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Week 1: Leading Culturally and Linguistically Appropriate Healthcare

Throughout the course, you’ll use the map below to engage important population health concepts. Click on each hot spot to learn more about the population in that area.

This week, you discovered that the focus of healthcare has a growing emphasis on population health. Emphasis on quality improvement and tracking outcomes has led to exploring “why?” Why do some patients have trouble controlling their diabetes? Why do so some pediatric diabetic patients show up in the emergency department with an uncontrolled episode? These questions have led the DNP scholar and other healthcare providers to consider the social determinants of health. This query also requires that consideration be given to “how?” How do healthcare providers improve outcomes for a given population? Explore these questions as they relate to the populations represented on the interactive map below.

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Create a culturagram for your selected population  

Hialeah, Florida. Culture of interest – Hispanic/Latino.  You may use the attached template.

  • Create a culturagram for your selected population. Refer to Week 1, Explore page 2, for guidance in creating a culturagram. You may use the attached template, if you desire.
  • Conduct a search for evidence. Identify one evidence-based intervention to reduce health disparities in the selected population.
  • Consider how the selected intervention addresses at least one of the CLAS standards.

Share your professional experience related to the topic.

Culturagram blank Template attached

Sample how to do the work and the culture gram are attached

Hialeah, Florida

o Culture of interest – Hispanic/Latino

o Population – 224,669

o Individuals diagnosed with heart disease prior to the study year – 1513

o age 30 – 40

o age 35 – 63

o age 40 – 143

o age 45 – 189

o age 50 – 203

o age 55 – 225

o age 60 – 299

o age 65 – 351

o Individuals newly diagnosed with heart disease in the study year – 409

o Age 30 – 3

o Age 40 – 12

o Age 50 – 41

o Age 55 – 82

o Age 60 – 97

o Age 65 – 174

o Individuals who died of heart disease in the study year – 531

o Age 50 – 86

o Age 55 – 105

o Age 60 – 130

o Age 65 – 210

o Average years of life expectancy reduction due to heart disease – 10

Hialeah, Florida

o Culture of interest – Hispanic/Latino

o Population – 224,669

o Individuals diagnosed with heart disease prior to the study year – 1513

o age 30 – 40

o age 35 – 63

o age 40 – 143

o age 45 – 189

o age 50 – 203

o age 55 – 225

o age 60 – 299

o age 65 – 351

o Individuals newly diagnosed with heart disease in the study year – 409

o Age 30 – 3

o Age 40 – 12

o Age 50 – 41

o Age 55 – 82

o Age 60 – 97

o Age 65 – 174

o Individuals who died of heart disease in the study year – 531

o Age 50 – 86

o Age 55 – 105

o Age 60 – 130

o Age 65 – 210

o Average years of life expectancy reduction due to heart disease – 10

Time in Community

Values about education, work, family structure and power

Contact with cultural, religious institutions’, holidays, food and clothing

Population

Effects of Trauma and Crisis Event

Health Beliefs

Oppression, discrimination, bias, and racism

Language Spoken Home/Community

Time in Community

Land occupied since the origins of earth,

Tribe shares genetic and language similarities with Aztec,

Kykotsmovi was Founded in 1906 from a dispute in Oraibi.

Values about education, work, family structure and power

Self-sufficiency, self-reliance, religion, peace and goodwill, spiritual knowledge, Earth stewards, family cohesion, stability and generosity, humility, and respect, reciprocity. Matrilineal system. Farming of corn for traditions

Effects of Trauma and Crisis Event

Lung diseases, cancer, alcoholism, addiction, mental illnesses.

Contact with cultural, religious institutions’, holidays, food and clothing

Ceremonial, rituals, and traditional culture in the reservation or during events

Harmony with nature and cycles of rebirth

Masks, headdresses and body paint, unmarried girls with braids over their ears.

Population of Kykotsmovi

776 people in 253 households,

32.8% have children under 18,

41.9% married couples

23.7% with female as household

10.3% 65 years or older living alone

Average household size 3.97 and average family size 3.69

Median income per household $23,750

Oppression, discrimination, bias, and racism

Missionaries and intruders (Spanish and U.S. forces)

Federal agents

Programs and government policies

Health Beliefs

Healers and plants and roots treatment

Prayers to the spirits, rituals

Language Spoken Home/Community

Spoke Hopi at home 56%

Spoke English at home 40%

Spoke Navarro at home 4%

Population chosen: Hopi Nation in Arizona

Culturagram: see below

Identify one evidence-based intervention to reduce health disparities in the selected population.

