Health Promotion Exam Two

Blaming and Stigmatizing the Victim

1. "Blaming the victim" can lead to discrimination of the individual. 2. Implying that the illness or disability has resulted from the failure of the individual to adapt a responsible lifestyle. 3. Individual may have limited control over their health behaviors. 4. School based programs for weight loss have been found to stigmatize children.

Health Perception-Health Management Pattern

1. A family's perceived health, management, and preventative practices 2. Selected assessment parameters Concerns about children Development issues Relationship of health/safety practices to children's health Health-related behaviors Environmental safety Health beliefs/practices, lifestyle practices, chronic diseases, unattended health problems, risk factors Use of health care, experiences in health care system

Ethical issue

1. A situation in which you must judge right from wrong 2. Deciding whether to do something or to do nothing. 3. A dilemma-making a difficult challenge

Cognitive-Perceptual Pattern (I)

1. Ability to understand and follow directions, retain information, make decisions, solve problems, use language appropriately 2. Perceptual and sensory patterns, including pain 3. Cognitive-perceptual functioning Affects capacity for independent functioning Must be assessed within context of environment Cognitive deficits require increased environmental controls 4. Developmental stage impacts pattern Undeveloped in children; not fully matured with adolescents May decline with aging

Couple Family

1. Adapting to expectation of a partner 2. Weave individual characteristics into "couple" 3. Decisions on employment, money, social network, household tasks 4. Need to negotiate conflict management 5. Interventions aimed at integrating sound health practices and habits into couple's lifestyle Rest, exercise, diet, smoking cessation, activities directed toward self-actualization

Childbearing Family

1. Adjust to new roles in function and responsibility 2. Explore ways to meet needs 3. Influenced by family of origin 4. Single-parent family becoming more common 5. Interventions to support child-rearing 6. Risks: insufficient resources, abuse/neglect, immature parents, beliefs re punishment and obedience

Adolescents Nutrition Requirements

1. Adolescents and their parents may misinterpret obesity prevention messages and begin eliminating foods they consider to be "bad" or "unhealthy." 2. Adolescent girls require approximately 2200 kcal/day, and moderately active adolescent boys require 2800 kcal/day for normal growth and development. 3. Adolescents who are athletes require even higher caloric intakes. 33 Strict adherence to a 2000-kcal/day diet may lead to an energy deficit and weight loss for many growing teenagers.

Mindfulness

1. An attitude of openness, acceptance, and curiosity to whatever arises. 2. Self-regulation of attention can effectively counter the effects of stressors.

Health Perception-Health Management Pattern (I)

1. An individual's perceived health and well-being Affect lifestyle and ability to function Provides clues to improve or maintain optimal quality of life 2. Assessment: Current health/safety practices, previous patterns adherence, use of health care system, health care access, health perceptions/beliefs 3. Past health management is a predictor Identify/address reason for failures of past interventions (e.g., belief systems, finances, literacy) 4. Five stages of change (see next slide)

Why doesn't everyone react to stressors in the same way?

1. An individuals' physical and psychological reactions to stress depends in part on how we personally interpret the stress, a process known as cognitive appraisal. A potential stressor has a stronger negative impact on people who perceive it as a threat than on people who see it as a challenge. 2. Cognitive appraisal has been shown to play an important role in determining the impact of the stress response.

Activity-Exercise Assessment (I)

1. Assess pattern of activities requiring energy and adequacy of pattern 2. Exercise patterns Type, frequency, duration, intensity Modes of transportation Barriers to exercise Response/subjective complaints Objective measures to assess function 3. Developmental norms Assess infant/toddler development

Coping-Stress Tolerance Pattern:Assessment and Interventions (I)

1. Assessment Determine stress tolerance and past coping behaviors Coping parameters Coping style, coping strategies Consider variety, flexibility, health-promotion value Coping effectiveness 2. Stress interventions Replace unhealthy coping strategies (smoking) Employ stress-management techniques Time management, cognitive rehearsal, relaxation

