LLU alumna Fayette Nguyen Truax is reducing health disparities experienced by vulnerable immigrant populations (Photo by Chet Williams)
Originally appeared in Fall 2022 edition of Scope
What does it take to squash a centuries-old infection driven by health disparities among a growing community of millions? Fayette Nguyen Truax, PhD, RN, CPNP-PC is reaching for the answer through her research and interventions designed to educate, test, and treat those most at risk of developing tuberculosis among Orange County communities: immigrants from Southeast Asian countries.
A respiratory disease, tuberculosis (TB) usually affects the lungs but can also affect the brain, the kidneys, or the spine. Left untreated, TB can be deadly. People who inhale air containing TB germs can become infected with a latent TB infection (LTBI), a dormant state of TB that places them at higher risk of developing active TB in the future.
Efficient screening, testing, and treatment of LTBI via oral medications coupled with culturally-sensitive TB education can stop the spread of TB, according to research by Nguyen Truax. However, to reduce TB cases in Orange County, treatment ofLTBI in high-risk Orange County residents with chronic diseases is the first step, since this population has a greater chance of LTBI reactivation. Nguyen Truax frequently encounters misinformation or lack of education about TB and LTBI in the community that filters into medication non-compliance among the highest risk groups.
I want to help these immigrants as someone who speaks the language, shares a similar background, and grew up in the same community.
The groups that are most at risk for LTBI reactivation are immigrants from Asian countries who have been living in the United States for five years, are over 50 years old, and have comorbidities. Often, unsuspecting immigrants with LTBI with no symptoms move to the U.S. and don’t seek treatment, “spreading the infection to others when their LTBI awakens,” says Nguyen Truax. Last year, two-thirds of all active TB cases in Orange County occurred among Asians, according to county health reports.
“I want these people to live happy, healthy lives with their families in the community,” Nguyen Truax says. “If they don’t accept treatment for latent tuberculosis and the disease becomes active, not only does it jeopardize longevity by increasing the risk of death in elderly people, it also affects their children, their family, and the whole community they love so much as the disease spreads to other vulnerable people.”
Among the highest risk tuberculosis populations of immigrants from Asian countries, the top countries of origin include the Philippines, India, and Vietnam. The latter of the list, in particular, piqued Nguyen Truax’s curiosity. “Vietnam is a small country, and there are many other Asian countries in close proximity to it. So why Vietnamese people?” she questioned.
She began to dig into the research of tuberculosis in this particular migrant population— but studies proved sparse and dated.
“I thought, ‘why hasn’t anyone looked into this particular Asian Vietnamese group?’ I want to be the researcher for this group,” she says. “I want to help these immigrants as someone who speaks the language, shares a similar background, and grew up in the same community.”
At age three, Nguyen Truax became one of roughly 700,000 “boat people,” refugees who fled Vietnam by boat following the collapse of the South Vietnamese government. She settled with her parents and six siblings in Orange County. Upon arrival, the family underwent testing and treatment for LTBI at the same county health department that Nguyen Truax has been working with for the past decade.
But her family’s completion of LTBI treatment was an exceptional one. The majority of Vietnamese immigrants do not get tested for LTBI, Nguyen Truax says. Even if immigrants do get tested, Nguyen Truax says they likely won’t accept, initiate, or complete treatment due to the stigma surrounding medications used to treat LTBI.
For instance, Vietnamese culture categorizes medicines into “cold” and “hot,” Nguyen Truax explains; herbal medications are considered "cold," while other medicines such as painkillers or antibiotics are “hot,” inflammatory, and harmful to the body. In addition, the standard regimen for treating LTBI consists of a daily dose of antibiotics for six to nine months — an extra-long time for someone to commit to taking medications they don’t trust, Nguyen Truax points out.
“These elderly immigrants are often misguided with information from Vietnam and how they grew up there,” she says. “It's not that they are stubborn. It's that they don't have the right education or avenues to access the right information.”
Now, Nguyen Truax works with both Orange County TB services and community clinics in the region to raise awareness in the Vietnamese community about TB and LTBI. She has created a video starring Vietnamese actors speaking Vietnamese to directly address culture-specific myths about LTBI and medications. She designed the script to convince Vietnamese viewers who are skeptical about LTBI treatment to accept and engage in the treatment process. The video myth-busts commonly held, misguided beliefs about medications from Vietnamese culture, offers facts about health consequences, and stresses the importance of accepting treatment.
