NSG 212 Exam 5 pt 2

groups in society

-Dominant group (usually largest group) •Group has the most authority to control values and sanctions of society -Minority group (smaller group) •A physical or cultural characteristic identifies the people as different from dominant group.

Difficult Conversations at End of Life...

-How do you respond to patient statements, such as: •"Just let me die." •"Please help me die." •"I'm dying, aren't I?" -ANA code of ethics: must cont care

Center for Organ Recovery & Education (CORE)

-Organ procurement agency req for all facilities. Notify them you have pt that may die. Core determines if they could donate. If so, core with talk to family -don't extubatne b4 you call

Cultural assimilation

-acculturation •Minorities living within a dominant group lose the characteristics that made them different. •Values replaced by those of dominant culture

NODA

-no one dies alone -Volunteers sit w/ pt who have no one (gone bc covid, but coming back)

gone from my sight poem

Contact palliative care team to get. What sx to expect w/ approaching death Poem in it ab loss (ship = death. Pt out of sight not gone)

"hard choices for loving people"

Copies at nurses stations for families struggling with deciding codes/orders for pt

Disenfranchised Grief

Grief for a loss that may not be considered socially acceptable or cannot be shared publicly. (ex. Father committed suicide not comfortable explain the COD)

Child-Life Services

If desired by the family of children experiencing loss, Child-Life Services may be available to speak with family and/or children about coping with loss and grief, provide information about resources, and assist in memory-making activities (thumb prints/recordings of those passing).

Spirituality

anything that pertains to the person's relationship with a nonmaterial life force or higher power

West Virginia Do Not Resuscitate (DNR) Card

orange form, only says no CPR, maybe in their wallet

West Virginia Physician Orders for Scope of Treatment (POST) Form

pink form

death photo on door

purple bg, dark leaf with water drop on it=that patient has died

Religion

term used to describe cultural or institutional religion

West Virginia Medical Power of Attorney (MPOA)

white form, person to make medical decisions for you when you can't

West Virginia Combined Medical Power of Attorney (MPOA) and Living Will

white form. person to make medical decisions for you when you can't and your current wishes

Grief

•"Grief is an internal emotional reaction to loss." •Mourning is the act of grieving and expressing grief. •"Bereavement is a state of grieving due to loss of a loved one."

crisis intervention (not tested)

•A problem-solving technique with five steps: -Identifying the problem -Listing alternatives -Choosing from alternatives (by pt) -Implementing the plan -Evaluating outcomes Designed to promote adaptive outcomes, such as improved coping abilities for future crises -Crisis: lvl of stress they cannot manage Pt can reuse skills to fix crisis sometimes (may not work if stress is totally diff)

Adapting to Acute and Chronic Illness

•Adaptation involves two types of tasks: -General tasks, such as maintaining self-esteem and personal relationships and preparing for the future -Illness-related tasks, such as handling disability and pain, performing the medical regimen as prescribed, and losing control and independence •"Going through the motions"

Effects of Long-Term Stress

•Affects physical status •Increases risk for injury or disease •Compromises recovery and return to normal functioning •Negatively impacts the entire body -Systems include: nervous, respiratory, cardiovascular, gastrointestinal, endocrine, musculoskeletal, immune, and reproductive -Long term stress and a loss = harder to cope and bounce back

support for the family

•Allow expression of feelings. •Encourage the family to plan visits so that the patient has time to rest. •Provide appropriate information when there are changes in the treatment plan. •Assess family members' desire to perform patient care and provide education as needed. (do you feel you have options?) •Monitor for caregiver fatigue. (didn't get the care they needed, may pass away b4 pt. Want to prevent this) •Provide privacy for the family to communicate and share feelings outside of the patient's presence. •Provide education about physical changes that occur as the patient approaches death if desired.

General Adaptation Syndrome (GAS)

•Also called "stress syndrome" •Theory of adaptation to stress developed by Hans Selye •Has three stages: Alarm reaction Resistance stage Exhaustion stage

Dysfunctional/Complicated Grief

•Also called unresolved grief •Types include chronic, delayed, masked, and exaggerated grief •Difficult progression through the usual grief stages •Usually prolonged grieving •May result in depression, decreased self-esteem, intense guilt, and suicidal ideation Physical complaints may continue for an extended time

Nursing Care for Situational Role Changes

•Anticipate when the patient may experience role overload or conflict. •Prepare patients for situational crises that are anticipated. •Educate family members about potential stressors and available resources. •Encourage the patient during stressful times. •Provide counseling about roles that are permanently changed. •Explore roles that the patient can give up. •Seek alignment between the patient's perceived roles and those attributed to the patient by others. •Assist the patient to improve personal opinion of self-worth. •Provide short-term respite care to assist the family caregiver. •Improve relationships by supplementing behaviors specific to roles. •Refer the patient to community and social services as appropriate. •Evaluate adaptation to the role change(s) by assessing the patient's level of acceptance.

Palliative Care

•Appropriate for anyone with a chronic disease or illness regardless of disease stage •Interventions focus on the relief of physical, emotional, spiritual, and psychosocial aspects of the disease. •Provided by an interprofessional team •Goal is to aggressively manage symptoms in clients with life-threatening illnesses to provide the best quality of life possible. -Step b4 hospice Goal: improve quality of life, help them meet their goals. Still trying to tx their disease and be as comfy as possible -purple shirt and black pants at ruby

Postmortem Care

•Ask if the family wishes to spend time with the body. •Determine whether the patient's personal belongings should be sent with a family member or the body. •Perform care with compassion and respect while attending to client and family wishes per their religious, cultural, and social practices. •Depending on facility policy, the nurse may be responsible for asking the family which funeral home they wish to use.