Nursing focus on wellness

1. Assisting to maintain/obtain optimal health 2. Accomplished through nursing process Assessment, diagnosis, outcome criteria, process criteria, implementation, evaluation 3. Health promotion: assessment of strengths, not only deficits 4. North American Nursing Diagnosis Association (NANDA); nursing diagnoses Includes life processes, health promotion

Ethical Issues Related to Health Promotion Strategies

1. Autonomy-based Concerns Manipulation and Deception Communication strategies 2. Blaming the Victim 3. Paternalism 4. Denormalization of behaviors and stigmatization of individuals

Families With Toddlers and Preschoolers

1. Balance home safety with child exploration 2. Parents to teach and model health behaviors Diet, hygiene, food, sleep, dental 3. Development influenced by religion, ethnicity, education, discipline techniques 4. Parents risk fatigue from parenting demands Need time as a couple, respite Economic restraints may be a limitation

Roles-Relationships Pattern (F)

1. Characteristics of family roles/relationships Structural (such as age, sex, education, role) Functional (process of how family tasks achieved) 2. Contemporary family structures Varied forms Influenced by societal changes, cultural practices Family is the most enduring link to health for children Decrease in "traditional" two-parent family; increased poverty, divorce patterns Places children at health risk (e.g., substance abuse, maladjustment) Family resilience frameworks to strengthen at-risk families 3. Family organization Influences performance health promotion and disease prevention Intervention strategies to accommodate changing family structure 4. Key health-promotion issues for families Violence (e.g., child abuse, elder abuse, spouse abuse) 5. Selected assessment parameters Describe pattern of relationships/roles Acceptable roles, flexibility, distribution of tasks Family social support networks—association with health, development Role models Care for family members Appropriateness of behaviors for family stage Further assessment for high-risk behaviors

Psychological Effects of Stress

1. Cognitive Changes: Stress responses may include reduced ability to concentrate, think clearly, or remember accurately. 2. Ruminative thinking is the recurring intrusion of thoughts about stressful events. 3. Catastrophic thinking, dwelling on and overemphasizing possible negative consequences of events 4. Impaired decision making skills

Health Promotion and the Nursing Process (I)

1. Collection and analysis of data 2. Problem identification/nursing diagnosis (NANDA) Problem, etiology, defining characteristics, contributing etiological factors, diagnostic variables 3. Planning the care Project outcomes, prescribe interventions 4. Implementing the plan 5. Evaluating effectiveness of plan

The Nursing Process and the Family

1. Comprehensive family assessment Includes family as group; interaction among members Home is natural environment for health promotion Home visits provide a wealth of information Families collaborate in all phases of nursing process Recognizing patterns Assessing potential for active, positive change 2. Nurse's roles Role model; collaborate with family; provide information, decision-making, problem-solving, liaison for services

Autonomy: Individual vs Society

1. Conflict of individual vs society 2. Examples of conflict: individual vs society Direct observed therapy for TB Bioterrorism, spread of HIV/AIDS, drug-resistant tuberculosis, and advances in genetic knowledge Confidentiality vs mandatory disease reporting

Analysis and Nursing Diagnosis: Developmental Stages

1. Couple family 2. Childbearing family 3. Family with toddlers/preschool children 4. Family with school-age children 5. Family with adolescents 6. Family with young adults 7. Family with middle-aged adults 8. Family with older adults

Coping-Stress Tolerance Pattern (I)

1. Depicts general coping and ability to effectively manage stress 2. Stress—necessary part of life; promotes growth Problem: poor tolerance; disruption of daily activities Not inherent, rather individual's perception of events Perception related to development, amount of stress, current levels of stress, social support 3. Coping: learned behavior Individual behavioral response to stress Problem-solving ability Use of defense mechanisms

Formulating Family Nursing Diagnoses

1. Derived from assessed validated data 2. Concise summary statement of problem or potential problem 3. Provide direction for outcomes and interventions 4. Planning with the family Must be formulated with cultural competence Negotiated with family until agreement occurs 5. Augment functions where members require assistance 6. Intervention types Increase knowledge/skills Increase strengths Decrease exposure, decrease susceptibility 7. Evaluation Performed with the family Outcomes evaluated via measures of family functioning

Sexuality-Reproductive Pattern (F)