“There were no tuberculosis-focused educational videos specific to Vietnamese people, or even Asians,” Nguyen Truax says. “I wanted Vietnamese immigrants to know that we as healthcare providers understand how they feel.”
Beyond directly addressing patients’ concerns, Nguyen Truax meets with healthcare providers in community clinics that serve mainly Vietnamese immigrants to address biases and streamline up-to-date testing and treatment methods. She has recently worked with the Vietnamese Physician Association of Southern California for community outreach. The organization invited her team to attend their annual health fair to provide TB education and perform LTBI screening.
I’m going to be persistent. I’m not going to give up. And that’s who we are as nurses.”
Nguyen Truax also helped arranged for a county physician to provide a short segment of TB education during primetime news at a local Vietnamese news station in Orange County, California. She has connected with county nurses to outline patients’ decision-making processes regarding LTBI treatment and tactics to meet patients at each point of hesitation — such as discussing the safety of the medications and addressing potential side effects. Nguyen Truax says health providers can be proactive about addressing patients’ concerns if they know the common roadblocks to completing treatment.
“As a nurse, I want to continue the ministry of healing,” she says. “As nurses, we don’t want to see people sick, we want to prevent illnesses. “So I’m going to be persistent. I’m not going to give up. And that’s who we are as nurses.”
These principles guide Nguyen Truax’s teachings to current healthcare providers in the community and the next generation of nurses she mentors at Loma Linda University School of Nursing. Nguyen Truax’s own journey at Loma Linda University started in the 1990s with her volunteer position to snuggle babies whose parents couldn’t be present at the hospital’s pediatric floors. During her time as a “snuggler,” Nguyen Truax says she interacted with wise, compassionate LLU nurses who inspired her to apply to the School of Nursing, where she graduated with a bachelor’s degree in 1999 and a master’s degree in 2005.
Post-graduation, Nguyen Truax cared for many immigrant children as a pediatric school nurse in Rialto Unified School District and grew familiar with the health disparities and conditions affecting immigrants. She obtained her PhD from the University of California, Los Angeles, in 2016 and chose to focus on TB testing and treatment in immigrants; it was then that Nguyen Truax endeavored to unveil the reasons behind medication non-compliance. To understand these factors, Nguyen Truax needed to shift her LTBI research focus from the beloved pediatric population to the decision-making process related to LTBI treatment in the adult immigrant population.
2020 signaled the lowest number of reported cases of TB in the past 35 years. County health reports link the TB trends to pandemic safety measures, leading to decreases in TB detection, transmission, and immigration or travel. Though the lowering numbers mark a milestone to celebrate, Nguyen Truax says she is bracing to battle a new surge in TB cases as measures relax.
Nguyen Truax says she plans to continue traveling to community clinics to meet with providers and improve LTBI testing and treatment approaches. She says she is also eager to pilot the Vietnamese video in clinics to test whether it is effective in opening patients’ minds to the prospect of accepting and completing LTBI treatment.
“I don’t want to see my people, these generations of Vietnamese people, get infected and then end up in the ICU when there is a way to treat LTBI and prevent TB infection,” she says. “It just takes some education and some convincing for them to understand the medications are there to treat those bacteria. I am just barely getting started.”
Invocation of safe harbor protections [Board Rule 217.20(d)]
How did nurses help to win the war? ›
At the time the nurse is requested to engage in the activity, prior to engaging in the conduct or assignment, he/she must notify the supervisor making the assignment that the nurse is invoking safe harbor.
American nurses served on shock, gas, orthopedic and surgical specialty teams where they could be moved to the front lines in groups of five or six. These teams could help stabilize soldiers who otherwise would have to endure long evacuation processes to reach this type of care.
Why does the bon require nurses to disclose? ›
Why does the BON require nurses to disclose that they have been diagnosed with, treated for, or hospitalized with certain mental illnesses? A. Nurses diagnosed with these disorders are required to not practice in psychiatric settings due to their mental health issues.
What is a nurse who commits an error that is a minor incident answer? ›
A nurse who commits an error that is a minor incident A. must be reported immediately to the Incident-Based Peer Review Committee or to the BON if there is no peer review at the nurse's place of employment.