Assessment: History

•Ask the patient questions regarding: -Present stressors and perception of them and ability to cope -Support systems -Sleep patterns -Changes in appetite or patterns of elimination and weight loss or gain -Adherence to treatment plan and healthy behaviors •Obtain the patient's vital signs. •Observe the patient's appearance, eye contact, cognitive status, and verbal and motor function. •Observe for tension, anxiety, and irritability. •As always, we are assessing if the patient is "normal" or "abnormal." •Stress and stress reactions are "normal." •However, we need to move the patient through the states so that they can arrive at coping. -What are they doing +/- to cope? How are they coping w/ tx?

Stress in the Nursing Profession (not tested)

•Assuming responsibilities for which one is not prepared •Working with personnel who are unqualified •Working in an environment with supervisors who are not supportive •Experiencing conflicts with peers •Providing care for patients who are suffering and their families •Providing care for patients in cardiac arrest or who are dying •Providing care for a patient who is disengaged or lacks resources for participation in care •Experiencing moral distress •Experiencing burnout

TRANSCULTURAL NURSING

•Awareness •Knowledge and skills •Encounters •Desires •CONVEY ACCEPTANCE! •FOSTER INDEPENDENCE •DEMONSTRATE RESPECT Focuses on the comparison and analysis of cultures/ subcultures to respond to INDIVIDUAL patient needs/ values.. NOT PREDETERMINED Need many skills to achieve this... Awareness.. Appreciation and sensitivity to the culture of others.. Need to have an awareness of the nursesOWN beliefs and BIASES/ PREDJIUCES ( discrimination).. Need to work through this.. Knowledge and skills knowledge of the culture including health/ wellness issues... WE don't want to impart OUR beliefs... Skills; need to have the ability to asses factors related to the care and treatment of peeps within the culture.. Cultural specific assessment Encounters ; need to have interaction with the culture to form knowledge, skills, awareness.. Desires; motivation to learn and participate with the culture.

THE BETTER MODEL ACRONYM

•BRING up the topic of sexuality. •EXPLAIN that you are concerned with all aspects of patients' lives affected by disease. •TELL patients that sexual dysfunction can happen and that you will address their concerns. •TIMING is important to address sexuality with each visit. •EDUCATE patients about the side effects of their treatments and that side effects may be temporary. •RECORD your assessment and interventions in patients' medical records (Mick, Hughes and Cohen, 2003).

COMMON CHARACTERISTICS OF RELIGIONS

•Basis of authority or source of power •Portion of scripture or sacred word •Ethical code defining right or wrong •A psychology and identity •Aspirations or expectations •Some ideas about what follows death

ETHNOCENTRISM

•Belief that one's ideas, beliefs, and practice are the best or superior or are most preferred to those of others

Family Stressors (not tested)

•Changes in family roles and structure •Feelings of anger, guilt, and helplessness •Loss of control over usual routines •Concern for future financial stability •We often don't think about the stress the family is going through. We need to think about their stressors and how THEY are reacting. •Family structure determines the ability of the family to cope. •Rigid family structure is strict and dictatorial. •Open family structure has few or no boundaries, consequences, or consistent behaviors. •Both structures can result in outcomes that are positive or negative. •Function is the course of action that the family uses to attain its goals, including family members' problem-solving abilities, communication skills, and available resources.

End of Life Care

•Comfort Measures does not mean "do nothing" and should not be presented to patients and families as such. It is a transition from aggressive curative treatment to aggressive symptom management. •Prioritize management of symptoms causing the most discomfort. (what is pt most concerned ab) Administer medications as ordered to manage symptoms. •Perform ongoing assessment of symptoms to determine the effectiveness of treatment and need for changes in the treatment plan. •Manage medication adverse effects. •Reposition frequently to maintain comfort, airway patency, and skin and mucous membrane integrity. •Maintain an environment (peaceful, turn off beeping) that promotes the patient's self-esteem and dignity. •Promote patient control by encouraging patient decision-making in health care, foods, and activities. •Encourage and assist the patient to perform activities of daily living as they are able and wish to do so. •Encourage relaxation techniques if indicated. Use therapeutic touch as appropriate. •Work with the interprofessional team. •Provide care and support to the patient and family. •Utilize therapeutic communication to develop, maintain, and facilitate communication among the patient, family, and healthcare team. •Assist with the understanding of information about progression of disease and options for treatment. •Assist the patient in clarifying personal goals to assist in effective decision-making. (will, see grandkid, wedding) •Support the use of coping mechanisms the patient has had success with in the past as appropriate. •Support the patient in participation in religious practices that provide strength and comfort as appropriate. •Be aware of comments in the presence of unconscious clients as hearing is the last sensation lost. (convo of terminal weaning not at bedside if pt cant participate) •Discuss patient and family concerns, such as changes in roles or finances, and make referrals as appropriate. -comfort cart outside room

Defense Mechanisms (not tested)

