Exam 3 Study Guide

If you were taking care of a patient with anxiety, what kind of outcomes or goals would you set for the patient?

Advice exercise, help identify triggers, assist with relaxation techniques • For anxiety, some NOCs (Nursing Outcomes Classification) would be Anxiety Self-Control, Anxiety Level, Concentration, and Coping. • For death anxiety, some NOCs would be Acceptance: Health Status, Anxiety Self Control, and Comfortable Death. • For decisional conflict, some NOCs would be Decision-Making and Information Processing. • For fear, some NOCs would be Acceptance: Health Status, Fear Self-Control, and Symptom Control.

What do we ask our patient when it comes to race?

• Culture is what people in a group have in common (socially transmitted behavior patterns, arts, beliefs, values, customs, and ways of life.), but it changes over time (dynamic). • Ethnicity is similar to culture in that it refers to groups whose members share a common social and cultural heritage that is passed down from generation to generation. The are only two ethnic groups in the United States; they are "Hispanic, Latino, or Spanish" and "Not Hispanic, Latino, or Spanish." If you know a client's country of origin, it is more accurate to use it when referring to the client's ethnicity (i.e. Mexican American). • Race refers to the grouping of people based on biological similarities, such as skin color, blood type, or bone structure. Many believe that race is socially determined. As a culturally sensitive nurse, ask people what race they identify with and what name they prefer to use for it. • Socialization is the term used to describe learning to become a member of a society/group. Acculturation is the term used to describe immigrants assuming the characteristics of a new culture. Assimilation is the term used to describe when new members gradually learn and take on the values, beliefs, and behaviors of the dominant culture.

Know the difference between chronic self-esteem as a nursing diagnosis and situational self-esteem.

• Nursing Diagnosis: Chronic Low Self-Esteem - The patient expresses ongoing and longstanding overall self-dissatisfaction and negative self-appraisal (Wide differences between "ideal" and "actual" self). Etiology example: depression. • Nursing Diagnosis: Situational Low Self-Esteem - The patient develops a negative perception of self-worth (self-disapproval) in response to a specific situation (i.e. loss or change). Etiology example: Failure to adapt to change in functioning. • Nursing Diagnosis: Personal Identity Disturbance - Negative and incorrect assessment of self-identity and inability to determine boundaries between self and others. Etiology example: Mental illness.

Know how knowledge deficits hinder healthcare.

• One of the most difficult obstacles in providing/obtaining care can be communication (verbal and nonverbal), especially when people are in foreign countries. • Lack of knowledge about the cultural and ethnic values, beliefs, and behaviors of people within their community is not unusual among healthcare providers. It can cause them to misinterpret a client's behaviors.

Which focus is most important to nursing? (Psychosocial, biomedical, etc...)

• One of the strengths of nursing is that we can go beyond biomedical (disease-oriented) focus to care for the whole person. The term psychosocial encompasses both psychological and social factors: A person's psychological state interacts with their social development and position within society to contribute to their overall - or biopsychosocial - well-being. In the biopsychosocial view of health, biological, psychological, social, and spiritual factors interact to contribute to health. Any human dimension may dominate health needs at a given time. For example, a patient suffering from a severe flare-up of psoriasis (a skin disease with red, scaly patches) may require physiological interventions during the acute stage. He may not be ready to deal with body image issues (psychological dimension) until his skin lesions are better.

Which common reason(s) does a nurse identify as causing a patient to be non-complaint with a plan of care?

• Patients may fail to comply with a proposed healthcare regiment if healthcare providers develop a plan of care that has no cultural or personal relevance for the patient (or family). Perhaps the plan does not consider the knowledge level of the patient or caregiver, or perhaps it is not feasible in terms of available support, time, energy, finances, or location. They may believe that the treatment offered them will not help or that illness is preferable to the proposed treatment. Noncompliance often occurs because the effort, inconvenience, or pain involved with a therapeutic plan of care is too much for them to handle. The challenge for nurses is to develop an individualized plan of care in collaboration with patients, based on mutual goals and respect.

If you have a patient who has been hospitalized for a lengthy amount of time, what things can you do as a nurse to promote wellness?

Make them more comfortable, be attentive, have a conversation, understand patient's side

Know how biological factors affect health and wellness.

Most people consider biological factors when they describe themselves as "well" or "ill." Biological factors that can affect health and wellness include: genetic makeup (i.e. breast cancer), gender (rheumatoid arthritis, osteoporosis, and breast cancer are more common in women, whereas ulcers, color blindness, and bladder cancer are more common in men), and age/developmental stage (i.e. 75% of breast cancer cases are diagnosed in women older than 50 or adolescent boys have much higher rates of head injury and spinal cord injury because of their tendency toward risk-taking behaviors). • Developmental stage also influences a person's ability to cope with stressors that tend to move them toward the illness end of the continuum. Infants or children who are ill, frightened, or hurt have a limited repertoire of experiences, communication ability, and understanding to help them in their responses. • When disease, loss, or other disruptions occur at a younger age than expected, they change our perception of the event and may present a greater challenge to our coping skills than disruptions that are expected. For example, a child's death may seem more tragic than that of an older adult. It is important, though, not to discount the impact of disruptions that occur during the period of a person's life when they might be expected.