1. Describes sexuality fulfillment and behavioral patterns of reproduction 2. Transmission of information/attitudes about sexuality to children 3. Selected assessment parameters Communication of needs Demonstration of love, commitment, care Addressing of family planning Decisions about choice of family planning, contraceptives Pregnancy histories Assessment of sexuality practices

Alternative/Complementary Stress-Management Interventions

1. Developed outside of Western medicine 2. Acupuncture: ancient Chinese technique Fine needles placed at specific meridian points on body Used to reduce pain; prevent/manage disorders 3. Hypnosis: from Greek word "sleep" Narrows consciousness; elicits relaxation, inertia, passivity; useful for smoking cessation, anxiety, pain

Cognitive-Behavioral Restructuring

1. Developing an awareness of negative thoughts and then learning ways to restructure and neutralize these thoughts to be less intrusive. 2. Thought stopping: Redirecting so thoughts are more positive.

Veracity

1. Devotion to the truth—trust is salient issue 2. Contemporary ethics favor candor and honesty 3. Allows for autonomous choices 4. Has cross-cultural implications

Families With School-Aged Children

1. Dichotomy: pursuing self-interests vs finding fulfillment in producing next generation 2. Goal: reorganization to prepare for expanding child's world 3. School achievement is venue for socialization 4. Interventions: educate re risks, teach benefits from healthy behaviors 5. Developmental task (for both parents and children) is "letting go"

(2) Bridging the gap between clinician and patient

1. Discuss patient's desires, understanding & agreement w/ plan 2. Follow-up with patients: telephone, text, pre-visit, post-visit, EHR 3. Ask patient about needs & obstacles 4. Serve as patient liaison

Nonmaleficence

1. Do no harm 2. Nurses must refrain from providing ineffective treatments or acting with malice toward patients 3. Ethical issue is whether the benefits of the treatment outweigh the burdens

Family Theories and Frameworks: Developmental Perspective

1. Duvall and Miller identified stages of family life cycle—critical family developmental tasks 2. Criticized for lack of diversity in family forms Middle class homogeneity 3. Overall family pattern—each family performs tasks in a unique manner 4. Progression through developmental stages is linear Regression may occur Tasks may appear in more than one state 5. Failure to accomplish a developmental task leads to negative consequences

Families With Middle-Aged Adults

1. Empty nest syndrome is common 2. Marriage status important: secure and stable vs faltering marriage 3. Challenges: grandparent role, needs of middle-aged children, care of aging parents 4. Health tasks: awareness of vulnerability to health problems 5. High risks: heart disease, CVA, cancer 6. Lifestyle choices important to reduce risks

(1) Providing self-management support

1. Encourage participation in care 2. Provide information 3. Teach disease-specific skills 4. Promote healthy behaviors 5. Impart problem-solving skills A meta-analysis of 53 randomized controlled trials concluded that self-management support improves blood pressure and glucose control

Health Patterns

1. Expression Pattern/sequencing of behaviors Role of environment Developmental influences 2. Assessment Status as functional (strength/wellness) Dysfunctional actual (nursing diagnosis) Potentially dysfunctional (risk) 3. Nurses determine cause and plan remedial actions 4. Health promotion is overarching goal 5. Problem in one area clue to dysfunction in other patterns

Family Theories and Frameworks: Structural Perspective

1. Families consist of both structural and functional components 2. Family structure refers to family composition, including roles and relationships 3. Family function consists of processes within systems from exchange of energy and info Information and energy exchange occurs between families and their environment

Coping-Stress Tolerance Pattern (F)

1. Family adaptation to pressures Ability to cope determines family success Relationships: support coping vs increased stress Life events: provoke stress, mobilize family coping Selected assessment parameters How family copes with stress Family strengths History of family stresses Family resources Dysfunctional adaptive strategies

Genogram

1. Family diagram 2. Highlights membership and structure 3. Three generations 4. Identifies family health patterns

Family Theories and Frameworks: Risk-Factor Perspective

1. Family risk-factor categories Lifestyle (overeating, drug dependency, smoking) Biological (genetics) Environmental (stress, pollution) Social, psychological, cultural, spiritual (crowding, isolation) Health care system (overuse, lack of access) 2. Epidemiology uses mortality and morbidity as indirect evidence of health 3. Family lifestyle stages associated with specific risk factors 4. Risk estimate calculates differences between group with risk and group without risk 5. Habits learned in family settings help to develop lifestyle behaviors 6. Healthy People 2020: states family objectives

