Margins Study Assistant

Chapter 1

What Is Population Health?

Summary

Concepts of upstream, midstream, and downstream approaches to intervention interact and evolve as population health evolves, with upstream interventions offering the widest-reaching health benefits to the population. Critical components of public health include outcomes, determinants, disparities, and risk factors. Population health extends to the global stage, involving global nursing, which aims to promote sustainable planetary health and equity for all individuals Population health is a comprehensive approach that considers the impact of various factors on health and involves collaborative efforts among health care professionals, communities, industries, academia, and…

Key terms

population health: an approach to supporting the health of people through research, data analysis, and health programming that considers the impact of public policy and environmental, social…
population: a group of people that may receive care in various settings at the local, regional, national, and global levels
determinants: factors that influence health; can include events, characteristics, or other entities that change a health condition or the level of a health problem
downstream: describes interventions that focus on the behavior of individuals to modify the risk of disease, prevent illness, or manage chronic conditions
outcomes: in a population health context, all possible results that may come from exposure to interventions aiming to prevent or treat a condition
risk factors: aspects of personal behaviors, lifestyle choices, exposures, or attributes that generally increase the likelihood or severity of acquiring a health condition
upstream: describes interventions that involve enacting policies that change regulations, increase access, or provide economic incentives to impact health across a population
global nursing: the use of evidence-based nursing processes to promote sustainable planetary health and equity for all people

Chapter 2

Foundations of Public/Community Health

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Summary

Public health facilitates health for all through organized efforts to prevent disease, reduce risk and disparities, and promote health. Educational programs, policies, health services, research, and direct care are all part of public health. While public health addresses the upstream and downstream factors of health conditions, its focus is upstream factors. Public health differs from population health in the focus and scope of work.

Key terms

community health: a specialty area of nursing and health practice focused on the health and risks of a specific locality or community of people
public health: a specialty area of nursing and health practice focused on supporting the well-being of society through organized efforts to ensure health is attainable for all
public health emergencies: illnesses or health conditions that pose a significant risk to communities that are either occurring or may imminently occur; the risk may be a substantial number of fatalities…
secondary prevention: initiatives implemented to detect diseases or health conditions early on in their course so they can be diagnosed early and promptly treated to stop or slow progression and…
primary prevention: initiatives that aim to prevent an adverse health event from occurring, such as immunizations and health promotion education
primordial prevention: initiatives that aim to reduce risk for a disease or condition across an entire population, such as social change and national policy
public health system: a network of institutions, agencies, organizations, and resources that collaborate to promote, protect, and improve the health of populations and communities
quaternary prevention: actions and decisions that protect overmedicalization of clients; protecting clients from interventions that might cause more harm than good

Chapter 3

Public/Community Health in Practice

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Summary

Community health focuses on the physical, mental, and social well-being of a community. Public/community health nurses have a rich history of service. Events such as World War II, the HIV and AIDS epidemic, and the COVID-19 pandemic were greatly impacted by nursing and have shaped modern public/community health nursing practice. Nurses in public/community health work in interprofessional teams and collaborate with community partners and policymakers to address health disparities and promote equity.

Key terms

community health: the physical, mental, and social well-being of a community; involves health promotion, risk reduction, and disease prevention
community: a group of people with at least one characteristic in common
contact tracing: identification of people who may have been exposed to a specific disease and are at risk for disease acquisition or spread
standards of practice: rules of conduct to which professionals are expected to adhere; support nurses’ decision making and delivery of care
community/public health nursing: specialty focused on improving the health of communities and populations through health promotion, disease prevention, risk reduction, community education, management of…
scope of practice: professional activities involved in a particular role; supports nurses working to their level of qualification, expertise, and competence
competencies: foundational knowledge, skills, and attitudes that enable nurses to meet client needs
social prescribing: referrals to community resources outside of traditional health care settings

Chapter 4

The Health of the Population

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Summary

Healthy People 2030 identifies high-priority health issues and challenges, which are referred to as leading health indicators (LHIs). A population health measure or metric is an indicator that reflects the quality of a group’s overall health and well-being. Life expectancy at birth, morbidity, mortality, and premature death are examples of population health outcome measures. Health is a state of complete physical, mental, and social well-being and wholeness.

Key terms

health: a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
health outcome: a change in the health status of an individual, group, or population that is attributable to a planned intervention or series of interventions, regardless of whether such an…
well-being: the subjective perception that life is going well; is important from a public health perspective, as it is an outcome
health indicators: health-related measures of data that are used to quantify and track an individual’s health status
Healthy People 2030: an initiative of the U.S. Department of Health and Human Services to improve the health and well-being of all people in the United States that has produced a list of…
leading health indicators (LHIs): high-priority, modifiable issues addressing social determinants of health, health disparities, and health equity that have a significant effect on health outcomes
morbidity: the state of being symptomatic or unhealthy due to a disease or condition; usually represented or estimated using prevalence or incidence
population health measure or metric: an indicator that reflects the quality of a group’s overall health and well-being

Chapter 5

Demographic Trends and Societal Changes

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Summary

As these demographic changes continue, the delivery of health care will have to change to ensure health equity and the elimination of health disparities, which currently impact underrepresented populations… The fastest-growing demographics are baby boomers, racial and ethnic minorities, and vulnerable groups like those living in poverty, sexual and gender minorities, and individuals with disabilities. For example, populations that tend to neglect health care until chronic diseases and mental health disorders become severe are more costly to treat than preventive care would have been. Such groups tend to experience higher rates and greater severity of chronic disease, lack of access to and a distrust of health care resources, and the inability to afford health insurance.