If you are caring for an adolescent client, who are they most excited to see during visiting hours?

Their peers, and family

What loss is experienced the most by people in the hospital who have long-term illness.

• Loss of Sense of Self. Think how patients feel who have to don a hospital gown and allow their body to be exposed for various tests or procedures, or how it feels to lose control of bladder or bowel function.

Know about the health-illness continuum.

• A person's position moves back and forth on the continuum with physiological changes, lifestyle choices, and the results of various therapies (10 is excellent health and 1 is gravely ill). In other words, the continuum is personal and dynamic; health changes over the course of time (i.e. How a patient feels day to day). • Dunn's health grid - a health grid that plots a person's status on the health-illness continuum against environmental conditions. Many nurses use this grid to help them predict the likelihood that a client will experience a change in health status. The sections of this grid include: high-level wellness (in favorable environment), emergent high-level wellness (in unfavorable environment), protected poor health (in favorable environment, i.e., through social and cultural institutions), poor health (in unfavorable environment). • Neuman's continuum - health is viewed as an expression of living energy available to an individual. The energy is displayed as a continuum with high energy (wellness) at one end and low energy (illness) at the opposite end. The person is said to have varying levels of energy at various stages of life. When more energy is generated than expended, there is wellness. When more energy is expended than is generated, there is illness - possibly death.

Know the difference between chronic and acute illness.

• Acute illness occurs suddenly and lasts for a limited amount of time. Acute illnesses, such as a cold, flu, or viral infection, may be minor and require no formal healthcare. Some acute illnesses, such as strep throat, may require a visit to a healthcare provider for treatment or even hospitalization or surgery, as in cholecystitis/ gallbladder inflammation. • Chronic illnesses last for long periods of time, usually six months or more, if not your entire life. Chronic illnesses require people to make changes to their lives such as regularly visiting healthcare facility, taking daily medications, or changing their lifestyle. People with chronic diseases often experience periods of remission (minimal symptoms) or exacerbation ("flare up"). Common chronic illnesses include AIDS, diabetes mellitus, rheumatoid arthritis, and hypertension.

What is considered to be the most effective treatment for serious depression, according to your book?

• As a nurse generalist, your independent role is not to diagnose and treat mental illnesses. Rather, it is to assess and document the patient's behavioral state as it relates to his medical-surgical condition. A depressed patient, for example, may not have the energy or motivation to recall or follow a medical regiment or keep appointments with healthcare providers. • Your most important nursing intervention is assessment. Be alert for risk factors and warning signs that may indicate the possibility of suicide; suicide risk must always be considered when a patient is depressed. Some other nursing interventions for depression include: promoting activity (group activities help build self-esteem), promoting and teaching good nutrition and hydration, using therapeutic communication, assess use of and provide information about CAM for depression, institute measures to build self-esteem, and provide information on support groups. • The presence of any of the following should alert you to document the patient's responses in your nursing notes and make a referral to a mental health specialist: personal/family history of recurrent depression or bipolar disorder, personal history of recurrence of depression within 1 year of stopping effective treatment, episode of major depression before age 20, and/or severe/sudden/life-threatening depressive episode. If you believe there is a risk for suicide, make the referral immediately.

Know what meaningful work is.

• Many people find that work is a healthy way to cope with stressors. For many people, volunteering, pursuing hobbies, and engaging in pleasurable activities can be forms of meaningful work. For example, some find that singing, playing a musical instrument, or listening to music is particularly healing. For others, it may be reading, painting, playing basketball, knitting, gardening, hiking in the wilderness, or even shopping.

As a nurse, if someone is not following the plan of care that is set forth for them, what can you do?

• As a nurse, your role is to help the patient (or family member) envision acceptable outcomes and to set smaller, realistic goals so that the patient recognizes progress. Use flexible envisioning, adjusting their goals and dreams to each new reality. Part of health is being able to dream, starting over if you need to but always envisioning that there is something worth striving for. • The following are aspects of a high level of communicating: settling in (Taking a few moments to settle in to the situation can be helpful in establishing a therapeutic relationship and facilitating communication. The patient is probably in a new environment, and your tune, words, and facial expressions can bring comfort and ease.), attuning (Try to focus on what the patient or family has to say instead of thinking ahead to what you want to ask next.), accepting (Acceptance of appearance, lifestyles, ways of coping, and values.), and enjoying (Broaden the repertoire of people you enjoy. To see and enjoy commonalities among individuals seemly so different.). • Being a better communicator - take time to communicate, identify the patient's main concern (You may have a plan of care that addresses areas that you know to be important, but it may fall far short of meeting your patient's needs if you have no addressed the concern that is fundamental to your patient.), and develop your observation skills (Observing the presence or absence of visitors and the effect on your patients. Observing signs of religious or cultural practices that have significance.).

If a Jewish patient asks a Christian nurse to pray for/with him. What does the nurse need to ask first?

