwith
Ithem Iadequately.
• Variables: Isocial Iclass, Irace, Ihomelessness, Isubstance Iabuse, Iprison/offending, Imental Ihealth Iproblems, IHIV Ipositive
• Women Iare Imore Ilikely Ito Ibe Imarginalized Ithan Imen, Ibecause Iof Itheir Igender. IThis Iis Ievident Ithrough Ithe
Isocial, Ieconomic, Iand Ipower Iimbalances Ithat Iexist Ibetween Imen Iand Iwomen. IFor Iexample, Imore Iwomen Ithan
Imen Ilive Iin
poverty, Iand Imen Icontinue Ito Ihave Imore Isecure, Ifull-time Ijobs Iand Ihigher Iincome Ithan Itheir Ifemale Icounterparts.
• A Iwoman Ican Ialso Ibe Imarginalized Ibecause Ion Iher IHIV Istatus, Ior IHIV Irisk. IShe Imay Iexperience Ieven Imore Istigma
IifIshe Iis Ialso Ia Ipart Iof Iother Imarginalized Igroups Iin Irelation Ito Iher Irace Ior Isexual Iorientation. IFor Iexample, Ia
Iwoman Iis Igay Iand Ian Iimmigrant Imay Ialso Iexperience Ihomophobia Iand Iracism.
Those Iat Irisk Ifor Imarginalization Iof Ihealth Icare Iinclude Ithose Iwithout Ishelter Iin Irural Ior Iurban Iareas, Ithose Iliving Iin Iremote Iparts Iof
ItheIcountry, Ifamilies Iof Ilower Isocioeconomic Istatus, Idisabled Ipersons, Irecent Iimmigrants Iand Irefugees, IIndigenous Ipopulations, Iand
Iseniors. IAdequately Iidentifying Iand Igaining Iaccess Ito Ivulnerable Icommunities Iare Iessential Isteps Ifor Ithe Ihealth Isystem Iin Iorder Ito
Irecognize Iand Iaddress Itheir Iunique Ihealth Ineeds.
, Four Idimensions Ithat Icapture Ithe Iprincipal Ideterminants Iof Ihealth Imarginalization: Iresidential Iinstability, Imaterial Ideprivation, Iethnic
Iconcentration, Iand Idependency.
(FYI: II Icouldn’t Ifind Ithis Iinformation Iin Ithe Itext Ibut II Ifound Iit Ihere Ihttps://ubcmj.med.ubc.ca/marginalization-in-
health/)I(online Ilesson Iwk I5) ISingletone Iand IKrause I(2009) Ihave Iidentified Ithe Iconfounding Ivariables Ithat Iresult Iin
Isubpar Ihealth
communication. IThese Iinclude Ilow Ihealth Iliteracy, Icultural Ibarriers, Iand Ilow IEnglish Iproficiency. IThe Ihealthcare Isystem Iis Ioften
Iconfusing Ifor Iindividuals Iwho Iare Iproficient Iin IEnglish Ibut Iare Inot Ifamiliar Iwith Ihealthcare Iknowledge Iand Iterminology. IOne Ican
Iimagine Ithe Isynergistic Ieffect Iof Ihaving Ilow Ihealth Iliteracy Iin Iaddition Ito Ihaving Iinadequate IEnglish Iskills. IThe Iconfluence Ican Ihinder
Ioptimal Iutilization Iof Ithe Ihealthcare Isystem.
(p28)Social Ideterminants Iof Ihealth Iand Iinequalities Idata Iare Iareas Ithat IAPRNs
can Ialso Iuse Ito Iinform Iand Iguide Itheir Ipractice Ito Idevelop Isocioculturally
IappropriateIinterventions. ISocial Ideterminants Ithat Ilead Ito Ihealth Iinequalities Iare
recognized Isituations Irelated Ito Iwhere Ipeople Iare Iborn, Igrow Iup, Iwork, Ilive,
and Ithe Isystems Iof Icare Iavailable Ito Ithem Ito Ideal Iwith Iillness Iand Idisease….. IExamples Iof
Isocial Ideterminants Ithat Iare Irelated Ito Ihealth Iinequalities Iinclude Ipoverty, Ieducational
Ilevel, Iracism, Iincome, Iand Ipoor Ihousing. IThese Iinequalities Ican Ilead Ito
poor Iquality Iof Ilife, Ipoor Iself-rated Ihealth, Imultiple Imorbidities, Ilimited Iaccess Ito
Iresources, Ipremature Ideath, Iand Iunnecessary Irisks Iand Ivulnerabilities.