•Compensation: Emphasizing a more desirable trait/over achieving in an attempt to overcome a perceived weakness •Denial: Refusing to acknowledge a disturbing condition •Displacement: Moving emotion from one object/person to another (anger at nurse when family dying) •Introjection: Incorporating qualities/values of another into their ego -Example: Older sibling teaching younger sibling •Projection: Attributing own thoughts/impulses to another •Rationalization: Giving logical/socially acceptable reasoning for questionable behaviors -Example: "I'm OK; you're OK." •Reaction formation: Exhibiting behaviors and attitudes that are the opposite of what he/she would normally do •Regression: Returning to earlier behaviors; seen in children (new sibling home and kid is having accidents all of a sudden) •Repression: Choosing to remove an event that produces anxiety from conscious awareness •Sublimation: Substituting good/positive behavior or goal for one whose usual method of expression is not socially acceptable or is blocked (ex. Like to fight, join fb team so they are cheering for for doing so) •Undoing: Making up for previous bad acts

Postmortem Care: After Family Viewing

•Complete required documentation. •Apply identification tags according to facility policy. •Transport patient remaining sensitive to visitors and staff or request transport for the patient as indicated by facility policy.

hospice care

•Comprehensive care provided in various settings, often the home •Indicated when a client's life expectancy is 6 months or less •Focus of treatment is shifted from a cure to quality of life and support for the client as they approach death •Indications for referral may include: comorbidities, poor performance status, poor nutrition, declining cognition, previous hospital admissions, pressure injuries (albumin so low, cant fix it), and advanced age. -End of life care focused on comfort, tx d/c for cause. Pain tx. Focus on dignity

Task-Oriented Reactions to Stress (not tested)

•Consciously considering the stressor and working to resolve problems or conflicts or satisfy needs •Attack behavior - Attempting to satisfy a need by overcoming obstacles -May be constructive or destructive •Withdrawal behavior - Physically withdrawing from the stressor or emotionally withdrawing by becoming apathetic, admitting defeat, or feeling isolated or guilty •Compromise behavior - Often involves negotiation or the substitution of goals to fulfill needs partially (ex. Do 1st 2 weeks of ATI and take a nap after) -Usually constructive

culturally...

•Culturally sensitive means that nurses are knowledgeable about the cultures prevalent in their area of practice. •Culturally appropriate means that nurses apply their knowledge of a patient's culture to their care delivery. Culturally competent means that nurses understand and address the entire cultural context of each client within the realm of the care they deliver. • Culturally responsive nursing care improves communication, fosters mutual respect, promotes sensitive and effective care, and increases adherence with the treatment plan as clients' and families' needs are met. Culturally responsive nursing care should encourage patient's decision‑making by introducing self‑empowerment strategies. •Cultural imposition: Belief that everyone should conform to the majority belief system

Elisabeth Kübler-Ross Theory of Grief:Grief Reactions

•Denial - Difficulty accepting the reality of a diagnosis, death, or loss •Anger - Expression of rage and hostility (ex. She would live if you did your job) •Bargaining - An attempt to negotiate for a cure or more time (with doctor or higher power) •Depression - A period of grief •Acceptance - The reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future.

categories of stress (not tested)

•Developmental stress: Occurs when a person progresses through normal growth and development stages •Situational stress: Does not occur in patterns that are predictable as a person goes through life -Examples: Traumatic injury, illness, marriage, divorce, new job, role change, and loss of family members, relationships, belongings, etc.

End of Life Care Orders

•Do Not Resuscitate (DNR) - May be called No Code, No CPR, or Allow Natural Death (AND) •Do Not Intubate (DNI) (incl in DNR in some facilities) •Comfort Measures Only - Goal of treatment is allowing the patient to die in a comfortable and dignified way as there is no longer an indication for further life-sustaining treatment. •Orders not to use certain other life-sustaining treatments may also be present based on healthcare provider discussion with the client regarding their wishes, such as ventilator support, dialysis, artificial hydration and nutrition, blood transfusions, medications - such as antibiotics, and/or surgery. •Terminal weaning - Mechanical ventilation is gradually withdrawn from a client with a terminal illness or condition that is not reversible and a poor prognosis. "pulling the plug"(given time to be w/ family after and pain meds and such to tx sx (ex. Anti cholinergic and Ativan). Gone in mins for us, others last a while) -Lawyer w/ ethical framework to decide if pt has no one

Nursing Care to Assist with Coping

•Encourage the patient to verbalize their feelings. •Show empathy in communication. •Discuss the abilities of the patient and their family to deal with the present situation. •Encourage patient autonomy in making decisions. •Encourage the patient to describe their effective use of coping skills in the past. (reuse if healthy) •Identify the abilities and strengths of the patient and family. •Identify community resources as appropriate and available. •Refer the patient to counseling services if appropriate.

types of dying

•Euthanasia - Means "good dying" •Active euthanasia - Taking measures or doing something to cause a client's death •Assisted suicide can be considered a type of active euthanasia. Assisted suicide is legal in certain situations in the District of Columbia, California, Colorado, Oregon, Vermont, and Washington as of 2017. It has also been allowed in Montana and New Mexico. •Passive euthanasia - Withdrawal of medical treatment (not doing something) with the intention of allowing a client's death •Historically, most societies have held the belief that passive euthanasia is legally and morally justified while active euthanasia has been considered illegal and immoral, although this distinction is being questioned by some today. •The American Nurses' Association Code of Ethics position statement is that the nurse "should provide interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life."