• Ask how the client prefers to address the Divine and ask if the client has any rituals or religious items that are needed before the prayer. • Determine whether the client wishes you to pray for them (Patient may be asking you to pray for them on your own time) or with them (determine whether they simply want you to be present while they pray or if they want you to begin the prayer). Ask what the client would like you to address in prayer. • Judaism can be categorized as Orthodox, Liberal, Conservative, or Reconstructionist. Jews celebrate the Sabbath from sunset on Friday to sunset Saturday evening; Orthodox Jews are prohibited from work during the Sabbath. Conservative Jews observe strict dietary laws: only kosher foods (Guidelines concerning how animals are slaughtered and do not contain pork, certain types of seafood, or combinations of dairy meat.) are accepted. Orthodox Jewish women prefer to have their bodies and limbs covered while Orthodox Jewish men prefer to keep their head covered with a heat or skullcap (kappel). Some Orthodox Jewish sects forbid contraception unless the woman's health is at risk and nearly all Jewish boys are circumcised. Organ transplants might be forbidden by some Orthodox Jews. Both Reconstructionist and Reform Judaism incorporate modern western societal values into their faith. • Harrison Ford is a quarter Jewish... not too shabby!

Why do we as nurses place less value on spiritual care with our patients? • Few nurses actually identify spiritual problems or provide spiritual interventions. This may be a result of economic constraints, poor staffing, insufficient time, lack of privacy, and high-tech care, which forces nurses to focus only on physical needs to the exclusion of spiritual needs.

• Barriers cited by nurses and providers as inadequate training, lack of time, lack of privacy, and not a component of their professional role. • Nurses studied in university settings, the spiritual underpinnings of nursing were replaced by what could be seen and tested by scientific method.

Know about the barriers that are in place that stop us from providing cultural care.

• Barriers to culturally competent care include: racism, sexism, language barriers (foreign languages, dialects, regionalism, street talk and jargon), and other barriers (lack of knowledge, emotional responses, and self-knowledge.).

Which are the best communication strategies a nurse can use to encourage patients to share personal and sensitive information during the interviewing process?

• Be aware of your own biases and discomforts that could influence your assessment. • Use active listening through eye contact and verbal response. Be sensitive, though; eye contact is uncomfortable for some people. • Proceed from general details ("How do you get along with your parents?") to the specific ("Do your mother ever hit you?"). • Use an open and positive voice tone, facial expression and body language (i.e. avoid frowning, criticizing, or expressing shock). • Keep the focus on the patient. • Be respectful and sensitive to cultural and gender-specific details. • Use open-ended questions (questions that cannot be answered with a yes or no). • Follow the patient's cues by using reflection and restating. • Be flexible and use humor as appropriate. • Provide empathetic feedback and touch as appropriate. • A comprehensive psychosocial assessment should include the following categories: biological details, recent life changes or stressors, lifestyle and relationships with the wider social environment, history of psychiatric disorders, functional abilities (behavioral performance), self-efficacy (the belief that you can influence your own behaviors and outcomes), usual coping mechanisms, understanding about current illness, major issues raised by current illness, health priorities, spirituality, and personality style.

What do we know about Hispanics and pain?

• Culture influences the patient's responses to pain. Because pain and comfort are subjective, you need to quantify them as objectively as possible by using a pain measurement scale. It is essential to investigate the meaning of pain to each patient and their view of acceptable ways to express or cope with pain. • Hispanics experience healthcare issues due to lack of access to preventative care and language barriers. They also endure pain longer and report it less frequently. Believe in bringing amulets or medals to help with care. • Asians often avoid using narcotics for pain relief and Puerto Ricans often use prayer to help deal with pain.

Which type of medicine do those of the Hindu faith typically practice?

• Most Hindus are lactovegetarians, consuming milk, but no eggs. Many will not eat beef and avoid bovine-derived medication. Fasting, which may mean eating only "pure" foods, such as fruit or yogurt, is common during major festivals but is not expected of the sick. Hindus prefer to wash in free flowing water (shower) and if a shower is not available, provide a jug of water. Hindus practice ayurvedic medicine, which encompasses all aspects of life, including diet, sleep, elimination, and hygiene. Some believe in the medicinal properties of "hot" and "cold" foods (does not refer to temperature or spicy qualities). Women are modest and usually prefer to be treated by female medical staff and some may consider touching a person's feet or head a sign of disrespect. Some Hindus wear "sacred thread" around the body or wrist which shouldn't be removed or cut without permission. Jewelry often has a religious significance. • Buddhists usually are vegetarians (include both milk and eggs). They also typically condemn abortion and active euthanasia.

Know the difference between being past-oriented, present-oriented and future-oriented.