(p37) IDisparities/inequity Ito Ibe Iassessed Iby Ithe Ifollowing:
• Race/ethnicity
• Gender
• Socioeconomic Istatus
• Disability Istatus
• LGBT Istatus
• Geography
(p40) IIt Iis Iwidely Irecognized Inow Ithat Ithe Isocial Ideterminants Iof
health, Isuch Ias Ihousing, Ieducation, Iaccess Ito Ipublic Itransportation, Iaccess Ito
Isafe Iwater, Iaccess Ito Ifresh Ifood, Iand Ithe Ibuilt Ienvironment, Iare Iall Irelated Ito Ia
Ipopulation’s Ihealth. IIn Iaddition Ito Iethnicity, Iother Icharacteristics Ialso
IcontributeIto Ithe Ipresence Iof Idisparities Ior Ithe Iachievement Iof Igood Ihealth
Isuch Ias
gender, Isexual Iorientation, Igeographic Ilocation, Iworking Ienvironment,
Icognitive,Isensory, Ior Iphysical Idisability, Iand Isocioeconomic Istatus.
3. How Idoes Iculture Iinfluence Ithe Idecisions Ia Iprovider Imay Imake Iwhen Iselecting Ian Iintervention?
Learning Iabout Ione’s Iculture Iand Iassessing Iepidemiological Ipatterns Iof Ihealth Iand Iillness Iacross Ithe Ilife Ispan Ifacilitates Ithe Inurse
Ipractitioner's Iability Ito Ifocus Ion Ihealth Iinitiatives Iand Iformulate Iplans Iof Icare Ileading Ito Ibehavioral Ichange Iand Isustainable Iquality
Ihealth Iand Ilifestyle Ioutcomes. IReligion, Iculture, Ibeliefs, Iand Iethnic Icustoms Ican Iinfluence Ihow Ipts Iunderstand Ihealth Iconcepts, Ihow
Ithey Itake Icare Iof Itheir Ihealth, Iand Ihow Ithey Imake Idecisions Irelated Ito Itheir Ihealth. IWithout Iproper Itraining, Iclinicians Imay Ideliver
Imedical Iadvice Iwithout Iunderstanding Ihow Ihealth Ibeliefs Iand Icultural Ipractices Iinfluence Ithe Iway Ithat Iadvice Iis Ireceived. IAsking
IaboutIpts’s Ireligions, Icultures, Iand Iethnic Icustoms Ican Ihelp Iclinicians Iengage Ipts Iso Ithat, Itogether, Ithey Ican Idevise Itreatment Iplans
Ithat Iare Iconsistent Iwith Ithe Ipt’s Ivalues.
Several Imodels Ihave Iemerged Ito Iassist Ihealthcare Iproviders Ito Imeet Ithe Ichallenge Iof Iproviding Iculturally Irelevant Icare. ICampinha-
IBacote I(2002) Iviews Icultural Icompetence Ias Ian Iongoing Ilearning Iprocess Ias Ithe Iproviders Icontinuously Istrive Ito Iachieve Ithe Ibest
Ioutcomes Ifor Ipatients, Ifamilies, Iand Ipopulations.
Culture Iis, I"the Ipractices, Ibeliefs, Ivalues, Iand Inorms Iwhich Ican Ibe Ilearned Ior Ishared, Iand Iwhich Iguide Ithe Iactions Iand Idecisions Iof Ieach
Iperson Iin Ithe Igroup”.
Health Iand Idisease Idenotes Ican Ivary Ifrom Iculture Ito Iculture. ITherefore, Ithere Iis Ia Iwide Ispectrum Iof Iwhat Iare Iconsidered Iappropriate
Iinterventions. IThus, Iculture Iinfluences Ithe Idecisions Ia Iprovider Imay Imake Iwhen Iselecting Ian Iintervention Ibased Ion Ithe Icultures'
Iperceptions Iof Idisease Icausation, Isymptomatology, Iand Ipathology.
Care Iis Iprovided Iwith Isensitivity Iand Iis Ibased Ion Ithe Icultural Iuniqueness Iof Iclients.
although Icultures Idiffer, Ithey Iall Ihave Ithe Isame Ibasic Iorganizing Ifactors Ithat Imust Ibe Iassessed Iin Iorder Ito Iprovide Icare Ifor Iculturally
Idiverse Ipatients. IThese Ifactors Iinclude. IAlthough Icultures Idiffer, Ithey Iall Ihave Ithe Isame Ibasic Iorganizing Ifactors Ithat Imust Ibe
IassessedIin Iorder Ito Iprovide Icare Ifor Iculturally Idiverse Ipatients. IThese Ifactors Iinclude
• communication I(verbal Iand Inonverbal);