What is the 217.11 standard of nursing practice? ›
Rule 217.11, Standards of Nursing Practice, requires that when assignments are made, both the charge nurse and the staff nurse take into consideration client safety, as well as the educational preparation, knowledge, skills, and physical and emotional abilities of the individual licensed nurse to whom a given ...
What is an example of a safe harbor in nursing? ›
Examples of when invocation of safe harbor may be appropriate include situations concerning clinical assignments related to staffing and/or acuity of patients where the nurse believes patient harm may result [Board Rule 217.11(1)(B) & (1)(T)] or situations when a nurse is requested to engage in unprofessional or ...
Did war nurses get paid? ›
Military nurses, who were typically nursing school graduates, were not afforded the wages or benefits of enlisted soldiers and yeomen (F), despite often believing that enlistment was what they were signing up for, according to Heidelbaugh.
What are nurses in the war called? ›
Most professional militaries employ specialised military nurses or nursing sisters. They are often organised as a distinct nursing corps. Florence Nightingale formed the first nucleus of a recognised Nursing Service for the British Army during the Crimean War in 1854.
How many female nurses died in ww2? ›
More than 59,000 American nurses served in the Army Nurse Corps and 201 died during World War II.
What is the most common reason nurses are disciplined by state boards of nursing? ›
Some of the most common reasons why the state Board of Nursing disciplines a nurse include: Alcohol or substance abuse. Failing to monitor a patient adequately. Lapses in moral character.
As a staff nurse, you do not have the authority to admit a patient and provide a diagnosis unless after all of the requirements of your policy are met, you make a nursing diagnosis.
What happens if a nurse does not follow the code of ethics? ›
Breaches in nursing ethics, depending on the incident, can have significant ramifications for nurses. They may face discipline from their state board of nursing, or from their employer. They can also face litigation.
What are 2 types of disruptive behavior from nurses? ›
Forms of disruptive behavior in health care
What are two 2 types of behavior from a staff nurse can be considered disruptive? ›
Humiliation in front of team members, patients, visitors and other hospital staff. policies and procedures. Refusal to complete tasks or carry out duties.
Disruptive behaviors among nurses can include refusing to work with a particular nurse, ignoring a call to help with a patient that requires multiple nurses, and ostracizing a nurse without explanation, as examples.
Who is responsible if a nurse makes an error? ›
When a nurse has made a mistake or has been negligent in the caring of a patient, the employer of the nurse will usually be held accountable. Generally, this is the hospital or other type of medical facility that a nurse works for.
What is standard 3 in RN standards of practice? ›
Standard 3: Criteria
What are the three standards of nursing practice? ›
Accepts accountability for decisions, actions, behaviours and responsibilities inherent in their role, and for the actions of others to whom they have delegated responsibilities.
As defined by the American Nurses' Association (ANA), standards of nursing practice consist of three components: Professional standards of care define diagnostic, intervention, and evaluation competencies. Professional performance standards identify role functions in direct care, consultation, and quality assurance.
What rule 216 related to continuing competency requires nurses to complete? ›
For each licensure renewal, Board Rule 216.3 requires every nurse to: complete 20 contact hours of continuing nursing education (CNE) in the nurse's area of practice within the licensing period OR.
Can you refuse an assignment as a nurse? ›
The ANA upholds that “registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
What is 3 safe harbor? ›
The three safe harbor contribution formulas
Basic match: Company matches 100% on the first 3% of deferred compensation, plus a 50% match on the next 2% of deferred compensation. Enhanced match: Company match that's at least as generous as the basic match at each tier of the match formula.
Under the Safe Harbor for Nurses act, a nurse is protected from adverse action by a facility when the nurse makes a good faith request to be allowed to reject an assignment.
What was the highest paid nurse? ›
What is the highest-paid nurse? Certified Registered Nurse Anesthetists! Earning $195,610 annually, CRNAs earn significantly more than any other type of nurse or nursing specialty.
What is the highest paid military nurse? ›
An Overview of a Military Nurse Salary
What rank does a nurse have in the army? ›
Most military nurse salary data falls between $58,000 and $100,000 per year, with the bulk of military nurses making around $70,000 annually.
A newly enlisted nurse with no previous military service would start at the rank O-1, or second lieutenant. With experience and years of service, the Army nurse could rise through the ranks to O-10, the highest rank. There is a special pay grade rank for nurses who were previously enlisted in military service.