• Culture specifics affect our health beliefs and behaviors (i.e. births and weddings) in the following ways: communication (Even if you speak the same language, culture influences how feelings and thoughts are expressed and which verbal and nonverbal expressions are appropriate to use.), space (A person's comfort level is related to space and if invaded their common reaction will be to move away. A similar concept, territoriality, means the geographic space a person views as owned or claimed, such as an area or room.), time orientation (Clients who are past-oriented may show up late or not at all for follow-up appointments; therefore, you should provide a written or telephone reminder of their appointment. Present-oriented clients would say that they know that they need to lose weight, but it is too difficult with teenagers in the house who eat junk food. Future-oriented patients are focused on illness prevention so education on health promotion is important.), social organization (Includes the family unit and the wider organizations, such as community/religious/ethnic, with which the individual identifies. Patriarchy or Matriarchy family. Patients who don't trust large institutions or government agencies are likely to use home remedies and delay seeing a conventional medical provider. Someone of high status is more likely to receive better care than a poor person.), environmental control (Patients may not view circumstances as something to be "controlled"; therefore, they tend to accept pain stoically.), and biological variations (i.e. African Americans statistically have poorer responses to certain categories of antihypertenisive drugs).

Which alternative therapies require you to be a licensed practitioner?

• Diet therapy, therapeutic touch, acupuncture, chiropractic, kinesiology, reflexology, and naturopathy. Stole this from Amelia. • Indigenous Healthcare consists of folk medicine and traditional healing methods, which may include over-the-counter (OTC) and self-treatment remedies. On the other hand, professional healthcare system is where doctors, nurses, and various alternative healthcare professionals (chiropractors and acupuncturists) are used. • Health and illness beliefs include: scientific/biomedical health system, magico-religious system (supernatural or mystical healing such as voodoo), and holistic belief system (focuses on the need for harmony and balance in the body with nature).

Know what ethnocentrism is.

• Discrimination. Your own group (cultural, professional, ethnic, or social) is superior to others. • The dominant culture (i.e. white Anglo-Saxon Christian of European descent) may assume their ways are the norm and that everyone else is culturally different. People in subcultures (i.e. street gangs, physicians, nurses, women, elderly adults, persons with disabilities, rural Midwesterners) have had different experiences from those in the dominant culture because of status, residence, gender, sexual orientation, ethnic background, or education. Nursing subcultures (critical care unit vs emergency department) within hospitals can affect quality of care and thus patient outcomes. The term minority group might be offensive to some people because it suggests inferiority and marginalization. Vulnerable populations (i.e. homeless, poor, mentally ill, people with physical disabilities, very young children, and older adults) can be considered subcultures of all of the major cultural groups. Some ethnic and racial minority groups are also vulnerable. For example, Native Indians and Native Alaskans have a higher incidence of type 2 diabetes in those under twenty years old.

If you are an I.C.U. nurse taking care of a patient and the family brings in lots of necklaces and medals, and lays them around the patient. What should you do?

• Don't move them, if possible???

Alaskan Natives also use this person to help with healthcare needs.

• Folk Healers or Shamans. • Alaskan Natives populations have higher infant mortality rates, and higher prevalence of asthma, diabetes, and cardiovascular disease.

If you are taking care of a patient with anxiety, how would you know your interventions are working?

• For anxiety (feeling of distress or apprehension whose source is unknown; threat is psychological in nature.) - plans coping strategies for anxious situations, uses relaxation techniques as required, reports absence of physical and psychological manifestations of anxiety. • For death anxiety (apprehension, worry, or fear surrounding thoughts of dying.) - reports feeling less fearful and discusses funeral arrangements with family. • For decisional conflict (Struggle related to determining a course of action) - Identifies relevant information about the decision and its consequences or recognizes how various alternatives conflict with others desires. • For fear (Feeling of dread or distress whose cause can be identified, often from a physical threat) - uses effective coping strategies and maintains social relationships and control over life. • For ineffective denial (Unsuccessful attempt to reduce anxiety by refusal to accept facts, feelings, or thoughts) - verbalizes understanding of the complications that may occur if the disease is not treated and follows prescribed regiment for treatments and medications.

What kind of situations could lead to family care-giver burnout?

• For example, an older woman caring for a spouse with Alzheimer disease may have a nursing diagnosis of Caregiver Role Strain related to the care of a spouse with dementia. Together you would establish acceptable goals and break them down into realistic steps. You also would identify outcomes to indicate that the caregiver actually experiences a reduction in strain, such as being able to sleep or having time to pursue meaningful activities. You would discuss with her the options available to provide support, but she would identify which options were acceptable to her and her spouse.

What religion considers health as a harmony with nature?

• Native Americans - health is a state of harmony with nature. Whenever disharmony exists, disease or illness can occur. The traditional healer is the medicine man/woman who wise in the interrelationships of land, humankind, and the universe. Note taking might be considered forbidden, so when you take a history or perform an exam, rely on your memory to record findings later. Native Americans may converse in a low tone of voice and may maintain long periods of silence.

What is illness to people?

• Nurses understand health and illness as individual experiences, emerging from each patient's unique responses. The person with an illness rarely perceives the experience as a medical diagnosis. Instead, people describe their illness in terms of how it makes them feel.

If you had someone undergoing a mastectomy, what nursing diagnosis would you use for them? Might they be grieving? (hint hint)

• Nursing Diagnosis: Body Image Disturbance - Confused image of physical self (physical appearance) or negatively evaluates body or an aspect of it. Etiology example: Eating disorders, gender conflict, or disfigurement.