Autopsy

•Examination of the tissues and organs following death •Findings may help to advance medical science (learn ab a disease) and pinpoint the cause of death. •Consent is a legal requirement, and it is usually the responsibility of the health care provider to obtain this consent. •If death occurs due to suicide, homicide, accident, illegal therapeutic practice, and in some cases within 24 hours of hospital admission, the coroner must be notified according to law. The coroner can then determine if autopsy is necessary and can order one even if the patient/family have refused to consent to autopsy. •Most facility policies require that all tubes and lines remain in the patient. •Forms must be completed per state and federal law.

hows it deal with nursing?

•Eye contact •Shaking hands •Form of greetings •Birth/ death rituals •Pregnancy rituals •Pain experience •Mental Illness stigma •Gender roles •Communication •Verbal and non-verbal Time andpersonal space -Mental Illness.. Some culture believe mind/body are connected.. If the body is not sick, then the mind is not sick! STIGMA -Communication Verbal; Tone of voice.. Asian..soft tone Italian/ middle eastern.. Loud tone/ use hands -Eye contact.. .. American.. Direct eye contact or I am lying Middle Eastern.. Will not make eye contact with the opposite gender; will see this as hos. tile or sexually aggressive Asian.. Direct eye contact is disrespecful Native Americans.. Direct eye contact may lead to soul loss or steeling of the soul Touch. ?? Use of space.. Keep their distance.. Europeans.. Different

FACILITATING THE PRACTICE OF RELIGION

•Familiarize the patient with religious services within the institution. •Respect the patient's need for privacy during prayer. •Assist the patient to obtain devotional objects and protect them from loss or damage. •Arrange for the patient to receive sacraments if desired. •Attempt to meet dietary restrictions. •Arrange for a priest, minister, or rabbi to visit if the patient wishes.

THE CULTURE OF POVERTY

•Feelings of despair, resignation, and fatalism •Day-to-day attitude toward life; no hope for future •Unemployment and need for financial or government aid •Unstable family structure; possibly characterized by abusiveness and abandonment •Decline in self-respect and retreat from community involvement

roles

•Functions a person takes on in life •People are seldom limited to one. •Often multidimensional •Often relative to roles of others •Affected by stress •Examples of roles: -Dependent child -Parent -Grandparent -Employer/employee -Committee member -Community activist

General Adaptation Syndrome: Alarm Reaction

•Functions of the body are increased to respond to stress. •There are increases in mental alertness, heart rate, blood pressure, and blood flow to muscles due to the release of hormones, including epinephrine, norepinephrine, and cortisone. -ex. bad news

General Adaptation Syndrome: Exhaustion Stage

•Functions of the body are no longer able to respond to the stressor and the individual is unable to adapt. •This stage results in either death or recovery. -Stressed balanced state for long time Ex. Physical (heart prob) is they type that may lead to death

RELIGIOUS BELIEFS

•Guide to daily living habits •Source of support •Source of strength and healing •Source of conflict: •Why would God do this to me? •I want to do one thing.. But God will judge me,

Physical Symptoms of Stress (not tested)

•Headache •Dilated pupils •Dry mouth •Stiff neck •Backache •Chest pain •Nausea •Constipation/diarrhea •Increased urination •Increased heart rate •Increased blood pressure •Increased respiratory rate •Increased sweating •Sleep disturbances •Weight loss/gain •Decreased sex drive

SEXUAL ORIENTATION

•Heterosexual •Gay or lesbian •Bisexual •Transsexual.. Lives as a gender that is different from that assigned at birth •Asexual.. Lacks romantic interests in others Questioning.. Unsure of his/her orientation

coping

•How a person handles issues and problems •Cognitive and behavioral efforts to manage stress •Influenced by the quantity, intensity, and duration of stressors; support system; availability of resources; and past experiences •Strategies are unique to each individual and may vary greatly from stressor to stressor.

Nursing Role Assessment

•Identify the roles the patient identifies as their own and that others attribute to the patient. •Assess five areas of family life including developmental, interactive, integrity, health, and coping processes. •Assess for discrepancies between the patient's identified roles and those others attribute to the patient. (id to relieve pt's stress) •Assess the impact of the addition or loss of a role on the patient. Identify who will take on roles that the patient cannot perform and make appropriate referrals.

culture blindness

•Ignores differences and proceeds as if they did not exist •A key prerequisite to the delivery of culturally responsive nursing care is the nurses' understanding and awareness of their own culture and any cultural biases that might affect care delivery. Nurses should accommodate each patient's cultural beliefs

NURSING DIAGNOSIS

•Impaired verbal communication •Relocation stress syndrome (risk for ) •Social isolation Spiritual distress

Clinical Signs of Approaching Death

•Labored breathing •Collection of mucus in large airways (death rattle) •Decreased level of consciousness •Relaxation of facial muscles •Inability to swallow •Slow and weak pulse •Decreased blood pressure •Bowel and/or bladder incontinence •Decreased urine output (hr and bp dec and blood to kidneys dec) •Cool, mottled (cyanotic) extremities (from fingertips/toes up) •Perspiration •Diminished sensation of touch •Difficulty speaking •Nausea, abdominal distention, and/or flatus •Agitation or restlessness •Loss of movement and reflexes