Key terms

ethnic minorities: population groups with a shared culture, tradition, religion, language, history, or other factor who live in communities or areas where most people are from a different ethnic…
health disparities: preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations
underrepresented populations: subgroups within a population—often identified by race, ethnicity, age, sex, gender, sexual orientation, or socioeconomic status—whose representation in society is…
health care consumer: recipient of health services, whether those services are paid for or provided at no cost
chronic disease: conditions such as hypertension, diabetes, kidney disease, heart disease, and cancer that individuals live with for a year or more and that require ongoing medical attention…
mental health: emotional, psychological, and social well-being; affects how an individual thinks, feels, acts, handles stress, relates to others, and makes choices
fastest-growing demographics: baby boomers, racial and ethnic minorities, and vulnerable groups like those living in poverty, sexual and gender minorities, and individuals with disabilities
health equity: state in which everyone has a fair and just opportunity to attain their highest level of health

Chapter 6

Structural Racism and Systemic Inequities

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Summary

Forms of racism include personally mediated racism, internalized racism, eugenics, and scientific racism Structural racism is a deeply rooted, persistent, normative process of institutional policies, systems, laws, and practices that limit opportunities, resources, and the power of individuals based on race. Structural racism in the United States can be traced back to British Colonial America, prior to the country’s founding, with the ill treatment and forced removal of Native Americans from their lands and the terrible… Despite some policies aimed at addressing structural racism and systemic inequities, their existence and effects remain.

Key terms

structural racism: a process resulting in a gap in access to societal opportunities based on race that results in institutional policies, systems, laws, and practices that limit opportunities…
racism: the unfair treatment of individuals based on race
scientific racism: belief that White Europeans are superior to non-White people
internalized racism: when members of a stigmatized race accept negative messages about their abilities and overall worth with self-devaluation, resignation, and hopelessness
Jim Crow era: a period during which laws perpetuating institutional racism and the denial of Black Americans’ constitutional rights were enforced across the southern United States, lasted from…
personally mediated racism: prejudice and discrimination where individuals or communities make assumptions about other individuals or communities based solely on race
eugenics: the erroneous theory that humans can be improved through selective breeding of populations
allostatic load (AL): the body’s physiologic “wear and tear” due to an individual’s exposure to stressors that accumulate throughout the lifespan

Chapter 7

Policies and Regulatory Conditions Impacting Health Outcomes

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Summary

Different payment models and care delivery models affect the quality of care. Public health policy refers to the laws, regulations, programs, behaviors, and decisions implemented in a society to promote public health. There is a direct correlation from access to health care, the cost of health care, and the quality of health care to health outcomes. When individuals cannot access health care services, health outcomes, including maintenance of chronic disease processes, are compromised

Key terms

health outcomes: the results of a health intervention
payment models: mechanism by which health care services are established and paid for
care delivery models: delivery strategies that prescribe the specific ways in which professionals work together to provide health care services
public health policy: laws, regulations, programs, behaviors, and decisions implemented in a society to promote public health
capitation: payment model in which physician practices receive payment per client per period, which is usually 1 month; health plan rules govern which clients are included in the physician…
fee-for-service: payment model in which physician practices are paid a flat rate for each client visit, test, or procedure performed; through this model, practices can achieve higher revenue with…
pay for performance: payment model in which physicians are paid according to prescribed practice performance on defined metrics, which are based upon the quality of care and/or utilization of care…
provider-sponsored health plans: health plans that are either sponsored or acquired by hospitals, physician groups, or health systems that assume responsibility for the total cost of care for clients enrolled in…

Chapter 8

Social Determinants Affecting Health Outcomes

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Summary

Population lives in poverty and experiences economic insecurity. BIPOC communities comprise half of the individuals who are economically insecure, and the cycle of poverty often persists across generations. Poor health outcomes, including early cardiovascular disease, metabolic disease, diabetes, and mental health disorders, are directly linked to living in poverty, illustrating the concept of the socioeconomic gradient Economically stable individuals and families have a steady source of income with consistent access to the resources that are essential for a healthy life, such as food, clothing, safe housing, transportation, quality…

Key terms

economic insecurity: a situation linked to poverty where an individual or family is unable to consistently afford housing, food, clothing, transportation, child care, or health care
built environment: includes transportation access and roadways, the availability of green space, locations for community gathering, and the buildings or other physical structures within the…
socioeconomic gradient: the association between low socioeconomic position (SEP) and increased disease risk and premature death
poverty: a state in which an individual lacks a socially acceptable amount of money or possessions
food deserts: areas where residents have limited or absent options for affordable and healthy foods
generational poverty: a persistent lack of a socially acceptable amount of money or possessions and disadvantage where children who grow up poor are more likely to be poor as adults

Chapter 9

Health Disparities

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Summary

The key to addressing health disparities is to minimize the effects of the social determinants of health Minority health refers to the characteristics and attributes of health specific to a racial or ethnic minority group who are socially disadvantaged and are underserved in health care. Sex refers to the physiological and biological characteristics of males and females; gender refers to male and female characteristics that are socially constructed. Health disparities occur when there is a difference in health care access and outcomes between two or more groups of individuals.