What is the highest ranking nurse called? ›
Chief Nursing Officer (CNO)
Are war nurses considered veterans? ›
Chief nursing officers are nursing administrators who work within the leadership team of a healthcare organization. They are considered the highest level of nursing leadership.
But veterans of the U.S. Cadet Nurse Corps have never been recognized for their service to the country. The cadet nurses remain the only uniformed corps members from World War II not to be recognized as veterans.
What were male nurses called? ›
During World War I male nurses served on the frontline, helping the injured. But, though holding the same training and diplomas as their female equivalents, they were known as “orderlies” and were paid about half of what women were.
Who was the famous nurse who killed patients? ›
Charles Edmund Cullen (born February 22, 1960) is an American serial killer. Cullen, a nurse, murdered dozens – possibly hundreds – of patients during a 16-year career spanning several New Jersey medical centers, until being arrested in 2003.
Who was the most famous nurse in ww2? ›
Ruby Bradley. Army Col. Ruby Bradley entered the U.S. Army Nurse Corps (ANC) as a surgical nurse – she would retire as one of the most decorated women in U.S. military history.
What were WWII nurses called? ›
These nurses, known as flight nurses, were specially trained to help transport stable patients from frontline makeshift hospitals in Europe to regular medical facilities in England for further medical treatment, using the same transport planes that the Airborne used to "drop" paratroopers.
Here are a few of the most common nursing mistakes: Forgetting to turn on the bed alarm for a patient at high risk for falls. Incorrectly programming an IV pump resulting in underdosing or overdosing. Failing to report a change in a patient's condition.
What state has the strictest nursing laws? ›
Florida's nurse practitioner supervision laws are among some of the strictest in the nation. State law requires that nurse practitioners work under the supervision of a physician when it comes to practice and prescribing.
What is the biggest ethical issue in nursing? ›
Perhaps one of the most common examples of ethical dilemmas in nursing occurs when nurses must determine if it is appropriate to discuss a patient's medical information with a parent or guardian. For years, parents and guardians were allowed access to medical records for any patient under the age of eighteen.
Can nurses text their patients? ›
HIPAA does not prohibit the use of text messaging in healthcare. It is perfectly acceptable for doctors, nurses, and other healthcare professionals to communicate with each other – and even patients – via text message.
Do doctors tell nurses what to do? ›
It is the physician who makes the key decisions about patient medical diagnosis and treatment and issues orders that nurses are expected to follow. Physicians, who in hospitals are not the direct supervisors of nurses, nevertheless wind up often telling nurses what to do.
Is it illegal to withhold a diagnosis from a patient? ›
Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient's knowledge or consent is ethically unacceptable.
What is unethical behavior for a nurse? ›
Examples include breaching nurse-patient confidentiality, theft of patient money, belongings or identity, and crossing nurse-patient professional boundaries.
What is ethical violation in nursing? ›
Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it.
What is an unethical behavior? ›
Unethical behavior is when a person, a professional, or an industry does anything that is considered unacceptable because they are against the social norms. Individuals, businesses, professions, and politicians may all engage in unethical behavior.
What is an example of nurse nurse conflict? ›
Value conflict occurs when two nurses have different personal values. For example, you overhear another nurse talking about their personal beliefs, which contradict your own. Although different beliefs and values can create tension, the goal of conflict resolution should be to reach a mutual, positive change.
Toxic Nursing Environment
What are the 7 caring behaviors encounters of nurses? ›
Typically, the employees have overwhelming stress and individuals seem to be rewarded for unethical, nasty, and harmful actions and attitudes. Employees working in these types of nursing environments can experience a sense of helplessness and feel their ideas may not be heard.
The top ten caring behaviors, derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by name (Taber's 1993).
How would you handle a conflict between two nurses on your staff? ›
What is the most common type of aggression nurses experience? ›
How Nurse Leaders Can Deal with Conflict
- Be Proactive in Intervening. ...
- Stay Calm. ...
- Communicate to All Parties. ...
- Suggest Solutions. ...
- Clear Communication Across All Staff. ...
- Encourage All to Be Respectful. ...
- Training and Education. ...
- Identify Potential Conflicts Before They Happen.
Within nursing teams, the most common type of violence is verbal abuse, which is considered less severe than physical aggression.
Who holds nurses accountable? ›
Nurses have a formal obligation of accountability placed on them by their Nurse Regulatory Board and must be willing to accept professional responsibility for the care they provide.