Sleep-Rest Pattern (F)

1. Family sleeping patterns 2. Selected assessment parameters Usual sleeping/rising habits Suitability according to age/health of each member Who decides bedtime Evidence of sleep disruption Naps; resting/relaxing

Values-Beliefs Pattern (F)

1. Family values, beliefs, goals, life meaning and spirituality—all affect behavior 2. Selected assessment parameters Identification of family values/beliefs Flexibility of rules Family view of spirituality; role of religion Cultural or ethnic practices; effect on illness/health Family traditions/practices Value conflicts within family Effect of values on health

Activity-Exercise Pattern (F)

1. Family's characteristics of activity level Family creates setting for physical activity; attitudes/beliefs about exercise 2. Selected assessment parameters Types of daily activities Family member involvement Amount of television/video game time Frequency, type of exercise for children Family fun activities

Self-Perception-Self-Concept Pattern (F)

1. Family's self-worth and feeling states 2. Manifest through shared aspirations, values, expectations, fears, successes 3. Selected assessment parameters Similarity/differences with other families Assets of family members Changes desired in family Feelings for family members Family handling of stress General tone of feeling in family

Nutritional-Metabolic Pattern (F)

1. Family's typical food and fluid consumption Growth/development, eating patterns, identification of risk factors for eating disorders, obesity, pregnancy, diabetes 2. Selected assessment parameters Nutrient dietary patterns (food diary) Shared meals Types of food Preparation, storage Family attitude toward food

Families With Young Adults

1. Goal: launch children 2. Parents return to marital dyad 3. Redefine relationships—multigenerational 4. Aging parents and adult children may present financial and emotional challenges 5. Focus of health promoting activities Coping with social and occupational pressures Promoting healthy aging Reassessing life goals

Families With Adolescents

1. Goal: loosen family ties 2. Promote identity formation, autonomy, responsibility 3. High-risk behaviors very common 4. Peer pressure very significant 5. Commonly challenge family values 5. Time of identity crisis and adjustment Include in decision-making Experience positive and negative consequences

Family Assessment: Functional Health Patterns

1. Gordon (2016): 11 functional health patterns 2. Systems approach with emphasis on developmental stages and risk factors 3. Evaluation of dysfunctional patterns in families 4. Risk factors predict potential dysfunction 5. Nursing process Family assessment: history, interview, roles, risks Nursing diagnoses Associated/etiological factors and influencing factors Interventions

Functional Health Patterns: Assessment of the Individual

1. Gordon's (2016) framework for NANDA Concept of functional patterns and pattern interaction Depicts individual's lifestyle Holism and totality of person's interaction with environment from foundation for health patterns Individual viewed as whole being using interrelated behavioral areas 2. 11 functional areas' health patterns from framework for nursing diagnoses 3. Health promotion; focus on nursing knowledge 4. Provides structure—holism is overarching goal 5. Characteristics/focus of patterns Examine patterns over time (e.g., blood pressure) Environmental influences on pattern Age-developmental issues: fulfill developmental tasks Functional: individual performance of tasks (ADL) Cultural: influences health patterns

Health Coaching

1. Health coaching is defined as health-related education, behavior change and support by a healthcare professional 2. Collaborative/Participatory Approach: Discuss patient's desires, understanding and development of plan to change behavior 3. Ask patients what changes they are willing to make rather than a "telling" patients what to do 4. Address health literacy 5. Ensure cultural and language issues are addressed

Typology of 11 Functional Health Patterns (Gordon, 2016)

1. Health perception health management 2. Nutritional-metabolic 3. Elimination 4. Activity-exercise 5. Sleep-rest 6. Cognitive-perceptual 7. Self-perception-self-concept 8. Roles-relationships 9. Sexual-reproductive 10. Coping-stress tolerance 11. Values-beliefs