Key terms

health disparities: health differences linked to social, economic, and/or environmental disadvantages
minority health: distinctive health characteristics and attributes of racial or ethnic minority populations who are socially disadvantaged due in part to being subject to racist or discriminatory…
gender: male and female characteristics that are socially constructed
socially disadvantaged: those who have experienced prejudice or bias because of their identities as members of racial, ethnic, or cultural groups, without regard for their individual qualities and…
sex: the physiological and biological characteristics of males and females
gender identity: a person’s internal experience and belief of gender, which may or may not correspond to their physiology or designated sex at birth
geography: a science that deals with the description, distribution, and interaction of the diverse physical, biological, and cultural features of the earth’s surface

Chapter 10

Socio-Ecological Perspectives and Health

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Summary

Genetics, individual and collective behaviors, environmental and physical influences, medical care, and social determinants influence the health of an individual and community. Nurses may apply theories of health behavior to address the health needs of clients and communities in a thorough and systematic way. Models and theories relevant to the study and change of health behavior include the Social Cognitive Theory, Theory of Planned Behavior, Health Belief Model, Transtheoretical Model/Stages of Change, and Pender’s Theory… Nurses need a thorough understanding of health behavior and the factors that may be supportive of or detrimental to health.

Key terms

genetics: the study of how genes, traits, and diseases are passed from one generation to the next
health behavior: the actions, habits, activities, policies, and procedures of individual clients, communities, organizations, and governments that can either support or undermine health
medical care: services rendered by a health care clinician during visits to clinics, offices, hospitals, surgical centers, schools, laboratories, and other places
theories: used to explain phenomena in a systematic way and to guide thoughts and decision-making processes
behavior: the way a person acts, the mannerisms they display, and the conduct they employ
socio-ecological model (SEM): a model that facilitates the study and organization of how client and community health behaviors and outcomes are affected by personal, situational, community, societal…
intersectionality: a concept that considers how disadvantages interact for clients at both an individual level and systems level to identify and describe the inequities, injustices, oppressions…

Chapter 11

Evidence-Based Decision-Making

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Summary

Evidence-based decision-making in public health is an objective method that involves seven steps: define, search, appraise, synthesize, adapt, implement, and evaluate. Research ethics are fundamental principles that guide the design and implementation of research. Often, interventions outlined in research may not fit the designated community and require adaptation. The first step is to define the problem, usually as a PICOT question.

Key terms

appraise: a part of the EBDM process that involves critically assessing each study for relevance and credibility to ensure the information provided is meaningful, trustworthy, and relevant
database: collection of information organized in a systematic method that is helpful when searching for sources of existing literature related to the topic of inquiry
search: a part of the EBDM process that involves reviewing the literature to examine what research is available to address a concern
adapt: a part of the EBDM process that determines if synthesized information can apply to the client (which may be a single person or a community) in discussion
PICOT question: as part of the EBDM process, involves the problem or concern being formatted to address the population, intervention, comparison, outcome, and time frame in the form of an…
research ethics: fundamental principles guiding the design and implementation of research centering on respect for society and participants, resources, and regulation of research to prevent…
synthesize: a part of the EBDM process that involves compiling information, looking for specific trends in data to determine what the research says about the concern or issue
implementation: a part of the EBDM process that involves acting on research information to carry out the determined plan

Chapter 12

Epidemiology for Informing Population/Community Health Decisions

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Summary

The epidemiologic triad describes disease as a result of the relationship among a susceptible host, an external agent, and an environment that brings the host and agent together. Epidemiology is the scientific study of the distribution and determinants of diseases and health outcomes to improve the health and safety of populations by establishing causal factors for health issues. By identifying causes and risk factors of disease development, public health nurses can intervene early to reduce morbidity and mortality from the disease. Epidemiology provides the opportunity to develop an evidence-based foundation for prevention programs

Key terms

epidemiology: scientific study of the distribution and determinants of diseases and health outcomes in populations
agent: something physical, chemical, nutritional, psychosocial, or biologic that can cause a health issue; must be present for a disease to occur
host: an individual, a family, a group of high-risk individuals, or a community within the context of the epidemiological triad
morbidity: having a disease, illness, or medical condition; includes disease, injury, and disability
airborne transmission: occurs when infectious agents are capable of remaining suspended in air over long distances and long periods of time, in contrast to droplets that fall to the ground within a few…
carriers: individuals with incubating disease or preclinical infection but without overt symptoms who are still capable of transmitting disease
cross-sectional study: a study in which a sample of individuals from a specified population is enrolled and the exposure and disease outcome are measured simultaneously for each participant; provides a…
environmental factors: in the epidemiologic triad, the biologic environment of plants, animals, and toxins, including vectors that carry infectious agents and the reservoirs where infectious agents are…

Chapter 13

Pandemics and Infectious Disease Outbreaks

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Summary

The lessons of pandemics throughout history have shaped how public health addresses emerging infectious disease threats. Pathogenic microorganisms cause infectious diseases that spread by direct or indirect transmission. If an environment is favorable for the infectious agent’s survival and opportunity exists for the host’s exposure to it, infection and disease will ensue. Some infectious disease outbreaks result from direct contact with an infected individual’s respiratory secretions, while others are transmitted through blood or bodily fluids.

Key terms

disease: communicable if the infected host has a portal of exit, a means of transmission, and a portal of entry into another susceptible host
infectious disease: disease caused by pathogenic microorganisms such as bacteria, viruses, parasites, or fungi; enters a human host, multiplies, and causes infection that can spread to others
infectious: easily transmitted between individuals
pandemic: an epidemic that spreads worldwide
environment: favorable for the infectious agent’s survival and opportunity exists for the host’s exposure to it, infection and disease will ensue
vectors: living organisms, such as ticks and mosquitoes, that can transmit infectious pathogens to humans
chain of transmission: key to control and prevention of these illnesses and outbreaks
emerging infectious diseases (EIDs): diseases that are newly affecting populations or diseases that have existed previously but only caused isolated disease that are now increasing in incidence and geographic range