What are the most common acts of negligence by nurses? ›
What are nurses not responsible for? ›
- Failing to record important information on a patient's chart.
- Not assessing a patient's condition (such as blood pressure or blood sugar levels) on time.
- Errors when administering medication.
- Failing to report test results to a doctor or other healthcare professional.
Registered Nurse Job Duties and Responsibilities
What specific portion of Board Rule 217.12 unprofessional conduct? ›
Assessing, observing, and speaking to patients. Recording details and symptoms of patient medical history and current health. Preparing patients for exams and treatment. Administering medications and treatments, then monitoring patients for side effects and reactions.
Unprofessional Conduct Rule 217.12 identifies behaviors in practice that are likely to deceive, defraud or injure clients. Actual injury to a client need not be established.
What is the rule for safe harbor? ›
Estimated tax payment safe harbor details
What is the safe harbor rule quizlet? ›
The IRS will not charge you an underpayment penalty if: You pay at least 90% of the tax you owe for the current year, or 100% of the tax you owed for the previous tax year, or. You owe less than $1,000 in tax after subtracting withholdings and credits.
What is the "safe harbor rule"? If a foreign tax rate is 90% or more of the US corporate tax rate, no part of a controlled foreign corporation's income is considered Subpart F income.
General Continuing Competency Information. Board Rule 216 is the Board's continuing competency rule and contains complete information on all of the requirements. All nurses who wish to maintain an active Texas license are required to demonstrate continuing competency for relicensure.
What is unprofessional conduct according to the Nurse Practice Act? ›
In general, examples of unprofessional conduct include, but are not limited to, physical abuse of a patient, inadequate record keeping, not recognizing or acting upon common symptoms, prescribing drugs in excessive amounts or without legitimate reason, personal impairment (mental or physical) that hinders safely ...
What would be considered unprofessional conduct? ›
“Unprofessional conduct” refers to acts or behavior that may be harmful to the health, safety, and welfare of the public. Unprofessional actions could be conduct that negatively affects a professional's ability to practice, or it could be conduct that outright violates one or more provisions of the regulatory act.
What are examples of unprofessional behavior in nursing? ›
Behaviors such as rude, loud, or offensive comments; sexual harassment or other inappropriate physical contact; and intimidation of staff, patients, and family members are commonly recognized as detrimental to patient care.
What is safe harbor Rule 37? ›
eDiscovery Federal Rule 37: Failure to Preserve Electronically Stored Information. (C) dismiss the action or enter a default judgment. This rule sets forth the circumstances under which discovery sanctions for failure to produce electronically stored information (ESI) may be imposed.
What is an example of a safe harbor statement? ›
An example of a safe harbor disclaimer that is generally given during earnings release of a company is this statement by Oracle: "Our discussion may include predictions, estimates or other information that might be considered forward-looking.
What is the 2500 safe harbor rule? ›
The safe harbor threshold limits the amount of tangible property you can deduct instead of capitalizing. You can deduct depreciable items with invoice amounts up to $2,500.
What is de minimis safe harbor? ›
The de minimis safe harbor is simply an administrative convenience that generally allows you to elect to deduct small-dollar expenditures for the acquisition or production of property that otherwise must be capitalized under the general rules.
What is safe harbor exclusion? ›
A safe harbor 401(k) plan excludes overtime and bonuses from the definition of compensation. The definition will satisfy IRC Section 414(s) if it (i) does not by design favor highly compensated employees, (ii) is reasonable within the meaning of Reg.
What is a safe harbor in layman's terms? ›
A safe harbor is a legal provision in a statute or regulation that provides protection from a legal liability or other penalty when certain conditions are met.
WHEN SHOULD ONE INVOKE SHNPR? Safe harbor must be invoked prior to engaging in the conduct or assignment for which nursing peer review is requested. When the nurse is requested or assigned to engage in conduct that the nurse believes is in violation of his/her duty to a patient.
What is continuing competence? ›
Continuing competence is career-long enhancement of knowledge, skill, and judgment required to practice safely and ethically. The Continuing Competence Program (CCP) is a regulatory program and quality assurance mechanism.
What is the rule 216.3 in Texas Nursing Board? ›
A nurse, including an APRN, who provides direct patient care must complete a human trafficking prevention course approved by the Health and Human Services Commission.