Stress-Management Interventions

1. Healthy diet Positive influence on health, physical performance, state of mind; balance in diet improves functioning 2. Physical activity Comprehensive health benefits; enhances well-being while decreasing stress

Environmental Factors

1. Home, neighborhood, community 2. Selected assessment parameters Home Type of dwelling, condition Adequacy of rooms, lighting, water, sanitation, sleeping arrangements Presence of infestation Neighborhood Crime Industry, pollution Public transportation access Community Available resources (schools, church, shopping, recreation) Available health facilities

Phase II: Resistance

1. If the alert phase continues for very long periods or if new stressors accumulate 2. Attempts to reestablish homeostasis 3. Cortisol is produced

Phase I: Alarm Reaction

1. Immediate reaction to a stressor and consists of the fight-or-flight syndrome (increased heart rate, rapid breathing, sweating) to mobilize the body for rapid action. 2. Hypothalamus signals sympathetic nervous system to release catecholamines: epinephrine and norepinephrine 3. Activation of the hypothalamic-pituitary-adrenocortical (HPA) system. ACTH stimulates the release corticosteroids 4. This is the positive phase of stress, when the human being automatically prepares him or herself for action.

Paternalism: NYC Sugary Drinks Cap Rule

1. In 2012, the NYC Board of Health told all "food service establishments" that they had to limit the size of containers used to sell sugary drinks (> 16 ounces.) 2. Purpose: increase public awareness of the health challenges of sugary drinks and their contribution to the obesity epidemic. 3. The soda rule became known as a " Bridge too Far." 4. Opponents argued that it was paternalistic and an imposition on citizens. 5. The rule was ultimately struck down by the New York Court of Appeals

Elimination Pattern (I)

1. Includes bowel, bladder, and skin: regularity and efficiency in excretion of waste Normal pattern varies between individuals Perceptions impact normal vs dysfunctional Affects interpersonal relationships 2. Assessment includes changes, pain, skin integrity, continence, constipation, UTI, wounds, perceptions, self-treatment 3. Closely related to nutrition pattern assessment 4. Stage of life and development are relevant

Activity-Exercise Pattern (I)

1. Individual's activity level, exercise, leisure Movement capability, activity tolerance, self-care activities, limitations, use of assistive devices, satisfaction with level of function, perceived problems 2. High value on mobility and independence 3. Activity level: significant impact on health Limitations affect self-care abilities Sedentary lifestyle linked to obesity/overweight Affected by environment 4. Assessment: select parameters Circulatory, respiratory, neuromuscular status, gait, posture, muscle tone, ROM, subjective complaints, exercise, fatigue

Sexuality-Reproductive Pattern (I)

1. Individual's sexual self-concept, sexual functioning, methods of intimacy, reproduction 2. Related to self-perception and relationship patterns 3. Body image, self-concept, role, sex identity are linked to sexual identity 4. Individual development influences reproductive capacity 5. Sexual expression influences Environment Norms within society may affect expression 6. Assessment objectives Consider continuum if sexual identity expression Assess knowledge of sexual functioning and health practices (pap, self-testicular examinations, etc.) 7. Parameters Sexual self-concept Sexual functioning Reproductive patterns Level of satisfaction 8. Firm, trusting relationship needed for discussion 9. Sexual education important for sexual understanding and increased satisfaction

Nutritional-Metabolic Pattern (I)

1. Individual's typical food and fluid consumption in relation to metabolic needs and perceived problems 2. Indicators of nutritional adequacy or problems Nutrient intake (24-hour recall) Frequent eating-out issues, fast-food issues Finances and meal preparation, problems with eating Metabolic demand—variable Differences between individuals Level of activity, stress Objective indicators: skin, mucous membranes, dentition, hair, overweight, underweight, dentition Other issues: food security, education , food prep

Information: Nurse-parent Communication

1. Information-quality and quantity of health care information 2. Interpersonal sensitivity-attention to and interest in individual's concerns and outcomes 3. Partnership building-extent to which health care provider invites individuals to state their concerns, perspectives and suggestions.