If you have an older adult patient admitted with dehydration to a medical-surgical unit and they are exhibiting confusion, distractibility, memory loss, and irritability. Which is the most important action by the nurse? (Think about depression and the older client)

• For patients with delirium (acute confusion), the nursing care focus is to keep the patient safe and to identify and alleviate the source of the delirium. Dehydration??? Stole that from Amelia. • Demonstrate caring behaviors is especially important for patients who are confused. Establish a therapeutic nursing relationship with your patient by emphasizing trust, consistency, honest communication, and unconditional positive regard. Use eye contact and touch; just keep in mind that people vary in their desire to be touched. • Nursing interventions for older adults include monitoring medications (metabolism changes with aging, the risk of adverse medication effects is high for older adults) and reminiscence (encourage the patient to talk about significant experiences that have occurred during their lives). • People with dementia are often anxious and fearful. Find ways to reassure and help the person feel more comfortable as you converse, such as the following: Gently hold or pat their hand, realize that they are probably distressed and are doing the best they can, be affectionate/reassuring/calm even when things make no sense, respond to the person's feelings instead of the content of their words (i.e. If a woman is constantly searching for her husband, say "You must miss your husband" or "Tell me about your husband" instead of "Your husband is not here."), supply words if the person is having difficulty finding the right word, ask the patient to point or describe it if you don't understand, and consider using alternative therapy (music). • Use the Geriatric Depression scale (screens depression in older adults).

How would you describe self-esteem?

• How well a person likes themselves. It is the difference between the "ideal self" and "actual self."Even mild illnesses and minor setbacks can cause people to question their self-worth. This is especially true if the problem is interpreted as one incident in a continuing pattern. The ideal self becomes unreachable.

What is the number one thing a nurse can ask a new client when trying to obtain cultural competency?

• If there were only one intervention you could use to improve your cultural competence, it should be to routinely ask patients what matters most to them in their illness and treatment.

If you have a patient that is dealing with debilitating anxiety that is stopping them from doing anything for 6 months, after documenting on the patient, what would you then want to do or who would you want to contact?

• If you suspect severe or disabling anxiety document the patient's responses. Involve a mental health professional immediately (same day) if you discover any of the following: suicidal thoughts, assaultive or homicidal thoughts and/or plans, loss of touch with reality (psychosis), or significant or prolonged inability to work and care for self or family. • Anxiety ranges from normal (real danger) to abnormal (out of proportion to the situation or lasts long after the threat is over), depending on its intensity and duration - how much anxiety is present and how long it has been present. The four levels of anxiety are mild, moderate, severe, and panic (disabling). Some ways to cope with mild anxiety include: exercising, talking with others, engaging in pleasurable activities, deep-breathing, and relaxation programs. People attempt to counteract severe anxiety with defense mechanisms (i.e. denial or displacement).

Know how sexism affects healthcare.

• In the dominant culture, it is traditionally more acceptable for women to cry out in pain than men. Similarly, the U.S. culture tends to view caring and nurturing as the province of women; thus, men were historically excluded from the nursing profession. • Women are often viewed as more emotional and less rational than men. Assertiveness, a trait considered positive in men, is viewed as aggressiveness and considered undesirable in women. Male chauvinism (assumption of male superiority) is common in many cultures (Middle Eastern Muslims) and may be overt or subtle.

How would you communicate with a patient that is depressed? Think about your therapeutic communication.

• It's important to establish a nurse-patient bond that shows an empathetic approach involving warmth, acceptance, and understanding even in the face of an unresponsive, even angry patient. If you identify signs of depression, be certain to communicate that to other members of the staff and to the primary care provider. • Some way that a nurse can communicate with a patient that is depressed include: do not avoid the patient because you fear saying the wrong thing (Talking about suicide does not increase the risk), be aware of your personal feelings and anxieties regarding suicide, be direct if the patient mentions suicide specifically (Ask whether they are having thoughts of harming themselves), do not leave the patient if they say yes that they are having thoughts of harming themselves (have someone contact his primary care provider for a psychiatric consultation can be ordered and possibly transfer the patient to a psychiatric unit if they are physically stable) and ask the patient if they have a plan for suicide and what their plan is. Never attempt to work with a suicidal patient by yourself. Involve other members of the team immediately.

Know about Jehovah's Witness religion.