Death Certificate

•Legally required for each client who dies •Nurse's responsibility to ensure death certificate is signed by a clinician who is able to sign depending on specific state laws •Advanced practice nurses but not registered nurses may sign death certificates after completion of special training in the state of West Virginia. -Always in black ink. Filled out by provider

RELIGIOUS INFLUENCES

•Life affirming: enhance life, give meaning and purpose to existence, strengthen self, are health giving and life sustaining •Life denying: restrict or enclose life patterns, limit experiences and associations, place burdens of guilt on individuals, are health denying and life inhibiting

Teaching Healthy Activities of Daily Living

•Lifestyle has a great influence on perceptions of stressors and stress reactions. -Adequate sleep -Adequate nutrition -Strong support systems and relationships

Normal/Uncomplicated Grief

•May show negative emotions, such as hopelessness, withdrawal, anger, resentment, and guilt •Over time, negative emotions will change to acceptance with some acceptance being evident by 6 months following the loss. •May demonstrate physical complaints, such as fatigue, change in sleeping patterns, chest pain, palpitations, nausea, and headaches -Normal to come back w/ holidays and such

Health Care Surrogate

•Medical decision maker not chosen by the patient (MPOA or durable power of attorney for healthcare are chosen by the patient when the patient has decision making capacity.) •Designated by hospital social worker when a patient is unable to make his/her own decisions and a previously completed medical power of attorney document is not available •Signed by a healthcare provider •Form follows the law and attempts to name the person who is closest to the patient and knows the patient's wishes the best as their medical decision maker Forms vary by facility -Hc worker guesses at who is closest to you Doesn't always work out well

Emotional Responses to Stress (not tested)

•Mind-body interaction -Connection between psychological stressors and the GAS (physiologic stress response) •Coping mechanisms -Behaviors used to reduce anxiety and stress -Stress from mind (loss, syallbus) and from physical (ex. See bear)

nursing care

•Modify the environment to reduce external stressors, such as excess noise and disruptions in the continuity of care. •Attentively listen; taking the time to understand the perspective of the patient. •Foster the expression of emotions through the use of effective communication. •Encourage the use of relaxation techniques as appropriate. •Encourage the use of health promotion strategies. •Identify support systems available to the patient. •Determine tasks that take priority and provide assistance with time management. Educate about stress management training if available.

Types of Grief

•Normal/Uncomplicated •Dysfunctional/Complicated •Anticipatory •Disenfranchised

General Adaptation Syndrome: Resistance Stage

•Normalization of body functions while responding to the stress •Body attempts to return to homeostasis while coping with the stressor •Heart rate, blood pressure, and hormones stabilize -Used to stressor being there, at a stressed balanced state

Types of Discomfort to Manage at End of Life

•Pain •Dyspnea •Excess oral secretions •Nausea and/or vomiting •Restlessness •Anxiety •Urinary incontinence and/or retention •Diarrhea, constipation, or bowel incontinence •Dehydration •Inability to perform activities of daily living

Symptom Management at the End of Life

•Pain - Pain medications, often opioids, such as morphine; repositioning; hygiene care; relaxation techniques; therapeutic touch; comfortable clothing; comforting possessions (music and massage therapy) •Dyspnea - Opioid pain medications, such as morphine (help w/ air hunger=gasping for breath); positioning the patient in semi-Fowler's; relaxation techniques; supplemental oxygen therapy •Excess oral secretions - Semi-Fowler's or semiprone positioning, anticholinergic medications, suctioning (death rattle from secretions into lungs) (scopolamine patch to dry you up) •Nausea and/or vomiting - Antiemetics •Restlessness - Pain medications, anxiolytics, repositioning, hygiene care, relaxation techniques, therapeutic touch, comfortable clothing, comforting possessions •Anxiety - Pain medications, anxiolytics, relaxation techniques, therapeutic touch, promotion of decision-making •Urinary incontinence - Nearby bedpan, absorbent pads, hygiene care •Urinary retention - Catheterization •Diarrhea and/or bowel incontinence - Nearby bedpan, absorbent pads, hygiene care •Constipation - Laxatives, enemas •Dehydration - Sips of water and/or ice chips -Drinks may be going into lungs but wanna drink. Inform of aspiration pneumonia risk. Give if that's what pt/fam wants

culture conflict

•People become aware of differences and feel threatened. •Response—ridiculing beliefs and traditions of others to make themselves feel more secure

Advance Care Planning

•Planning for care in the future at times when the client is unable to make his/her own decisions •Advance Directives - Legal documents giving direction for situations at end-of-life (signed, witnessed to ensure no coercion) •Health care proxy - Also called a durable power of attorney for healthcare; appoints a medical decision maker for times when the client is unable to make his/her own decisions •Living will - Gives the client's wishes for medical treatment •POLST - Physician's Orders for Life-Sustaining Treatment: Document with medical orders indicating patient wishes regarding commonly used treatments in medical crises (on fridge, provider orders there for EMS to see, done by someone w/ special training))

Factors Influencing Grief and Ability to Cope

•Prior losses •Significance and type of loss •Developmental stage (child vs adult) (child may think they caused the death) •Gender •Social support and relationships •Socioeconomic status •Spirituality and religion •Culture and ethnicity •Coping strategies: exercise, therapy)