Chapter 14

Environmental Health

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Summary

Environmental health aims to prevent illness, death, and disability by reducing exposure to harmful environmental conditions and promoting behavior change. Environmental health addresses primary and secondary causes of illnesses and injuries, encompassing topics such as air quality, water quality, food safety, hazardous waste management, and occupational health. Environmental health professionals monitor air quality and work to reduce pollutants to protect human health. Vulnerable populations, such as children, older adults, and low-income communities, are at higher risk from environmental burdens, and creating healthier environments can prevent a significant portion of the worldwide…

Key terms

environmental health: the branch of public health that aims to prevent illness, death, and disability by reducing exposure to harmful environmental conditions and promoting behavior change
environmental burden: the harm caused by environmental factors on human health and well-being, which includes damage, destruction, or impairment of natural resources
climate justice: the fair and equitable treatment of all individuals and communities, particularly those disproportionately affected by the consequences of climate change and environmental…
toxicokinetics: the study of how chemicals are absorbed, metabolized, and eliminated
adaptation: the process of adjusting or changing practices, infrastructure, and behaviors to minimize the negative effects of climate change by reducing vulnerabilities and enhancing…
Anthropocene: current geological period representing the profound impact of human activities on Earth’s ecosystems, driven by factors like industrialization, urbanization, deforestation, and…
bioaccumulation: the gradual accumulation of contaminants, such as heavy metals like mercury and lead, within the tissues of living organisms
biological agents: significant environmental health hazards that include molds, dust mites, cockroaches, pollen, bacteria, viruses, protozoa, parasitic worms, and pet dander, saliva, and waste

Chapter 15

Health Promotion and Disease Prevention Strategies

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Summary

Health promotion and disease prevention are overlapping yet distinct processes that guide the Healthy People 2030 initiative. Nurses play an important role in both health promotion and disease prevention Nurses select and perform health promotion and disease prevention interventions at the individual and community levels. The nurse can use the five key action areas of the Ottawa Charter for Health Promotion to guide interventions.

Key terms

disease prevention: specific interventions geared toward decreasing the burden of both communicable and noncommunicable diseases and their associated risk factors
health promotion: the process of enabling people to increase control over and to improve their health
preventive care: routine health care including screenings, check-ups, and counseling to prevent illness, disease, or health-related problems
Ottawa Charter for Health Promotion: provided a common, socio-ecologic definition of health promotion in 1986
cognitive-behavioral theories: theories at the intrapersonal and interpersonal level that share three common concepts: behavior is mediated by cognition, knowledge is necessary for behavior change, and…
tertiary prevention: targets both the clinical and outcomes stages of disease; actions are implemented in symptomatic individuals with the aim to reduce the severity of disease and any associated…
high-risk approach: an approach to prevention that targets prevention only to those who are identified to be at high risk for disease
Diffusion of Innovations Theory: a model for behavior change that addresses how new ideas, products, and social practices spread within an organization, community, or society or from one society to another

Chapter 16

Creating a Healthy Community

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Summary

Nurses use many approaches, such as windshield surveys, to identify community health risks. Inclusive practices in community-based work align with the concept of decolonization in nursing When the community is the client, nurses address the community’s collective health instead of the acute and chronic health needs of individual clients. Community health nurses focus on promoting health, reducing risk, ameliorating disparities, and increasing equity.

Key terms

community: a group of people with at least one characteristic in common
windshield survey: a method of direct observation in which the nurse views the community or neighborhood while driving around and looking through the windows of the vehicle
decolonization: processes that systematically dismantle colonial ideologies of superiority, thought, approaches, and privilege
dimensions of community health: the people (also known as status), structures, and processes that may be assessed and measured to determine the care delivery and health outcomes of a community
nursing process: a guiding framework for nurses to deliver care in a systematic and personalized way to individuals and communities through scientific reasoning, problem-solving, and critical…
advocacy: support for a specific health cause or recommendations for community or policy change

Chapter 17

Assessment, Analysis, and Diagnosis

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Summary

The process defines people, place, and community systems using a variety of primary and secondary data sources that include quanatitative and qualitative data. It uses a systematic, collaborative approach to gather primary and secondary data to comprehensively describe the community. CHA is the first step of the nursing process for populations and communities. It uses frameworks, models, and tools to guide community assessment.

Key terms

secondary data: data obtained through existing reports on the community that were collected by another entity or for a purpose other than community health assessment
qualitative data: data expressed in word form that cannot be quantified; describe perspectives of individuals and populations
community health assessment (CHA): provides a comprehensive picture of a community’s current health status, factors that contribute to higher health risks or poorer health outcomes, and available community…
health indicators: numerical measures of health outcomes, such as morbidity and mortality, that have been analyzed and are used to compare rates or trends of priority community health outcomes and…
primary data: data collected by the assessor directly from community members; PHAB considers primary data to be data for which collection is conducted, contracted, or overseen by the health…
gap analysis: analysis that is performed to identify and address the disparity between what is desired and real-world conditions
community engagement: the process of working collaboratively with and through groups of people to identify the health needs of community residents and strategies to address those needs
community health improvement plan (CHIP): a long-term systematic plan to address issues identified in the community health assessment that describes how the health department and the community will work together to…

Chapter 18

Planning Health Promotion and Disease Prevention Interventions

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Summary

Logic models are created as a visual representation of a community program. Theories and models of health promotion, disease prevention, and behavior change are used in the development of community health programs. Health promotion and disease prevention approaches, such as the HBM, transtheoretical model, and SCT, are applied to motivate and promote program participant behavior change A participatory approach plays a key role in the success of community health programs.