Family

1. Interacting individuals related by blood, marriage, cohabitation, or adoption 2. Interdependently perform functions via fulfilling expected roles 3. Enduring influence on health: individual and family Patterning diet, activity, hygiene, coping Providing resources Fostering resilience Individualization within family cohesiveness 4. Influence children's lifestyle choices 5. Healthy People 2020: families as means for health promotion

Assessing Cognitive-Perceptual Pattern (I)

1. Language capabilities, cognitive skills 2. Sensory deficits (hearing/vision, sensation) 3. Use assistive devices 4. Pain scales 5. Education, memory changes, learning style 6. Appropriate appearance, dress, hygiene 7. Behavior, attention span 8. Assessment tools (e.g., Folstein Mini-Mental State Examination) 9. Cognitive data/sensory abilities will guide care—individualized teaching plan

Cognitive-Perceptual Pattern (F)

1. Language, cognitive skills, perception that influence family activities 2. Decision-making power within family to solve problems is important 3. Selected assessment parameters Family access/interpretation of information about health How decisions are made about health in family Knowledge/choices about lifestyle Types of care used, including alternative or traditional practices

Autonomy: Manipulation and Deception

1. Manipulation influences people by altering their understanding of a situation 2. Power dynamics 3. Nurse-patient interaction: "Sharing the power" 4. Empowerment 5. Decision-sharing

Family Development Stages: Duvall and Miller

1. Married couples—no children 2. Childbearing families—birth to 30 months 3. Families with preschool children—2.5 to 6 years 4. Families with school children—6-13 years 5. Families with teenagers—13-20 years 6. Families launching young adults 7. Middle-aged parents 8. Aging family members

Moral distress

1. Moral distress occurs when the nurse knows the ethical correct action to take but is powerless to take that action 2. Can impact an individuals' physical, mental, and spiritual aspects and also their social relations

Phase III: Exhaustion

1. Most negative phase of stress 2. Endocrine activity is heightened; high circulating levels of cortisol begin to have pronounced negative effects on the circulatory, digestive, immune, and other systems. 3. Diseases of adaptation, such as HTN, heart disease, arthritis, nervous and mental diseases, diseases of compromised immune diseases.

Socio-behavioral Effects of Stress

1. Overeating 2. Excessive use of alcohol or drugs 3. Excessive smoking 4. High-fat foods 5. Social isolation

(3) Help with health system navigation

1. Particularly important for the marginalized, vulnerable populations: Who might fall into this category?

Family Theories and Frameworks: Family Systems Theory

1. Patterns of living among individuals in family system 2. Behaviors and member responses influence patterns 3. Families have unique culture, value system, history 4. Values provide means for interpreting events 5. System boundaries control information flow 6. Family is unified whole vs sum of parts 7. Changes in one part (member) affect whole family 8. Family assessment is tool to foster health promotion

Sleep-Rest Pattern (I)

1. Perception of adequacy re individual's sleep and relaxation is single most important factor 2. Deficits: stress response, decreased immune system response, unhealthy relationships 3. Assessment Subjective reports of fatigue/energy levels Data include difficulties in sleep onset, interruptions, sleep disturbances Assess sleep quality and quantity 4. Interventions: counseling, medical referral, development bedtime routine, relaxation techniques, meds not first option

Consequences of Stress

1. Physical 2. Physiological 3. Socio-behavioral 4. Spiritual

Ecomap

1. Pictorial technique to document family organizational patterns 2. Functional rather than structural approach to family assessment

Roles-Relationships Pattern (I)

1. Position(s) assumed by an individual 2. Need for relationships with others is universal 3. Assessment Individual's perception of satisfaction with relationship Describe pattern of relationships/roles Family, work, and community focus Parameters include structure, tasks, communication patterns, power, decision-making, stress, social support 4. Relationships affect whole person—may exhibit in other areas/patterns Sleep, appetite, sexuality

Transtheoretical Model Stages of Readiness to Change

1. Precontemplation—not considering change 2. Contemplation—considering change 3. Planning and preparation—planning change 4. Action—implementing change 5. Maintenance—maintaining change Stages have important consideration for planning care—interventions must be appropriate to stage of readiness

Five Roles of a Health Coach

1. Providing self-management support 2. Bridging the gap between clinician & patient 3. Helping patients navigate the system 4. Offering emotional support 5. Liaison for continuity of care