Postmortem Care: Preparing the Body

•Provide privacy. •Removes all lines and tubes - unless this is a coroner's (medical examiner's) case or organs or tissues are to be donated. •Elevate the client's head as soon as possible to prevent discoloration of the face. •Cleanse the body as indicated. •Align the body in the supine position with the head on a pillow, eyes closed, dentures in place, and arms with palms down on top of the sheet and blanket. •Change linens and gown. •Comb the patient's hair and replace hairpieces if present. •Tidy the room, removing unnecessary equipment, supplies, and soiled linens. •Provide a calm environment by reducing lighting and minimizing noise.

coping with death of patient

•Providing long-term care for patients can lead to the development of personal attachments. •Bearing witness to patient deaths can be very difficult for health care professionals and can result in feeling numb or burned out. •Many settings are beginning to implement "Pause" guidelines to stop health care professionals for a moment of reflective silence to honor the deceased. •Coping Strategies for Nurses can include: -Attending the patient's funeral -Writing to the patient's family -Debriefing with co-workers -Implementing stress management techniques -Seeking the care of a professional counselor -Compassion fatigue possible after constantly being exposed to pt death

Stress Management Techniques

•Relaxation •Meditation •Yoga •Guided imagery •Breathing exercises •Biofeedback •Anticipatory guidance •Massage •Crisis intervention

NURSING INTERVENTIONS

•Religious/ spiritual/ death rituals •Pain •Nutrition •Communication •Apologize if you offend them •Family patterns/ gender roles •Culture and life transitions •Re-patterning : accommodate as much as we can; we want to RE-PATTERN or attempt to change unhealthy lifestyles or wellness styles into healthy ones while still maintaining cultural integrity Religious/ spiritual/ death rituals .. Need to respect the religious/ spiritual needs/ practices of the patient; need to find ways to facilitate the requests of the cultures Pain; pain is reacted to and displayed differently by different cultures; may need alternate to 0-10 pain scale; may need different assessment techniques; remember, pain my have a religious influence Nutrition provide food choices based on culture/ religuon/ respect traditions; allow patient to consume foods that may be seen as treatments ( teas) ; communicate food intolerances and preferrences Communication; use interpreters ; very carfully use NON VERBAL, as this may have different meanings in different cultures Family patterns/ gender roles ; who makes the decisions in the family? Culture and life transitions; some cultures use rituals to mark the passing through life events; puberty, pregnancy, child birth, death and dying Repatterning ; accommodate as much as we can; we want to REPATTERN or attepmpt to change unhealthy lifestyles or wellness styles into healthy ones while still maintaining cultural integrity

Situational Role Changes (not tested)

•Result from situations not resulting from physical growth and development •May disrupt one or more of the patient's roles •Resolution may result in physical, spiritual, and mental healing. •Illness is an example of such a situation and results in role stress as roles may change simply due to the illness and its progression. •Nurses must assess patient roles and how situations, such as illness, may impact these roles. •Patients may experience advancement or regression as a result. •May result in temporary or permanent role changes •With temporary role changes, when illness resolves, the patient will resume the role. •With permanent role changes, illness has impacted the patient's health to the point that previous roles are no longer possible. -Ex. Want to leave AMA bc no one to feed pt's dogs

stress (not tested)

•Results from external and internal forces that disrupt a person's state of balance •Can be perceived as "bad" or "good" •Can be situational, developmental, or sociocultural •Results in impairment and weakening of the immune system and is a causative factor in many health problems

Stress: Caregiver Burden (not tested)

•Results from the accumulation of stress experienced by a patient's family members after providing care for the patient for a period of time •May include difficulty sleeping, fatigue, and illness, such as elevated blood pressure and psychiatric illness

roles issues (not tested)

•Role conflict - Occurs when one must take on opposing roles that are incompatible; may be interpersonal or inter-role -Example of interpersonal role conflict: Occurring when a parent expects a teenager to perform household tasks and participate in sports -Example of inter-role conflict: Occurring when a mother wishes to stay home with her child but has to return to work due to family finances •Role strain - Occurs when one feels inadequate for a role resulting in anxiety and frustration -Example: Caring for a parent with dementia; your kid diagnosed w/ T1DM •Role overload - Occurs when one has more roles and responsibility than they can manage; very common -Example: Taking on the roles of student, parent, and employee •Role ambiguity - Occurs when there is confusion or uncertainty about the expectations for a role when taking on that role (ex. New job) •Sick role - The way others and society expects one to behave when ill -Examples: Caring for self while one is ill and/or continuing to provide care for grandchildren -Conflict: role w/ 2 dimensions that cant both occur (ex. Mother wants to work to provide for kid and to spend time w/ kid) or 2 diff roles cant both occur

SEXUAL IDENTITY

•Self-identity •Biological sex •Gender identity •Gender nonconformity... atypical behavior for gender •Gender dysphoria.. Discomfort/ anxiety with biological sex -Gender role behavior or expression •Cisgender.. Matches societal norms •Transgender.. May be different from societal norms •Sexual orientation Attraction to others

culture

•Shared system of beliefs, values, and behavioral expectations •Provides social structure for daily living •Defines roles and interactions with others and in families and communities •Apparent in the attitudes and institutions unique to the culture •Subcultures.. Large group of people who are members of a larger cultural group: WVU nursing student •Age, Gender, Marital status, Family structure, Income, Educational level, Religion, Life experiences •LANGUAGE.. Primary means of communicating culture. •Culture Shock .. Feelings a person may experience when placed in a different culture .. May feel strange, increase anxiety, discomfort ; their own patterns of behaviors and adaptation are no longer accepted or working •Ethnocentrism.. The belief that one's culture is superior to others and interferes with cultural competent care •Stereotyping: assumptions about an ethnic group or culture