It is understood that environmental health hazards are linked with chronic diseases. Safe drinking water, air pollution emissions, and hazardous contaminants have challenged the Hopi Nation and surrounding Native American reservations for many years (Mayer et al., 2019). The Hopi, located in northwestern Arizona, live in an enclave in the Navajo Nation and receive public water from the Navajo aquifer, known to be contaminated with arsenic (Carson et al., 2020), (Mayer et al., 2019). Extraction of natural resources, coal, oil, and uranium leaving behind toxic contaminates, power plants, dump sites, and nuclear testing have affected Native Nations exposing the population to diverse diseases, especially asthma and kidney cancer, or renal failure (Mayer et al., 2019). Adding to these problems, lack of economic development, poverty, low educational level, and unemployment are the perfect storm for chronic health conditions such as addiction and mental health.

Arsenic contamination, droughts, and climate change are affecting the availability of water for the Hopi.  Without safe water, the Hopi will not be able to harvest corn and survive on their land. One evidence-based intervention that would reduce health disparity for the Hopi, is to bring safe water to the Hopi reservation. As explained by Carson et al., (2020), the cost of a pipeline is very high and the Hopi are the poorest Native American Tribe as they have limited income and no casino like their neighbors, the Navajo Nation (Carson et al., 2020).

Consider how the selected intervention addresses at least one of the CLAS standards.

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care has for objectives to improve quality and equity in healthcare (U.S. Department of Health and Human Services Office of Minority Health, 2018). The Principal Standard refers to the delivery of Quality, effective, equitable, understandable health care, in the preferred language, respecting health literacy and communication need (U.S. Department of Health and Human Services Office of Minority Health, 2018). The project of providing safe water to the Hopi Tribe is the basis of survival for this population. Water is an essential need for any human being and would improve the health of the Hopi Tribe by providing harvest, and reducing the rate of renal cancer to cite only the most important.

Share your professional experience related to the topic.

As a Family Nurse Practitioner, I work in a Federally Qualified Health Center in Phoenix. My professional experience treating Native Americans is limited to patients who left the reservation to work in Phoenix for better wages. The data from 2020 provided by the Arizona Department of Health Services shows that the Hopi Tribe accounts for near 12,000 persons spread over 2,532 sq miles, with a median household income of $37,000, with no hospital, pharmacy, Skilled Nursing Facilities, ambulance services, or Home Care Agency (AZDHS, 2020). In my practice, I see Native Americans mainly for uncontrolled diabetes, hypertension, addiction, and obesity. The majority of Natives outside the reservation seek medical care at the Indian Health System because it is free. Last year, the Navajo Nation was severely affected by the pandemic and received little to no help from the State or the Government, to the point that Doctors Without Borders dispatched a team to the Navajo Reservation to help with testing and ambulatory treatments of Covid-19. The reservation was on lockdown for months which was effective to reduce the infection rate. This year,  vaccinations and fundings were allocated to the Navajo Department of Health. Knowing the discord between Navajo and Hopi, I hope that all Native will have access to resources and the Covid vaccines, but at this time, it looks like the Reservation will be the first place in the United States to be 80% vaccinated and building heard immunity.

References

Arizona Department of Health Services (AZDHS). (2020). Hopi Tribe Primary Care Area- 2020 Statistical Profile.  https://www.azdhs.gov/documents/prevention/health-systems-development/data-reports-maps/primary-care/navajo/11.pdf (Links to an external site.)

Bonvillain, N. (2005). The Hopi, Indians of North America. https://salmon.net.dn.ua/Litera/history-&-culture/NBonvillain-TheHopi.pdf

Carson, R. T., Hanemann, W. M., & Whittington, D. (2020). The Existence Value of a Distinctive Native American Culture: Survival of the Hopi Reservation. Environmental and Resource Economics75(4), 931–951.  https://doi.org/10.1007/s10640-020-00412-5 (Links to an external site.)

The Hopi Foundation. (2020). Hopisinom.  https://www.hopifoundation.org/about-hopi (Links to an external site.)

Mayer, B., Joshweseoma, L., & Sehongva, G. (2019). Environmental Risk Perceptions and Community Health: Arsenic, Air Pollution, and Threats to Traditional Values of the Hopi Tribe. Journal of Community Health44(5), 896–902. https://doi.org/10.1007/s10900-019-00627-8

U.S. Department of Health and Human Services Office of Minority Health. (2018). The National CLAS Standards.

culturalgram Hopi 2021.docx

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