• Jehovah's Witnesses adhere to the commands of God as written in both the old and new testaments of the bible. Individuals within this faith refuse blood transfusion. They also will not eat raw meat, red meat, or meat that has not been bled properly. Jehovah's Witnesses do not celebrate birthdays or holidays, except for the anniversary of the death of Christ (Christian Easter or Jewish Passover). Although Jehovah's Witnesses abstain from tobacco and other recreational drugs, they may drink alcohol but do not condone drunkenness. • Christianity has many denominations including: Roman Catholicism, Orthodoxy, Protestant denominations (Lutheran, Baptist, United Methodist), and others (i.e. Jehovah's Witnesses, Mormons, Christian Scientists). • Roman Catholics might wish to receive the sacrament of anointing the sick, once known as the last rites. Sacrament of Reconciliation (confession) might be requested by some patients. • Christian Science followers might not drink tea or coffee. Parents usually consent to medical care for their children (i.e. blood transfusions), but perhaps not for themselves. • Mormonism followers wear sacred undergarments and the garments are only removed for purposes such as hygiene, elimination, or being intimate in marriage. Mormonism prohibits the use of tea, coffee, alcohol, and tobacco. • Seventh Day Adventism is distinguished mostly by observance of Saturday as the Sabbath. The church is officially against active euthanasia, although a passive form through withdrawal of medical support is allowed. Most members avoid alcohol, tobacco, illegal drugs, and caffeinated beverages. Some members might be vegetarians or adhere to old testament kosher laws. Birth control is permitted for married couples.

How can nurses become culturally competent?

• Purnell model for cultural competence stress teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, and communities. In the context of nursing, Purnell's model defines cultural competence as "adapting care to be congruent with the patient's culture." The levels of cultural competence include: unconsciously incompetent, consciously incompetent, consciously competent, and unconsciously competent. • Obtain a health history. Ask them if they use alternative health methods. We also have to let people know we are okay with them using non-traditional methods, sometimes they will not tell us because they are scared of being ridiculed. • Some strategies that nurses can develop to become more culturally competent include: reflect and know yourself (recognize your own biases, learn from your mistakes), keep learning (learn about other cultural groups, take advantage of opportunities to interact with different cultures), accommodate and negotiate (incorporate beliefs and practices from various cultures into your nursing care, encourage helpful or neutral cultural practices, accommodate cultural dietary practices when possible), collaborate (work with the folk medicine practitioner, consider the cultural role of the family member who makes the primary decisions), and being respectful. • "Take a trip to BALI" or [B]e aware of your own cultural heritage, [A]ppreciate that the client is unique (influenced but not defined by their culture), [L]earn about the client's cultural group, and [I]ncorporate the client's cultural values/behaviors into the care plan.

What special consideration might you need to make when caring for a Rastafarian patient?

• Rastafarianism is a personal religion with no churches, services, or official clergy. Wearing secondhand clothing is taboo, so the patient might be unwilling to wear hospital gowns that have been worn by others. Rastafarians do not eat pork or shellfish, some are completely vegetarian, and some do not drink milk or coffee. Many prefer alternative therapies (i.e. herbalism, marijuana, or acupuncture), do not believe in contraception, and avoid any treatment that will contaminate the body. • Islam - Muslims are forbidden to eat pork. They may eat other meat, but it has to be halal meat. Muslims ALWAYS wash their hands before eating, and it is customary to eat with the right hand (unless prevented by injury). Muslims prefer to wash in free-flowing water. Women prefer to be treated by female staff and are forbidden to expose their bodies to or to be touched by any man other than their husband. Women might wear a locket containing religious significance around their neck in a small leather bag and should never be removed. After the birth of a baby, prayer are whispered in the baby's ear so the first thing heard are words of prayer.

Know about role strain, interpersonal conflict, etc...

• Role strain is a mismatch between role expectations and role performance. For example, you expected to sail through your nursing program and instead you find yourself so overwhelmed that lately you have begun to skip classes. • Interpersonal role conflict is when there is mismatch between your expectations and the expectations of others. An example is your ideas about how to perform the nursing student role may be different from those of your instructors. We nursing students think we should pass and our instructors think we should fail.... • Interrole conflict is when two roles make competing demands on an individual. For example, if you are a single parent and your child's sudden illness causes you to miss class. (Mother Role vs Nursing Student Role)

25. Know about self-concept.

• Self-concept is one's overall view of oneself. Self-concept forms out of a person's evaluation of his physical appearance, sexual performance, intellectual abilities, success in the workplace, friendship and approval from others, problem-solving and coping abilities, and unique talents. The dynamic self means that who we are is subject to change through social and environmental influence. • Components of self-concept include: body image (Physical appearance and physical functioning. Both cognitive understanding and sensory input influence body image. Anorexia nervosa. When changes in appearance or functioning occur abruptly, they are more difficult to accept. Negative body image has been associated with depression, initiation of smoking among adolescents, increased risk for unintended pregnancy and STDs, and increased incidence of being bullied. Blindness, deafness, paraplegia, and many genetic deformities can affect body image.), role performance (Defined as the actions a person takes and the behaviors he demonstrates in fulfilling a role. Instead of expectations, role performance is the reality. i.e. role strain, interpersonal role conflict, and interrole conflict.), personal identity (Your view of yourself as a unique human being, different and separate from all others. Personal identity, unlike body image, is relatively constant and consistent over time. People with a strong personal identity are less likely to compare themselves to others unlike people with weak personal identity. Patients with serious or chronic illnesses have an impaired sense of identity.), and self-esteem (How well a person likes themselves. It is the difference between the "ideal self" and "actual self."Even mild illnesses and minor setbacks can cause people to question their self-worth. This is especially true if the problem is interpreted as one incident in a continuing pattern. The ideal self becomes unreachable.). • Developmental stages can affect how self-concept is formed. Infants learn that the physical self is different from the environment (me vs not me). Children lean to internalize others' attitudes about the self, primarily parents and peers ("Who do they say that I am?"). Child and adults internalize standards of society ("How do I compare to others?"). Adults learn to self-actualize and self-adjust ("This IS who I am and who I will continue to be."). • Some factors that affects a person's self-concept include: gender (Women rate cooperation as important to their send of self, whereas men place a higher value on individual achievement. Physical appearance seems more important to women.), developmental level, socioeconomic status, family and peer relationships, illness and hospitalization (Depersonalizing effect because the patient may feel like an object to be examined, poked, prodded, and discussed.), and locus of control (People who allow their inner "voice" to influence their self-concept have what is called an internal locus of control. These people feel like they can exert control over their lives. People who have an external locus of control attribute control of their situation to external factors, including other people, institutions, and God. They feel that they lack the ability to change what happens to them.).