Key terms

logic model: a tool to visually present the relationships among resources that are used to implement a program, the activities planned, and the intended results of the program
program: an organized public health action or set of related activities undertaken to achieve an intended outcome
coalition: a group of people and organizations that work to address community needs and solve community problems
community engagement: the process of working collaboratively with and through groups of people to identify the health needs of community residents and strategies to address those needs
outcome objectives: the stated intended results of activities or a program, focusing on changes in knowledge, skills, and attitudes of participants and community members or changes in policies…
program planning: selecting and implementing a set of activities to achieve desired health outcomes; serves as a blueprint for the coordination of resources to carry out planned activities
social networks: linkages among individuals, groups, and organizations that arise out of geographical location, work relationships, school relationships, or recreational activities
process objectives: direct activities to be completed in a specific time frame and describe participants, interactions, and activities

Chapter 19

Planning Community Health Education

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Summary

Cultural sensitivity should be the foundation for planned interventions to ensure they meet the needs of the community in question while respecting its culture The next step of community health education is to develop a health education plan. Planning health education should be taken seriously using a multidisciplinary approach. Planning principles include completing a community health needs assessment to identify a community’s strengths, resources, and needs.

Key terms

community health education: the process of providing information regarding optimal health and wellness at the community level
cultural sensitivity: an awareness of similarities and differences between cultures without making value judgments about those similarities and differences
active listening: preparing to hear what another person is saying, receiving the sent message, and responding thoughtfully
national campaigns: a series of planned activities or marketing offerings intended to communicate information to the public on a national scale
public service announcement (PSA): a message, video, or broadcast authorized by a government agency or nonprofit organization to provide information about an issue to the public
TeamSTEPPS®: an evidence-based set of teamwork tools aimed at optimizing client outcomes by improving communication and teamwork skills among health care professionals
coalitions: formalized groups of various team members who actively work together toward a common goal
communication barriers: circumstances that may impede the overall outcome or block progression of a plan

Chapter 20

Implementation and Evaluation Considerations

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Summary

A systematic process is used to evaluate the efficacy, effectiveness, and efficiency of the program components and the program as a whole. The program team utilizes strategies to enhance participant recruitment and retention. To successfully implement community health programs, the program team strategizes to decrease potential barriers and enhance facilitators of implementation. Facilitators and barriers are identified based on community needs assessments; intended target population assessment of sociocultural, linguistic, and literacy needs; literature and research; and previous experience…

Key terms

efficiency: occurs when the effect of program interventions, or outputs, are greater than the resources, or inputs, used to provide the interventions
systematic process: used to evaluate the efficacy, effectiveness, and efficiency of the program components and the program as a whole
recruitment: finding community members from the target population to participate in a community health program
facilitator: person or thing that makes implementation of program interventions and activities easier
effectiveness: ability of a community program to achieve the desired outcome in real-life settings
retention: continued participation in a community health program until completion
efficacy: maximum potential effect under ideal conditions
accuracy standards: benchmarks that substantiate that program evaluation methods, data, and documentation are appropriate and contain accurate information

Chapter 21

Cultural Influences on Health Beliefs and Practices

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Summary

Race, ethnicity, culture, and nationality are related concepts that are often used interchangeably but have distinct meanings. A person’s race and ethnicity can shape their cultural experiences and traditions, while their nationality can influence their legal status and access to resources. Understanding the complexities and nuances of these concepts is important for promoting diversity, equity, and inclusion in society Culture is a broad term that refers to the shared beliefs, values, customs, behaviors, and artifacts that characterize a particular group or society.

Key terms

ethnicity: inherited affiliation with a group that is defined by shared cultural traits, such as language, religion, nationality, history, or other cultural factors
culture: a historically transmitted pattern of meaning based upon learned and shared values, beliefs, attitudes, and customs that involves patterned responses to behavior and…
race: a societal construct commonly defined by physical characteristics, such as bone structure, skin, hair, or eye color, as well as social factors and cultural backgrounds; not…
diversity: the representation and relative size of different groups, such as racial and ethnic groups, in a population
nationality: an individual’s county of citizenship
natural events: events that are considered an inherent aspect of the world and are perceived to have some degree of predictability and be subject to some element of control
unnatural events: viewed as the consequence of disharmony in nature and are often associated with forces of evil; not predictable and beyond human control
social dimension: the impersonal business zone, associated with people who are working together

Chapter 22

Transcultural Nursing

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Summary

The practice of transcultural nursing is based on understanding culture’s influence on health care decisions, illness, and health. Transcultural nursing involves providing client-centered care that is culturally competent and sensitive to individuals from diverse cultural backgrounds. Transcultural nursing aims to promote culturally inclusive health care, enhance client engagement, and reduce health care disparities by incorporating the cultural beliefs, values, and practices of clients into the… Cultural models are frameworks or patterns of thinking and behavior shared among members of a particular cultural group.

Key terms

transcultural nursing: a framework that seeks to provide culturally sensitive and competent care to individuals from diverse cultural backgrounds, recognizing that culture significantly shapes an…
practice of transcultural nursing: based on understanding culture’s influence on health care decisions, illness, and health
cultural care negotiation: the process of finding a mutually acceptable way to provide nursing care that is congruent with the client’s cultural beliefs and practices
transcultural nursing models: models of nursing care that are designed to be effective across different cultural backgrounds and settings
culturally sensitive environment: a health care environment that is designed to be welcoming and respectful of diverse cultural backgrounds
cultural essentialism: the belief that there are inherent, unchanging qualities that define a particular culture
ethnocentrism: the belief that one’s own cultural group is superior to others
cultural bridging: the act of building connections between individuals or groups from different cultures to promote understanding and collaboration

