Discuss various theories of health promotion, including Pender’s Health Promotion Model, the Health Belief Model, the Transtheoretical Theory, and the Theory of Reasoned Action.Discuss at least two definitions of health.Critically analyze racial and cultural diversity in the United States.Describe the importance of air, water and food quality as a determinant of health. Please present the assignment in an APA format, word document, Arial 12 font attached to the forum in the discussion tab of the blackboard title “week 4 discussion questions”. The assignment must include at least 2 evidence-based references (excluding the class textbook) no older than 5 years. Refences must be quoted in the assignment in order to comply with APA. A minimum of 700 words is required.
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Chapter 14
Environmental Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Environmental Health Is …



… all the physical, chemical, and biological
factors external to a person and all the
related factors impacting behaviors.
… encompasses the assessment and control
of those environmental factors that can
potentially affect health.
… targeted toward preventing disease and
creating health-supportive environments.
– WHO (2013)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Environmental Health


The purpose of environmental health is to
ensure the conditions of human health and
provide healthy environments for people to
live, work, and play.
Accomplished through…



Risk assessment
Prevention
Intervention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Using a Critical Theory Approach





Uses “thinking upstream” framework.
Raises questions about oppressive situations.
Involves community members in the definition
and solution of problems.
Facilitates interventions that reduce healthdamaging effects of environments.
Asks critical questions about clients’ work and
home environments to help discern the
contributions of specific hazards to health.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Benefits of an Environmental Health
History




Increased awareness of environmental/
occupational factors
Improved timelines and accuracy of diagnosis
Prevents disease and aggravation of
conditions
Identifies potential work-related
environmental hazards and/or environmental
hazards in and around clients’ homes
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5
I PREPARE
Environmental Exposure History








I – Investigate potential exposures
P – Present work
R – Residence
E – Environmental concerns
P – Past work
A – Activities
R – Referrals and Resources
E – Educate
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6
Figure 14-1
From U.S. Department of Health and Human Services: Healthy People 2010, ed 2,
Washington, DC, U.S. Government Printing Office, 2000.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Areas of Environmental Health






Built environment
Work-related
exposures
Outdoor air quality
Healthy homes
Water quality
Food, safety, and
waste management
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Built Environment

The connection between
people, communities,
and their surrounding
environments that
affects health behaviors
and habits,
interpersonal
relationships, cultural
values, and customs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Built Environment: Examples





Drunk driving
Second-hand smoke
Noise exposure
Urban crowding
Technological hazards
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Work-Related Exposure

Poor working conditions that result in
potential injury or illness
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Work-Related Exposure: Examples




Asbestosis
Asthma
Lung cancer
Agricultural accidents
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Outdoor Air Quality

The purity of the air
and the presence of
air pollution
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Outdoor Air Quality: Examples





Gaseous pollutants
Greenhouse effect
Destruction of the
ozone layer
Aerial spraying of
herbicides and
pesticides
Acid rain
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14
Healthy Home

The availability, safety, structural strength,
cleanliness, and location of shelter, and
indoor air quality
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Healthy Home: Examples





Homelessness
Rodent and insect infestation
Poisoning from lead-based paint
Sick building syndrome
Unsafe neighborhoods
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Water Quality


The availability, volume,
mineral content levels,
toxic chemical pollution,
and pathogenic
microorganism levels
The balance between
water contaminants and
existing capabilities to
purify water for human use
and plant and wildlife
sustenance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Water Quality: Examples





Contamination of drinking supply
by human waste
Oil spills in the world’s
waterways
Pesticide or herbicide infiltration
of ground water
Aquifer contamination by
industrial pollutants
Heavy metal poisoning of fish
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18
Food Safety

Availability,
accessibility, and
relative costs of healthy
food free from
contamination of
harmful herbicides,
pesticides, and
bacteria
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Food Safety: Examples





Malnutrition
Bacterial food
poisoning
Food adulteration
Disrupted food chains
by ecosystem
destruction
Carcinogenic chemical
food additives
FDA food safety campaign:
http://www.fightbac.org/safe-food-handling
http://www.foodsafety.gov/
Figure 14-5
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Waste Management

The handling of waste
materials resulting from
industry, municipal
processes, and human
consumption as well as
efforts to minimize waste
production
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Waste Management: Examples





Use of nonbiodegradable
plastics
Poorly designed solid waste
dumps
Inadequate sewage systems
Transport and storage of
hazardous waste
Illegal industrial dumping
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Waste Management: Examples
(Cont.)