Know the different barriers to health and wellness

• Some factors that affect how people experience health and illness include: nutrition (i.e. Osteoporosis and some forms of cancer can be influenced by our diet. Scurvy and night blindness are unknown in people who consume a nutritious diet. Diabetes mellitus and heart disease are influenced by our diet.), physical activity (i.e. People who are active might perceive themselves as unhealthy if they are unable to maintain previous levels of activity. Weight training can reduce the risk of osteoporosis. Aerobic activity decreases the risk of heart disease.), sleep/rest (i.e. Growth hormone, which assists in tissue regeneration, synthesis of bone, and formation of red blood cells, is released during sleep. People kept awake experience difficulty concentrating and performing routine tasks. Sleep issues are common among nursing students, mothers of infants/children, and people in pain.), meaningful work (Work can be a healthy way to cope with stressors. By supporting clients' life work, hobbies, and personal interests, you help them nourish their health.), lifestyle choices (i.e. tobacco, alcohol, or substance abuse), personal relationships (i.e. family, friends, coworkers, pastors, or counselors), culture (It influences health decisions, behaviors, perception, and view of self as well or ill.), religion/spirituality, environmental factors (i.e. Establishing an area as the patient's area with photos and other mementos. Other patients may be soothed by a chapel or a walk in the park. Environmental pollutants commonly cause illness.), and finances (Money doesn't buy happiness, but it sure as **** buys nice healthcare). • A client's apparent lack of concern or lack of compliance to a treatment regiment may be, in reality, a problem of access to healthcare. One or more factors may keep individuals and families from getting the help that they need (i.e. distance from the resources, knowledge of available resources, trust in the available resources, financial status, and lifestyle adjustments such as a change in employment). • Not all disruptions are incapacitating, but all challenge our ability to function and enjoy our everyday lives, and they tend to move us toward the illness end of the health-illness continuum. Factors that disrupt our health include: physical disease (i.e. May reduce our ability to perform our life roles or engage in activities. The diagnosis of chronic or life-threatening disease may bring shock, fear, anxiety, anger, or grief.), injury, mental illness (Difficult for healthy people to fully appreciate the level of pain, suffering, and chronic sorrow. People suffering from mental issues may experience a loss of income and their mental issues can affect their friends/family. Mental illness carries with it a stigma.), pain (Pain can change personality, erode coping skills, and interfere with healthy communication. Some nursing interventions can inflict pain such as making patients turn in bed after a surgery or putting needles in them.), loss (Loss of a job, end of a romantic relationship, death of a loved one, or loss of youth, beauty, functioning, or identity. Think about the loss of sense of self that occurs when patients have to don a hospital gown and allow their body to be exposed for various tests. Or how it feels to lose control of bladder or bowel function. Think about paralyzed patients.), impending death, competing demands (Children need to be cared for. Bills still need to be paid. Job responsibilities. Symptoms might be ignored. Competing demands can take a heavy toll on people with chronic illnesses.), the unknown (i.e. Parent's bringing their first baby home from the hospital.), imbalance (i.e. Justice, good things should happen to good people and bad things to bad people. Death of a child or treatment failure are examples of bad things happening to good people.), and isolation (Having someone physically present does not necessarily remove the sense of loneliness.).

Know what traits you would look for in someone who was contemplating suicide.

• Some of the warning signs of a patient contemplating suicide include: withdrawal from social contract, desire to be left alone, preoccupation with death and dying or violence, risky or self-destructive behavior (drug use or unsafe driving), changes in routine (sleeping patterns, eating habits), giving away belongings or getting affairs in order, personality changes (shy people become very outgoing), saying goodbye to people as if they won't be seen again, and talking about suicide (i.e. "I'm going to kill myself" or "I wish I were dead" or "I wish I hadn't been born").

What spiritual assessment tool would you use for a patient over 65 years old?

