Culture (chapter 5)

Environmental Health (chapter 9)

Health Education (chapter 11)
Program Planning (chapter 12)
Fall Semester A.Jackson
Race: biologically designated groups of people whose
distinguishing features, such as skin color, are inherited

Ethnic group: collection of people who have common
origins and a shared culture and identity; they may share a
common geographic origin, race, language, religion,
traditions, values, and food preferences (Spector, 2004).

Microcultures: smaller groups within a subculture

Ethnocentrism: belief or feeling that ones own culture is
best

Key Terms
Cultural diversity (cultural plurality): variety of cultural
patterns coexisting within a designated geographic area

Subcultures: relatively large aggregates of people within a
society sharing separate distinguishing characteristics

Ethnorelativism: seeing of all behavior in a cultural context

Ethnicity: group of qualities that mark his or her
association with a particular ethnic group or who share
cultural and/or physical characteristics including one or
more of the following: history, political system, religion,
language, geographical origin, traditions, myths, behaviors,
foods, genetic similarities, and physical features (Ethnicity
Online, 2007)

Other Key Terms (cont.)
Develop cultural self-awareness.

Cultivate cultural sensitivity.

Assess the client groups culture.

Show respect and patience while learning about other
cultures.

Examine culturally derived health practices.
Transcultural Nursing Principles
Ecology is the study of the interactions and relationships
between living organisms and their environments.

Ecosystems are dynamic communities that no organism
including humans can exist outside of.

The scientific study of ecosystems provides an
understanding of the relationship between humans and the
environment and why knowledge of environmental health
is so important for nurses.
Ecology, the Human and the
Environment
Ecological Model for Public Health
ANAs Workforce Ecosystem
Model
Job assignments including:
the volume of work, the
professional skills required,
the duration of experience
in a particular job category,
and work schedules.
On-the-job activities of
health care workers,
including interactions
among workers and the
nature and scope of the
work.
Individual and group factors
such as stress, job
satisfaction, and
professionalism, as well as
skills that may be
underdeveloped in the
nursing population, such as
financial literacy.
Aspects of the
workplace such as
light, aesthetics, and
sound
Structural and process
aspects of the
organization as a
whole, such as the
use teams, divisions
of labor, shared
beliefs, and an
increasing leadership
capacity among
nurses
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/Workforce-Advocacy/Workforce-Ecosystem-2.html
Upstream Focus

John McKinley in 1979, A Case for Focusing Upstream
Identifies root causes of disease and manufacturers of illness
It considers socioeconomic factors and also the
environmental origins of disease and health problems.
Public health nurses are often the sentinels of surveillance
who detect unusual illness patterns and respond to
environmental emergencies in work and community settings.
Concepts and Theories
Environmental Principles for Public Health Nursing

ANAs Principles of Environmental Health for Nursing
Practice

American Nurses Association (ANA) Nursing: Scope and
Standards of Practice
Standard 16 Environmental Health

Healthy People 2020 Initiatives

Core Functions of Public Health
Guiding Documents
Precautionary Principle

In the absence of clear data that indicate the safety of an
action, chemical, or material that poses a threat to human
health, it should not be used.

The principle states, When an activity raises threats of
harm to human health or the environment, precautionary
measures should be taken if some cause and effect
relationships are not fully established scientifically.
Concepts and Theories
(cont.)
I. Basic knowledge and concepts
All nurses should understand the scientific principles and underpinnings of the relationship
between individuals or populations, and the environment (including the work environment). This
understanding includes the basic mechanisms and pathways of exposure to environmental health
hazards, basic prevention and control strategies, the interdisciplinary nature of effective
interventions, and the role of research.

II. Assessment and referral
All nurses should be able to successfully complete an environmental health history, recognize
potential environmental hazards and sentinel illnesses, and make appropriate referrals for
conditions with probable environmental etiologies.
An essential component of this is the ability to access and provide information to
patients and communities, and to locate referral sources.

III. Advocacy, ethics, and risk communication
All nurses should be able to demonstrate knowledge of the role of advocacy (case and class),
ethics, and risk communication in patient care and community intervention with respect to the
potential adverse effects of the environment on health.

IV. Legislation and regulation
All nurses should understand the policy framework and major pieces of legislation and
regulations related to environmental health.

GENERAL ENVIRONMENTAL HEALTH
COMPETENCIES FOR NURSES (IOM)
Class Advocacy
Class advocacy can take the form of policy
advocacy or advocacy for reform or social
change.
Class advocacy uses the power and influence
of collective action to bring about a just
society.
The three parties in class advocacy are a
marginalized population, a change agent
system (collective action), and a target system
(what and who maintains the status quo).

Case Advocacy
Case advocacy is concerned with individual justice
In case advocacy there are three parties: the client,
the worker and the other party.