Nuclear facility emissions
Radioactive hazardous wastes
Radon gas seepage in homes
and schools
Nuclear testing
Excessive exposure to x-rays
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Effects of Environmental Hazards
Figure 14-6 From Environmental Protection Agency: Air Pollution and Health Risk.
http://www.epa.gov/ttnatw01/3_90_022.html. Retrieved March 27, 2013.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Emerging Issues in Environmental
Health








Environmental public health infrastructure
Natural disasters
Global climate change
Ozone depletion
Fossil fuel burning
Marine dumping
Active land mine abandonment in war-torn
areas
Destruction of tropical rain forests
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Critical Community Health Nursing
Practice






Approach environmental health at the
population level
Take a stand; advocate for change
Ask critical questions
Facilitate community involvement
Form coalitions
Using collective strategies
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26
Chapter 13
Cultural Diversity and Community Health
Nursing
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Cultural Competence


Cultural competence is respecting and
understanding the values and beliefs of a certain
cultural group so that one can function effectively in
caring for members of that cultural group.
Culturally competent community health nursing
requires that the nurse understand…



Lifestyle
Value system
Health and illness behaviors of diverse individuals, families,
groups, and communities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Standards of Practice for Culturally
Competent Nursing Care
1.
2.
3.
4.
Social Justice
Critical Reflection
Knowledge of Cultures
Culturally Competent
Practice
5. Cultural Competence in
Health Care Systems
and Organizations
6. Patient Advocacy and
Empowerment
7. Multicultural Workforce
8. Education and Training
in Culturally
Competent Care
9. Cross-Cultural
Communication
10. Cross-Cultural
Leadership
11. Policy Development
12. Evidence-Based
Practice and Research
From: Expert Panel on Global
Nursing and Health (2010)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Population Trends

In 1970


By 2010


Minority groups increased to 36% of population
By 2025


Minority groups were 16% of population
More than half of all children will be minorities
By 2050


More than 54% of total population will be minorities
First time in U.S. history that minorities will make up a
majority of the population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Population Trends (Cont.)

By 2060, projected demographic trends:

White 44%
➢ Hispanic 30%
➢ African American 15%
➢ Asian 9%
➢ American Indians & Alaska Natives 2%
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Immigration to the United States


Since 1991, more than 13 million legal
immigrants
In 2010, almost 40 million foreign-born
individuals in the United States (12.9% of
population) from:




Latin America 53.1%
Asia 28.2%
Europe 12.1%
Other regions 9%
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Diversity Among Nurses

Minorities are generally
underrepresented by nursing workforce
(HRSA, 2009):






White/non-Hispanic 81.8%
African American 4.2%
Hispanic 1.7%
Asian and Pacific Islander 3.1%
Native American and Alaska Native 0.3%
Minority groups tend to be geographically
distributed in the United States.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Cultural Perspectives and Healthy
People 2020



Developed a set of national health
targets…eliminating racial and ethnic
disparities in health
Embraced and focused on ways to
close the gaps in health outcomes
Focused on disparities among racial
and ethnic minorities, women, youth,
older adults, people of low income and
education, and people with disabilities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Health Disparities
AHCRQ (2005) reveals that:
 Cancer mortality rates are 35% higher in
African Americans than in whites.
 African Americans with diabetes are seven
times more likely to have amputations and
develop renal failure than are whites with
diabetes.
 30% of Hispanics and 20% of African
Americans lack a usual source of health care
(compared with less than 16% of whites).
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Health Disparities (Cont.)
AHCRQ (2005) reveals that:
 Hispanic children are nearly three times as
likely as non-Hispanic white children to have
no usual source of health care.
 African Americans (16%) and Hispanic
Americans (13%) are more likely to rely on
hospitals or clinics for health care than are
whites (8%).
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Addressing Racial and Ethnic
Disparities in Health Care

Disparities can be reduced or
eliminated when adults have:


Health insurance and
A medical home
– Commonwealth Fund, 2007
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Transcultural Nursing

“…a formal area of study and practice
focused on a comparative analysis of different
cultures and subcultures in the world with
respect to cultural care, health and illness
beliefs, values, and practices with the goal of
using this knowledge to provide culturespecific and culture-universal nursing care to
people.”
– Leininger (1978)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Transcultural Nursing Terminology

Culture specific refers to the
“particularistic values, beliefs,
and patterning of behavior
that tend to be special, ‘local,’
or unique to a designated
culture and which do not tend
to be shared with members of
other cultures”
– Leininger (1991)

Culture universal refers to
the “commonalties of values,
norms of behavior, and life
patterns that are similarly
held among cultures about
human behavior and
lifestyles and form the bases
for formulating theories for
developing cross-cultural
laws of human behavior”
– Leininger (1978)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Transcultural Nursing Terminology
(Cont.)