Therapeutic Communication Techniques

•Silence •Offering self •Active listening •Presenting reality •Asking questions •Clarifying - May accomplish this through restating, reflecting, paraphrasing, or exploring •Offering broad opening statements or general leads •Demonstrating recognition and acceptance •Focusing •Giving information •Summarizing •Touch •Sharing feelings

Coping Mechanisms (not tested)

•Sleeping, crying, laughing, cursing •Exercise, physical activity •Drinking, smoking •Withdrawal, lack of eye contact •Limiting relationships with others to those with similar interests and values -Too much of anything is unhealthy

Factors Affecting Stress and Adaptation (not tested)

•Sources of stress •Types of stressors •Personal factors

RELIGION AND BELIEFS

•TAYLOR pages1796-1797 (PLEASE LOOK!!) •Religion can influence cultural practices (birth, death, marriage, moral beliefs) •Acceptance/ forms of birth control. •These may be different from your PERSONAL religion/ beliefs. •We need to honor the PATIENT'S wishes and beliefs. •Support religious rituals. -Icons -Statues -Prayer rugs Devotional readings -Music RELIGION BELIEFS SELECT HEALTH CARE PRACTICES -Adventist Believe in the person's choice and God's sovereignty. The body is believed to be the temple of the Holy Spirit. • The taking of all narcotics and stimulants is prohibited because the body is the temple of the Holy Spirit and should be protected. Many groups prohibit meat. • Many regard Saturday as the Sabbath. • Approach to health care is holistic. -American Muslim Mission Accept the Koran as their sacred scripture (see Islam); most stress the importance of cooperation among Blacks in business and education to build self-esteem. • Members are encouraged to obtain health care provided by members of the Black community. • Major tenets involve prayer rituals, dietary restrictions (prohibitions against pork and alcohol), hygiene (extreme cleanliness), lifestyle modifications, and marital faithfulness. -Baha'i International Community Believe in a basic harmony between religion and science • Seek out competent medical care and pray for health. • Obligatory prayers, holy days, and the 19-day fast. • Permanent sterilization is prohibited, and abortion is discouraged. -Buddhism Buddha—or "the Great Physician"—taught the Four Noble Truths to indicate the range of "suffering," its "origin," its "cessation," and the "way" that leads to its cessation. The real cause of human suffering is ignorant craving. The Noble Eightfold Path—which consists of right views, aspirations, speech, conduct, mode of livelihood, effort, mindfulness, and concentration—leads to the cessation of suffering. • Buddhists do not outwardly proclaim healing through faith. However, spiritual peace and liberation from anxiety attained through the awakening to Buddha's wisdom may be an important factor in expediting healing and the recovery process. • Accepts modern science. The doctrine of avoidance of extremes is applied to the use of drugs, blood, vaccines. • Buddhism does not condone taking lives of any form. • Check with the patient about any special diet restrictions and the observance of holy days. -Christian Scientist They deny the existence of health crises; sickness and sin are errors of the human mind and can be overcome by altering thoughts, not by using drugs or medicines. • They will use orthopedic services to set a bone but decline drugs and, in general, other medical or surgical procedures. • They do not allow hypnotism or any form of psychotherapy, which alters the "Divine Mind." • A Christian Science Practitioner may be called to administer spiritual support. • Alcohol and tobacco are not used. -Church of Jesus Christ of Latter Day Saints (Mormons) Devout adherents believe in divine healing through the "laying on of hands," though many do not prohibit medical therapy. The Church maintains an extensive and well-funded welfare system, including financial support for the sick. • Disapprove of alcohol, tobacco, and caffeinated beverages. • A special undergarment worn by some members should be removed only in an emergency. Confucianism Inherent in Confucianism is the appreciation of life and the desire to keep the body from untimely or unnecessary death. • Appreciate life and desire to keep the body from untimely or unnecessary death. • Historically emphasized public health solutions to impending health problems. --Daoism (Taoism) Health is a manifestation of the harmony of the universe, obtained through the proper balancing of internal and external forces. Implicit throughout the Daoist tradition is the tendency to understand salvation in the biomedical sense of health and qualitative improvement and prolongation of human life. The universal principle of the Tao is the mysterious biologic and spiritual life rhythm or order of nature. • There is a "medicinal" concern for maintaining and prolonging human health and life (sheng). Knowing and living a natural life—following the Tao—is the secret of both health and sagehood. • Long tradition of seeking pragmatic medical techniques, along with its religious techniques of meditation and ritual for establishing a harmony of body and spirit, humanity, and nature (holistic approach). -Hinduism Doctrine of Transmigration. Moral factors, linked with the all-embracing doctrine of "karma," are believed to be significant in promoting health or causing disease. • Hindu medicine shows a surprising openness to new ideas, at least in respect to practical treatment. • Many Hindu dietary restrictions conform to individual sect doctrine. • The nurse administering medications should avoid touching the patient's lips. • Certain prescribed rites are followed after death; disposal of the body is by cremation. -Islam Allah, one God, who is only one, all seeing, all hearing, all speaking, all knowing, all willing, all powerful. Must be able to practice the Five Pillars of Islam. May have a fatalistic view of health. • Obligatory prayers, holy days, fasting (Ramadan), and almsgiving. • Koranic law and customs that influence birth, diet (eating pork and drinking alcohol are forbidden), care of women, death and prayer rituals. • Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought. -Jehovah's Witnesses They oppose the "false teachings" of other sects; opposition often extends to modern science, including medicine. • Blood transfusions violate God's laws and therefore are not allowed. • The courts have not supported the right of Jehovah's Witness parents to refuse lifesaving treatment for their children. • Use of alcohol and tobacco are discouraged. Judaism Formation closely bound with a divine revelation and with commitment to obedience to God's will. The Hebrew Bible is the authority, guide, and inspiration of the many forms of religion of the Jews (currently Reform, Conservative, Orthodox). • For observant Jews: special needs in the areas of diet, birth rituals, male and female contact, and death. • Treatment and procedures should not be scheduled on the Sabbath. Native American Religions Difficult to generalize; notion of cosmic harmony, emphasis on directly experiencing powers and visions and a common view of the cycle of life and death. Death is not the end but the beginning of new life (reincarnation or transcendent hereafter). • Rituals mark important life changes: birth, puberty, initiation rites, death. • Medicine men and women have specialized spirits from whom they receive the mission to cure. • Common therapeutic measures: sucking, blowing, and drawing out with a feather fan. -Protestantism Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Most accept modern medical science. • Religious practices vary according to denomination; may include prayer, faith healing, "laying on of hands," and anointing. • Sacraments: baptism, communion, confirmation. Roman Catholicism Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is also the healer. Human life is a gift of God. Many take an antiabortion stance; most accept modern medical science. • Importance of private devotions and Mass attendance on Sunday. • Seven sacraments (importance of baptism, Eucharist, penance, and the anointing of the sick). • Dietary habits. • Sexual ethical norms. • Only natural means of birth control; abortion, euthanasia, and sterilization are forbidden. -Sikhism Draws on features from Islam and Hinduism to establish a reformist movement with the aim of creating a new world order based on equality and social justice for all. The holy book is a code of conduct for daily life and an instruction for reaching true understanding and unity with God, the ultimate goal. • Respect the special dress code including "Kesh," uncut hair for both men and women, and "Kara," a steel bangle worn on the right wrist. Removing a turban without permission, except in an emergency, is considered an insult. • Sexual activity is allowed only within marriage. Large families are encouraged, more for cultural than religious reasons. • Sikhs prefer a nurse or doctor of the same sex. Unitarian Universal Association of Churches and Fellowships Encourage creativity, reason, and living an ethical life. No member is required to adhere to a given creed or set of religious beliefs. The inherent worth and dignity of every person is affirmed. • Free to accept what they take to be best for their health.