Chapter 23

Culturally and Linguistically Responsive Nursing Care

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Summary

Implicit and explicit biases, stereotypes, othering, and ethnocentrism play a role in nurses’ interactions with clients. Personal factors that affect a nurse’s ability to provide culturally responsive care include value system, beliefs, customs, cultural identity, and knowledge and attitudes about other cultures. Cultural identity is the unique combination of beliefs, values, attitudes, behaviors, customs, practices, experiences, and language that make up an individual’s sense of belonging to a particular group. To provide culturally and linguistically responsive nursing care, nurses must develop cultural humility and awareness and prioritize client self-determination

Key terms

culturally responsive care: the process of providing care to individuals or populations while fully considering their cultural backgrounds, values, and preferences; involves actively making sure that all…
explicit bias: overt prejudicial attitudes or preconceptions that exist at a conscious, intentional level and are often expressed verbally
biases: prejudicial attitudes or preconceptions that act as filters to the way one perceives, interprets, and reacts to the world
cultural humility: acknowledging, respecting, and valuing cultural differences by taking responsibility for one’s own perceptions and ideas; cultivating a deep respect for all cultures represented…
cultural identity: the unique combination of beliefs, values, attitudes, behaviors, customs, practices, experiences, and language that make up an individual’s sense of belonging to a particular…
othering: the process of excluding, marginalizing, or differentiating individuals or groups based on their perceived differences from the dominant group in a society
culturally congruent care: care that is meaningful to, and aligns with, a client’s or population’s health beliefs and behaviors (Leininger, 1991, 1999)
interpretation: a process that occurs during oral communication in which the words spoken in one language are rendered into another spoken language in real time

Chapter 24

Designing Culturally and Linguistically Appropriate Programs

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Summary

Culturally and linguistically diverse populations continue to grow, and health care professionals, including nurses, are recognizing the need to consider cultural attitudes, beliefs, and values to provide equitable and… The CLAS standards provide a framework to provide culturally and linguistically appropriate services There are a range of tools and strategies, including cultural competency self-assessments, communication, and interventions such as the ACCESS model, that are aimed at identifying strengths and pinpointing areas where… By focusing on these aspects, nursing professionals and health care organizations can create an environment where all clients, regardless of their cultural or linguistic background, feel understood, respected, and…

Key terms

cultural safety: an environment that is spiritually, socially, and emotionally safe, as well as physically safe for people where there is no assault, challenge, or denial of their identity, of…
cultural brokers: individuals who act as intermediaries or go-betweens among different cultures, using their knowledge and understanding of different cultures to help facilitate communication…
limited English proficiency (LEP): individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand the English language
professional medical interpreter: an individual who has passed a certification examination to demonstrate they have met nationally set standards to ensure client safety and compliance with federal guidelines and…
qualified bilingual staff member: a staff member who has completed an assessment of their ability to communicate in a medical setting directly with clients who speak a target language
community engagement: collaborating with community organizations and partners to develop culturally appropriate services and programs
workforce diversity: when the workforce of an organization resembles the population at large

Chapter 25

Managing the Dynamics of Difference

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Summary

Nurses can adopt this approach to develop cultural competence, which ultimately leads to “conscious permeability.” Dealing with conflict in client care, particularly when cultural differences are involved, requires excellent communication skills, empathy, cultural awareness, and a dedication to respectful resolution. To provide culturally responsive care, nurses must respect clients’ values, customs, and beliefs. Cultural responsiveness encompasses cultural awareness, knowledge, skills, encounters, and humility.

Key terms

conscious permeability: the mindful act of learning to become culturally humble and use a cultural lens throughout the entire encounter with the client
empathy: the capability to understand and share the feelings and perspectives of others, demonstrating sensitivity and compassion
systemic oppression: the dominant group’s ability to impose their version of reality and dictate what is considered normal, true, and right
unconscious impermeability: a lack of recognition that cultural humility is necessary to become culturally competent
blind spots: unconscious or implicit biases that individuals are unaware of
agent group: those with dominant social status either by birth or acquisition who may knowingly or unknowingly take advantage of their position over the target group
confirmation bias: a tendency to notice and remember information confirming one’s existing beliefs; can reinforce and strengthen those beliefs over time
counter-stereotypic imaging: the deliberate representation of individuals or groups that challenges or counters traditional stereotypes associated with them

Chapter 26

Health Promotion and Maintenance Across the Lifespan

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Summary

Health promotion and disease prevention related to maternal health focuses on the well-being of the pregnant client during pregnancy, childbirth, and the postpartum period, with an emphasis on prenatal care, commom… Taking a holistic approach considers sociocultural and linguistic factors to best impact the health of the childbearing client and their infant The early years of a child’s life are crucial for their development. Nurses must understand the risk factors, common health issues, educational needs for caregivers, and age-appropriate education for this population.

Key terms

dual language learners (DLLs): children who are learning two or more languages simultaneously or learning a second language while still learning their first language
preterm birth: when a baby is born before 37 weeks of pregnancy
abusive head trauma (AHT): a preventable, severe form of physical child abuse that results in injury to the brain of an infant or child; includes shaken baby syndrome
concussion: a traumatic brain injury caused by a bump, blow, or jolt to the head or body, which causes the person to experience any of a defined set of signs or symptoms
developmental disabilities: a group of conditions due to an impairment in physical, learning, language, or behavior areas, which begin during the developmental period, may impact day-to-day functioning, and…
family engagement: the process used to build genuine relationships with families to promote strong parent-child relationships, family well-being, and better outcomes for children and families

Chapter 27

Caring for Vulnerable Populations and Communities

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Summary

Poverty, lack of affordable housing and health care, domestic violence, and mental illness contribute to homelessness. Musculoskeletal injuries, chronic pain, and disability are common among veterans, along with depression, PTSD, and SUD, placing them at increased risk for suicide. Homelessness occurs when an individual lacks a regular, fixed nighttime residence. Groups experiencing homelessness are twice as likely to experience many chronic diseases and disorders and are often exposed to communicable diseases, violence, malnutrition, and weather-related exposures.