Ethnocentrism is a
person’s tendency to
view his or her own way
of life as the most
desirable, acceptable, or
best, and to act in a
superior manner toward
another culture.

Cultural imposition is
a person’s tendency to
impose his or her own
beliefs, values, and
patterns of behavior on
individuals from another
culture.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Leininger’s Theory of Culture Care
Diversity and Universality


Describes, explains, and projects nursing
similarities and differences focused primarily
on human care and caring in human cultures.
Uses world view, social structure, language,
ethnohistory, environmental context, and the
generic or folk and professional systems to
provide a comprehensive and holistic view of
influences in cultural care and well-being.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Leininger’s Sunrise
Model depicting the
theory of cultural
care diversity and
universality
Figure 13-1
From Leininger MM: Culture, care,
diversity, and universality: a theory of
nursing, New York, 1991, National
League for Nursing Press.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Overview of Culture


Culture refers to the complex whole, including
knowledge, beliefs, art, morals, law, customs,
and any other capabilities and habits
acquired by virtue of the fact that one is a
member of a particular society (Tylor, 1871).
Culture represents a person’s way of
perceiving, evaluating, and behaving within
his or her world, and it provides the blueprint
for determining his or her values, beliefs, and
practices.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Overview of Culture (Cont.)
Four basic characteristics of culture—it is:
1. Learned from birth through the processes of
language acquisition and socialization
2. Shared by members of the same cultural
group
3. Adapted to specific conditions related to
environmental and technical factors and to
the availability of natural resources
4. Dynamic
– Sir Edward Tylor, 1871
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Subculture



A fairly large aggregate of people who share
characteristics that are not common to all
members of the culture
Enables them to be a distinguishable
subgroup
May be based on ethnicity, religions,
occupation, health-related characteristics,
age, gender, sexual preferences, or
geographic location
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Culture and Formation of Values

Common human problems related to values and
norms:





What is the character of innate human nature (human nature
orientation)?
What is the relationship of the human to nature (personnature orientation)?
What is the temporal focus of human life (time orientation)?
What is the mode of human activity (activity orientation)?
What is the mode of human relationships (social
orientation)?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Human-Nature Orientation


Innate human nature may be good, evil, or a
combination of good and evil.
The dominant U.S. cultural group chooses to
believe the best about a person until that
person proves otherwise.
– Kohls (1984)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Person-Nature Orientation



Destiny, in which people are
subjugated to nature in a
fatalistic, inevitable manner.
Harmony, in which people and
nature exist together as a single
entity.
Mastery, in which people are
intended to overcome natural
forces and put them to use for the
benefit of humankind.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Time Orientation



The focus may be on the past, with traditions
and ancestors playing an important role in the
client’s life.
The focus may be on the present, with little
attention paid to the past or the future.
The focus may be on the future, with progress
and change highly valued.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Activity Orientation



Being, in which a spontaneous
expression of impulses and desires is
largely nondevelopmental in nature.
Growing, in which the person is selfcontained and has inner control,
including the ability to self-actualize.
Doing, in which the person actively
strives to achieve and accomplish
something that is regarded highly.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Social Orientation



Lineal relationships: Exist by virtue
of heredity and kinship ties. Follow an
ordered succession and have
continuity through time.
Collateral relationships: Focus
primarily on group goals—and family
orientation is important.
Individual relationships: Personal
autonomy and independence
dominate; group goals become
secondary.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Culture and the Family

Cross-cultural differences may exist in:

Structural differences
➢ Functional diversity
➢ Socialization context
➢ Sex roles and parenting values
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26
Culture and Socioeconomic Factors

Socioeconomic status (SES) is a composite
of the economic status of a family or
unrelated individuals based on:

Income
➢ Wealth
➢ Occupation
➢ Educational attainment
➢ Power
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Culture and Socioeconomic Factors
(Cont.)

Poverty guidelines

Determined by comparing pretax cash income
with the poverty threshold adjusted for family size
and composition issued annually by USDHHS.
➢ The U.S. Census Bureau (2012) reported that the
poverty rate in 2011 was 15%
• African American population—27.6%
• Asian population—12.3%
• Hispanic population—25.3%
• Children under 6 years—24.5%
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28
Culture and Socioeconomic Factors
(Cont.)

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