Evaluation With the Family

1. Purpose: to determine family response to planned interventions 2. Were the interventions successful? 3. Five measures of family functioning can guide determining effectiveness of plan Changes in interaction patterns Effective communication Ability to express emotions Responsiveness to needs of individual members Problem-solving ability

Elimination Pattern (F)

1. Regularity and control of family's excretory functions 2. Age-specific developmental assessment Toilet training Changes from usual pattern Elimination problems with elderly Incontinence Constipation

Autonomy

1. Respect a person's right to make their own decision even when choice is ill-advised 2. Support people in their individual choices 3. Do not force or coerce people to do thing

Families With Older Adults

1. Retirement: decreased income, adjust living standards 2. Challenges: safe/comfortable home, adjust to loss of spouse, preparing for end-of-life 3. Goals for health promotion Maintain function, limit disability Maintain quality of life 4. Diseases and dysfunction become increasingly common

Self-Perception-Self-Concept Pattern (I)

1. Sense of personal identity Goals, emotional patterns, feelings about self, self-image, self-worth 2. Developmental level is key factor Delays in self-esteem block progress toward subsequent tasks (Erickson's developmental stages) 3. Family and relationships impact pattern 4. Self-esteem affect actions and accomplishments 5. Assessment: comments, beliefs, nonverbal clues Posture, eye contact, restlessness, twitch/shift, anxiety, mumbled or rapid speech, foot shuffling, tapping

Values-Belief Pattern (I)

1. Spiritual values, beliefs, and goals 2. Perceptions of right and wrong 3. Assessment objective: determine basis for health-related decision/actions 4. Assessment techniques: summarizing, verifying, obtaining information Beliefs about self, relationships, society, purpose of life, sources of strength, expectations about health 5. Interventions must be based on value system and health beliefs to be effective 6. Individual values affect all of the patterns

General adaptation syndrome (Hans Selye)

1. Stress can be useful or harmful 2. Stress increases efficiency and productivity to a point 3. Point exists where stress has negative impact

Implementation With the Family

1. The implementation phase is dynamic Nurse and family work together New info used to change/adapt plan as needed 2. Interventions assist with functions that members cannot independently perform 3. Nurses assist families to improve capacity to act independently 4. Focus of plans is to foster health promotion

Planning With the Family

1. The planning process Order the priority for actual or potential problems Identify what can be handled by nurse/family and what must be referred to other professionals Specify actions and expected outcomes 2. The nursing plan Provides direction for implementation Framework for evaluation

Public Health Policy: Demormalization of behaviors

1. Tobacco reduction programs 2. Negative social meanings and stereotypes associated with tobacco. 3. Identifies smoking as shameful. 4. Smokers can come to be seen as weak-willed, "outcasts," "lepers," and abusers of public services. 5. The ethics of using stigma in tobacco control has become a debate

Justice

1. Treating people fairly and without bias 2. Not favoring some individuals/groups over others 3. Acting in a non discriminatory/non prejudicial way 4. Respect for peoples rights

Privacy

A persons right to remain private, to not disclose information

Eustress

Challenging and useful stress; not destructive

Distress

Chronic and excessive stress; body unable to adapt; threatens homeostasis

Benefit

Defined by person themself It is not what we think is important

Modifiable factors of stress

Individual can modify through change environment, interactions, behavior

Fidelity

Loyalty, maintaining the duty to care for all no matter who they are or what they may have done

Confidentiality

Only sharing private information on a "need to know basis"

General Adaptation Syndrome

Phase I: Alarm Reaction Phase II: Resistance Phase III: Exhaustion

Paternalism

Previously paternalism was the norm Physician knows what is best Prevailing view until late 1960s

Beneficence

Providing care that improves the patients health or outcome

Intrinsic factors of stress

Stressors created or exacerbated by individual response to stress

Extrinsic factors of stress

Stressors over which individuals do not have control

Stress

The negative emotional and physiological process that occurs as individuals try to adjust to or deal with stressors

Ethics

The study of what is right or good and incorporates a variety of concepts such as duty, virtue, and liberty