1. Assessment
Monitoring health status
Investigation of health hazards
Surveillance of health issues
Examining causes
Assessing needs
2. Assurance
The enforcement of policy
3. Policy development
Provides guidance through the essential community services
Engages scientists to analyze and develop policies to ensure
health based upon sound evidence
Core Functions
Overpopulation

Effects: food scarcity, water shortages, depletion of other vital
resources

Demographic entrapment: population > ability of ecosystem to
support it or acquire needed support or when population
exceeds its ability to migrate to other ecosystems in a manner
to preserve its standard of living

Governments role: solutions possibly controversial depending
on culture, religious beliefs, personal values and convictions

Nurses role: teaching about birth spacing, preventing high-risk
pregnancies, preventing growing epidemic of HIV/AIDS,
providing family planning education, and providing prenatal
care
Major Global Environmental
Concerns
Air pollution

One of the most hazardous sources of chemical
contamination; adverse effects including costs to property,
productivity, quality of life, and human life

Difficulty establishing actual cause and effect

Certain geographic areas more susceptible to ill effects due to
weather or physical terrain
Major Global Environmental
Concerns (cont.)
Dusts, gases, and naturally occurring elements
Dustssilica dust, asbestos; gasessulfur oxides, nitrogen
oxides, chlorine, ozone, sulfur dioxide, carbon monoxide,
radon
Pollen, volcanic ash, airborne microorganisms
Acid precipitation
Air contaminants + precipitation = sulfuric and nitric acid
(acid rain)
Effects: killing small life forms; danger to forest and
freshwater ecologies
Major Global Environmental
Concerns (cont.)
Ozone depletion and global warming

Effects: increased risk for skin cancer and cataracts;
indirectly damaging food chain, increasing exposure to
vector-borne diseases, raising of ocean levels, and negative
impact on crop production

Governments role: clean air legislation, reduction of
greenhouse gases

Nurses role: detection, community education, lobbying
for appropriate legislation
Major Global Environmental
Concerns (cont.)
Water pollution

Surface water (lakes and streams); underground sources

Effects: cause of disease, contamination of streams, lakes, and
wells, contamination of fish, upset of ecosystem

Governments role: legislation for water quality testing;
groundwater protection

Nurses role: examining household or city drinking water;
identifying increased incidences of water-related diseases;
promoting safe healthy water
Major Global Environmental
Concerns (cont.)
Deforestation, wetlands destruction, and
desertification

Effects: upset of ecosystem; gases contributing to ozone
depletion; geographic changes/landslides; drought, famine,
starvation

Governments role: saving wetlands and forests

Nurses role: acting as a voice at the local level; leading and
collaborating to initiate grassroots efforts to save wetlands
and forests
Major Global Environmental
Concerns (cont.)
Energy depletion

Nonrenewable sources primarily used today; nuclear energy still
controversial, including building of plant and disposal of nuclear
waste

Governments role: discovery, rediscovery, or tapping of other
renewable sources of energy; use of environmentally friendly
sources

Nurses role: education about energy conservation, alternative
energy sources; encouragement to become interested in and
knowledgeable about potential energy depletion
Major Global Environmental
Concerns (cont.)
Unhealthy or contaminated food

Inherently harmful foods, contaminated foods, foods with
toxic additives

Food irradiation/cold pasteurizationfor global food safety

Governments role: regulatory agencies and monitoring

Nurses role: education about proper food storage, cooking,
and handling
Major Global Environmental
Concerns (cont.)
Waste disposal

Issues involving disposal of human waste, garbage,
hazardous waste

Governments role: establishment of standards for safe waste
disposal; monitoring and enforcing compliance

Nurses role: educating public and lobbying for enabling
legislation; encouraging use of recyclable products; avoiding
use of aerosol sprays, plastics and other non-recyclable items
Major Global Environmental
Concerns (cont.)
Insect and rodent control

Effects: irritation/discomfort; direct threat to health via
attack; contamination of food; vectors for disease
transmission (mosquitoes, flies, ticks, roaches, fleas, rats,
mice, and ground squirrels)

Governments role: vector surveys, research, control;
community awareness; pest control programs

Nurses role: increasing awareness of threat; remaining alert
to evidence of insects/rodents; educating persons; notifying
proper authorities; surveying communities; influencing
policy makers
Major Global Environmental
Concerns (cont.)
Safety in home, worksite, and community

Exposure to toxic chemicals, radiation, noise pollution,
biologic pollutants; injury hazards; psychological hazards

Governments role: standards and regulation; monitoring of
chemical use and production; public education and
community safety programs

Nurses role: monitoring; preventive measures for injuries;
safety education; promotion of first-aid/CPR; noise
education; active lobbying for crime prevention, reduction of
workplace stressors, and development of educational and
support programs
Major Global Environmental
Concerns (cont.)
Learn about possible environmental health threats.

Assess clients environment and detect health hazards.

Plan collaboratively with citizens and other professionals to
devise protective and preventive strategies.

Assist with the implementation of programs.

Take action to correct situations in which health hazards
exist.
Strategies for Nursing Action
in Environmental Health
Educate consumers and assist them to practice preventive
measures.

Take action to promote the development of policies and
legislation that enhance consumer protection and promote a
healthier environment.

Assist with and promote program evaluation to determine the
effectiveness of environmental health efforts.