Key terms

veteran: an individual who is serving or has served in the active military, naval, or air service and if they are no longer in the active military, they were discharged under conditions…
disability: an impairment in the body or mind that results in difficulty doing certain activities and interacting with the environment
homelessness: a condition where individuals or families lack a regular, fixed, and adequate nighttime residence; includes individuals or families living in shelters or living in public or…
domestic violence: violent or aggressive behavior within the home, usually involving abuse of a spouse or partner
poverty: a state in which an individual lacks a socially acceptable amount of money or possessions
sexual minority youth (SMY): young individuals who identify as lesbian, gay, or bisexual; who are not sure of their sexual identity; or who have had same-sex partners
migrant farmworker: an individual who is required to be absent from a permanent residence to seek paid employment in agricultural work
migrant workers: workers that are mobile, moving frequently to locations that offer work, most often in a seasonal pattern

Chapter 28

Caring for Families

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Summary

Everyone has their own definition of family. Whatever that definition, the nurse must work with the family and their dynamics. The functions and characteristics of the family can and will affect the health of the individual. Families go through life cycles, from starting a family to growing old.

Key terms

family: a group of two or more people (one of whom is the householder) related by birth, marriage, or adoption and residing together (including related subfamily members)
family household: a group of two or more people (one of whom is the householder) related by birth, marriage, or adoption, including any unrelated people (unrelated subfamily members and/or…
family unit: a household maintained by a householder who is in a family; includes any unrelated people (unrelated subfamily members and/or secondary individuals) who may reside together
intimate partner violence (IVP): abuse that is caused by someone who is or has been romantically involved with the victim
Calgary Family Assessment Model (CFAM): model used to assess a family’s strengths, resources, problems, and illness suffering by studying the family’s structure, development, and function
Calgary Family Intervention Model: model based on CFAM; provides a framework for nurses to use to have therapeutic conversations that target the family’s functioning as a system using three domains of family…
Duvall’s Family Development Theory: a theory of family development that asserts that families must move through certain stages, in order, and in each stage attain certain developmental tasks
family group: any two or more people (not necessarily including a householder) residing together and related by birth, marriage, or adoption

Chapter 29

Caring Across Practice Settings

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Summary

Occupational and environmental health nursing focuses on providing preventive health care, health promotion, and health restoration in a safe and healthy work environment. OSHA creates and enforces workplace safety standards to ensure safe and healthy conditions for workers. NIOSH provides evidence for many of the standards that OSHA enforces. School nursing protects and promotes student health by facilitating optimal development and academic success.

Key terms

standard: a regulatory requirement established by the agency that serves as criteria for evaluating whether employers are following OSHA laws (a.k.a. regulation)
occupational and environmental health nursing: a specialty practice focused on providing preventive health care, health promotion, and health restoration within the setting of a safe and healthy environment
school nursing: a nursing specialty with a focus on protecting and promoting student health by facilitating optimal development and promoting academic success
justice-involved: individuals who are involved with the criminal justice system in jails, prisons, juvenile detention centers, and substance misuse treatment centers
root cause analysis (RCA): a component of an incident investigation that is used to identify, evaluate, and correct the causes of accidents
correctional nursing: providing nursing care to clients within the criminal justice system, jails, prisons, juvenile detention centers, and substance-misuse treatment centers
ergonomics: a set of practices, such as adjustable desk heights and keyboards that more naturally fit the wrist’s contours, in workplaces that increase worker efficiency and productivity…
individual health plan (IHP): a plan used by schools that outlines what to do if a student has a medical event while at school; serves as an agreement between the school and the student, outlining the…

Chapter 30

Care Transition and Coordination Across the Community

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Summary

Transitional care is as a process that supports clients as they move between different health care settings, ensuring continuity and safety. Factors contributing to poor transitions of care outcomes include communication breakdown, care fragmentation, limited health literacy, socioeconomic factors, and health disparities. Transitional care promotes seamless and well-coordinated care, reducing medication errors, preventing readmissions, and enhancing client engagement. By understanding the importance of effective care coordination and transitions, health care professionals can strive to optimize client outcomes and overall health care system performance

Key terms

care coordination: the deliberate organization and integration of health care services across different providers and settings to facilitate the delivery of holistic and continuous care to…
care fragmentation: the division and disconnection of health care services and providers, leading to disjointed and uncoordinated client care
care transition models: strategic frameworks designed to improve the coordination and continuity of health care as clients transfer between different locations or different levels of care
discharge planning: a transitional care process that aims to ensure a smooth transition for a client from a hospital or other health care setting to their home or another facility (such as a…
transitional care: a comprehensive and coordinated set of actions designed to ensure the safe and smooth transfer of clients, encompassing a range of services and interventions aimed at supporting…
universal transfer tool: tool or form that helps ensure that essential information, such as client medical history, current medications, diagnoses, and care instructions, is accurately and…
care transitions: critical junctures in health care where individuals move from one health care setting to another or experience changes in their care needs
teach-back: teaching technique that involves asking the client or family to explain in their own words what they need to know or do about the client’s health to ensure the client and their…

Chapter 31

Caring for Populations and Communities in Crisis

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Summary

A TIC-informed approach uses six guiding principles to ensure every client interaction is mindful and places the client’s well-being first; the client is not harmed further or retraumatized by working on their past. TIC is a therapeutic approach that centers on the understanding that trauma can have long-lasting emotional, neurological, psychological, social, and biological effects. It acknowledges that ACEs can significantly impact present and future health. A trauma-informed approach requires the nurse’s constant attention, caring awareness, and sensitivity