• The JAREL spiritual well-being scale was developed and used by nurses especially for clients 65 years and older. The 21-question toll assess three key dimensions: (1) faith/belief, (2) life/self-responsibility, and (3) life-satisfaction/self-actualization. • The application of the HOPE (sources of [H]ope, [O]rganized religion, [P]ersonal spirituality/practices, and [E]ffects on medical care and end-of-life issues) is an easy-to-use screening method. Explores in greater detail the relationship between the client's spirituality and healthcare needs. • SPIRIT (Spiritual, Integration, Ritualized, Implications, Terminal) is another comprehensive spiritual assessment tool developed.

If you have a patient who has cancer and is receiving chemotherapy, what might be the most important need for them on Maslow's Hierarchy of Needs?

• The five stages of Maslow's Hierarchy of Needs are as follows: self-actualization, esteem, love and belonging, safety needs (security, employment, resources, health, property), and physiological needs (air, water, food, shelter, sleep, clothing, reproduction). • Example: You have a patient who speaks little English and so you put a great deal of effort into obtaining materials in her primary language and you've arranged for an interpreter. When you enter the room to educate your patient, you notice that they are in a great deal of pain. What will you do? Clearly that until the pain (a physiological need) is controlled, your patient cannot be educated. You arrange medication and reschedule. • Chemotherapy opens you up to the risk of infection right? So could the answer also be "safety needs" because the book mentions "protection from physical harm (e.g. falls, infections, environmental elements, and effects of medications). That being said wouldn't cancer be a physiological issue like pain. I think the answer is physiological because you can't fulfill safety needs without first fulfilling your physiological needs

Know the different stages of illness.

• The five stages of illness behavior are as follows: experiencing symptoms (Symptoms are a signal that illness has begun. If the symptoms are recognizable, you may identify the problem and turn to previously used remedies. Common problems rarely progress beyond this stage. If the symptoms are unusual, severe, or overwhelming then you progress to the next stage.), sick role behavior (This sick role relieves you of normal duties, such as work or school. The severity of the symptoms and anticipated length of illness determine whether you will progress farther along the stages of illness.), seeking professional care (Validation of their illness, explanations for their symptoms, appropriate treatment, and information about the anticipated length of illness.), dependence on others (The severity of the illness and type of treatment determine the extent of dependence. This may be limited to listening to the provider's instructions, filling the prescription, and following directions given in the office. An exception is when hospitalization is required and you depend on hospital staff/nurses to aid with ADLs, medications, and treatments.), and recovery (Gradually resumes independence, but severe illnesses may require a newly defined level of optimum function.). • Factors that influence illness behavior include: nature of the illness, hardiness of the individual (Hardy individuals are willing to seek out information and take initiative in dealing with life situations rather than sitting back and letting someone else control their lives. "I can deal with this" attitude.), and intensity/duration/multiplicity of the disruption (Dealing with cumulative effects of illness and other life disruptions can break down what might otherwise be excellent coping skills. Burnout.).

If a patient refuses pain medication, what are some things you would need to do?

• The two main ways of responding to a client's cultural health practice is negotiation (i.e. the nurse negotiates with the client to continue seeing the folk healer, but also to come to the clinic every couple of weeks to have their blood pressure checked.) and repatterning/restructuring (i.e. A client is refusing to take the prescribed pain medication so the nurse changes their tactic and uses massages, distractions, and other nonpharmacological techniques to help relieve pain.).

Which question is most important to ask of a newly admitted patient to effectively incorporate spiritual care in the nursing care plan?

• Their religious preference??? Stole that from Amelia. • It may be difficult to obtain meaningful information on the initial admission assessment due to time constraints in completing the paperwork, collaboration with the healthcare team, and the stresses involved in getting the client introduced to the healthcare setting. Obtain the essential data of the client's church preference, name of clergy, whom to call in case of emergency, dietary requirements/restrictions, and any religious implications for medical care (i.e. refusal of blood transfusions).

What do you do for patient's that speak a foreign language?

• Translator???

If you were transferring a patient form a hospital to a long-term care facility, there are certain things you will have to do as a nurse, but what would be most important?

• When patients are admitted to a healthcare facility, you will need to support them in their transition from wellness to illness, in dealing with the unknown, and in adjusting to a new environment. The relationship and trust you establish in your first contact with patients can go a long way toward relieving their anxiety and preserving the energy needed for healing. Try to set a tone of caring, respect, and understanding. • You can make the transition smoother for patients if you incorporate the following activities: prepare the room, greet the client, introduce yourself to the client and family, orient the client to the room and the unit, gather a health history, and establish a relationship with the client. • When transferring a patient to a long-term care facility, a nurse should plan in advance (notify the patient and family of the impending transfer), prepare the patient's records (copy for the new facility if needed), pack personal items and treatment supplies, coordinate the transfer with the receiving facility, and make the final assessment.

Know about Yom Kippur and how that would affect people taking medication.

• Yom Kippur (The Day of Atonement) is a special day of fasting for Jews, but fasting is not required if it would be a danger to the patient. Orthodox Jews might want alternatives to oral medications (i.e. injections or suppositories).

What would you need to do as a nurse when you find out your patient is taking over the counter remedies?

• You should assess for CAM use to be sure that the method is not contraindicated and that the patient has informed the primary care provider about its use.