Apply environmentally related research findings and
participate in nursing research.
Strategies for Nursing Action
in Environmental Health
http://www.youtube.com/watch?v=0-kc3AIM_LU
10 Americans
Emphasis: health status, longevity, quality of life

High school completion; school health education
Undergraduate health risk behavior information
Work-site health promotion; participation in employer-
sponsored health promotion
Patient satisfaction with health care provider communication
Community-based health promotion
Culturally appropriate health education
Senior health education
Healthy People 2020:
Educational and Community-
Based Programs
CHN/PHN educator goal: effecting change in peoples
behavior

Changing behavior
Many different reasons for change
Attempts and failure several times before success
Working at some changes possibly lifelong
Most change on own without special programs
People are different; what works for one may not work for
another
Health Promotion Through
Change
Purposeful and intentional

Change by design not default

Improvement as the aim for planned community health
change

Accomplishment through an influencing agent
Planned Change
1. Recognize symptoms
2. Diagnose need
3. Analyze alternative solutions
4. Select the change
5. Plan the change
6. Implement the change
7. Evaluate the change
8. Stabilize the change
Steps of Planned Change
Factors that influence an individuals ability to maintain
good health include social, economic, and physical factors
such as:
Access to social and economic opportunities
Safe housing
Quality education
Clean water, food, and air
Safe workplaces
Equitable social interactions
Adequate community resources
Social Determinants
Cognitive: mind and thinking processes
Knowledge-recall
Comprehension-remembering with understanding
Application-understand and apply to new situation
Analysis-examining parts and drawing conclusions about
relationships
Synthesis-all the above steps utilized to create a new plan or
solutions
Evaluation-judging the usefulness of new material compared
with a stated purpose or specific criteria

Affective: emotion, feeling, affect

Psychomotor: visible demonstration of performance skills
requiring some type of neuromuscular coordination
Domains of Learning
Behavioral: Stimulus-response (Pavlov) & Conditioning
(Thorndike and Skinner)
Cognitive: (Piaget & Gestalt field)
Social: Bandura
Humanistic: Maslow & Carl Rogers
Adult Learning: Knowles
adult learners are self-directed
have a lifetime of experience
knowledge has to apply to them



Learning Theories
Primary Prevention Strategies
Health education and counseling: healthy lifestyle behaviors, exercise, stress
management, nutrition, genetic, family
Immunizations
Adequate housing and employment opportunities
Educational and recreational opportunities
Environmental modifications and regulationsclean air and water, environmental
sanitation
Occupational hazard protection
Injury prevention
Secondary Prevention Strategies
Screening test and surveys
Community assessments
Case-finding activities
Routine physical and mental exams
Early medical treatment
Tertiary Prevention Strategies
Effective and complete medical treatment
Work therapy and workforce retraining and reeducation


Source: www.sagepub.com/upm-data/3989_Chapter_1.pdf
Public Health and Levels of
Prevention
Client readiness to learn

Client perceptions about subject matter

Educational environment

Client participation

Subject relevance

Client satisfaction

Client application of material
TeachingLearning Principles
Formal or informal, planned or unplanned
Methods
Lecture
Discussion
Demonstration
Role-playing
Materials (visual images, anatomic models, equipment,
printed support materials, examples)
Content, complexity, reading level, culturally appropriate
Teaching Methods and Materials
Cultural or language differences

Hearing impairments

Developmental delays

Memory losses

Visual perception distortions

Problems with fine or gross motor skills

Distracting personality characteristics

Demonstrations of stress or emotions
Clients With Special Learning
Needs
Issue to explore
Extent of problem; target population
Views of target population (authoritative knowledge)
Working with target population: formal and informal
leaders; local knowledge
Delineating problem to be addressed
Rating importance and changeability (to narrow focus)
Factors influencing behavior change (predisposing,
reinforcing, enabling)
Identifying Group or Community
Health Problems
Assure quality through measurable outcomes and
standards of practice in programs and services
Setting measurable goals and objectives
Evaluating outcomes
Quality indicators of client outcomes: quantitative
measures of clients response to care; part of a broader
quality management program; used to determine goal
achievement
Benchmarking: continuous, collaborative, systematic
processes for measuring and examining internal
programs strengths and weaknesses; also studying
anothers processes to improve own.
Evaluation of Outcomes
Donabedian Model

Quality Health Outcomes Model

American Nurses Association Model

Omaha System

Quality Practice Setting Attributes Model
Models Used in Program
Evaluation
Influencing the behavior of target audiences through
changes in:

Behavior

Policies that impact health behaviors

Perceptions and support for public health as an
institution
Social Marketing
Individual or group providing another individual or group
the support (money) for a specified purpose

Funding for program development or project support
Planning grants
Start-up grants
Management or technical assistance grants
Facilities or equipment grants
Grants
Sources: government, private philanthropic,
corporate sources

Letter of inquiry possibly before
application/proposal

Grants highly competitive

Grants (cont.)
Order of steps:
1. Define the project
2. Identify the proper funding source
3. Contact funders
4. Acquire proposal guidelines
5. Know submission date
Seeking Grant Funding
END......hint....study those
concepts/words in PINK text