Key terms

asylum seeker: a person who has left their country and is seeking protection from persecution and serious human rights violations in another country but who has not yet been legally recognized…
mental health crisis: describes the current state of the U.S. health care system as it continues to be overburdened by the rise in mental health issues, as available mental health services are…
prejudice: a preconceived negative opinion of someone that is not based in facts; may predispose people to dislike and/or disrespect people with a specific diagnosis, such as schizophrenia…
sex trafficking: the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes of a commercial sex act in which the commercial sex act is induced by force…
stateless: a person who does not enjoy citizenship—the legal bond between a government and an individual—in any country; some stateless people are also refugees, but not all refugees are…
opioid naive: the connotation that an individual is not chronically receiving opioids daily
forcibly displaced: forced to leave one’s home because of conflict caused by humans (war, religious or political persecution, etc.) or by natural disasters

Chapter 32

Principles of Disaster Management

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Summary

Natural disasters occur as a result of weather or a natural event. Human-made disasters occur as a result of human action. The health and safety of communities are directly impacted by disasters. Biological terrorism is the intentional release of biological agents to threaten populations and can lead to disaster and mass casualties.

Key terms

disaster: any occurrence that causes destruction or human injury or loss that overwhelms the community’s available resources
natural disaster: disasters that arise from forces of nature, such as weather events (hurricanes, tornadoes, snowstorms, heat waves, and droughts), geological events (mudslides, floods…
biological terrorism: the intentional release of biological agents into the atmosphere or environment to threaten a civilian population
human-made disaster: directly caused by actions of people that inflict devastation and destruction of human life
health and safety of communities: directly impacted by disasters
NA-TECH: Natural Hazards Triggering Technological Accidents; human-made disaster resulting from technological accidents that are triggered by natural events
Strategic National Stockpile (SNS): supplies, medicines, and devices for lifesaving care that can be used in the short-term when the immediate supply of critical medical assets is unavailable or insufficient to…
triage tag: standardized method used to sort victims quickly, indicate the level of treatment needed using tag colors that are universally recognized and correspond to a predetermined set of…

Chapter 33

Advocating for Population Health

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Summary

Nursing coalitions can be more effective than individual advocacy. Nurses have an ethical responsibility to advocate for change to support populations most at risk for inequities. Nurse advocates work to address the social determinants of health that create health disparities among populations. The nursing profession can act to reduce disparities and advance health through advocacy at many levels

Key terms

coalition: a group of people with shared vision or concerns such as nurses or nursing associations and other groups that join forces to support a cause
advocacy: an act of support on behalf of another for a cause that improves health for persons and/or populations
advocate: a person who champions causes, such as disease awareness or other health issues
Campaign for Action: a coalition of nurses dedicated to transforming health and health care by nurses in collaboration with consumers, educators, and businesses in the United States
International Council of Nurses (ICN): a federation of more than 130 national nurses’ associations that works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing…
National Academy of Medicine (NAM): an independent scientific advisory organization formed in 1970 that aims to improve health for all by advancing science and health equity and providing independent…
political action committee (PAC): a political committee organized for the purpose of raising and spending money to elect and defeat candidates

Chapter 34

Engagement in the Policy Development Process

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Summary

Each nurse has the power to use their individual voice to influence local health policy, and collective action by nursing organizations has the power to change national policy Policy evaluation is the examination of a policy’s implementation, performance, and impact on the intended target The term policy most commonly refers to a formal or informal rule, law, or plan of action followed by a group, organization, or government. A family living in poverty may not have adequate food, housing, or access to services, which could be a root cause of their health problems and contributes to the continuation of the cycle of poverty

Key terms

policy development process: the steps or stages that are followed as a specific problem or concern generates a plan of action intended to correct it
policy: a course or principle of action adopted or proposed by a government, party, business, or individual
cycle of poverty: a series of events that occur between generations; once a person or family becomes impoverished, it is almost impossible to change their economic status, and external…
policy evaluation: determining how a policy is working and whether the intended outcomes are happening
health policy: policies that describe a health goal and a way to accomplish it
directly observed therapy (DOT): system in which medication is dispensed at a clinic or pharmacy to a client one dose at a time to ensure compliance for those who are at high risk for noncompliance (such as with…
health policy process: the steps or stages that are followed as a specific issue is identified and a plan of action intended to correct it is made
agenda setting: the identification of an issue or issues that require resolution and bringing these issues to the attention of community partners and concerned parties

Chapter 35

Leading the Way to Improving Population Health

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Summary

Nurses can draw insights from past public health achievements. Nurses have been instrumental in spearheading endeavors to enhance client well-being and medical outcomes and will continue to shape the trajectory of health care Nurse leaders can play an important role in promoting health equity. They can serve as role models for inclusivity and cultural competence and can create a more inclusive and equitable health care system by inspiring others to embrace compassionate care and by advocating for ongoing…

Key terms

workforce shortage: arises when the availability of skilled workers is inadequate to meet the target audience’s needs
digital divide: the gap between those who have ready access to and use digital technologies, such as computers, smartphones, and the internet, and those who do not
Health in All Policies (HiAP): an approach that seeks to incorporate health considerations into policymaking across various sectors and government agencies
internet of medical things (IoMT): integrates medical devices and wearables with internet connectivity for remote monitoring, real-time data collection, and communication between clients and health care providers
community-based participatory research (CBPR): collaborative research partnerships between community members, researchers, and public health practitioners
community health workers (CHWs): essential public health workers who link communities, health care systems, and state health departments