death

•The 1981 Uniform Determination of Death Act gives a legal definition of death as either "(1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem." •Most protocols for the pronouncing of death require two distinct clinical examinations. •Medical criteria for the certification of death include: cessation of breathing, flat encephalogram (EEG), no response to stimuli that is deep and painful, and lack of spontaneous movement and reflexes.

USING AN INTERPRETER

•The Joint Commission requires that an interpreter be available in health care facilities in the patient's language (2010). • Use only a facility‑approved medical interpreter. •Do not use the client's family or friends, or a non-designated employee to interpret. •Inform the interpreter about the reason for and the type of questions that will be asked, the expected response (brief or detailed), and with whom to converse. •Interpreters must recognize their role without being biased of the client's response. •Allow time for the interpreter and the family to be introduced and become acquainted before starting the interview. •Refrain from making comments about the family to the interpreter because the family might understand some of the discussion. •Ask one question at a time. •Direct the questions to the client, not to the interpreter. • Use lay terminology if possible, knowing that some words might not have an equivalent word in the client's language. • Do not interrupt the interpreter, the client, or the family as they talk. • Do not try to interpret answers. •Following the interview, ask the interpreter for any additional thoughts about the interview and the client's and family's responses, both verbal and nonverbal.

STEREOTYPING

•The assumption that all members of a culture or ethnic group act alike •May be positive or negative •Negative includes racism, ageism, and sexism

Local Adaptation Syndrome (LAS)

•The body's localized response to stress •Instead of involving the whole body, only a specific part of the body is involved, such as an organ or tissue •LAS is precipitated by stress that may be pathologic or traumatic. •A short-term adaptive response that is primarily homeostatic •Two most common types: inflammatory response (ex. Splinter) and reflex pain response (cooking and touch smthhot and drop it)

evaluating the care plan

•The care plan is considered to have been successful if the patient and family are able to: -Verbalize the causes and effects of anxiety and stress -Identify and utilize sources of support -Problem solve to find solutions for stressors -Practice techniques to reduce anxiety and healthy lifestyle habits -Verbalize increased comfort and decreased anxiety

Anxiety (not tested)

•The most common stress response •"A vague, uneasy feeling of discomfort or dread" •Source of this feeling is often nonspecific or unknown •Mild: Increased alertness and perceptual fields, such as hearing and vision •Moderate: Narrowed perceptual fields to focus on the immediate concern •Severe: Narrowed focus on details that are specific •Panic: Experience of terror and dread and loss of control

Anticipatory Grief

•The process of starting to "let go" of someone or something before the loss actually occurs. (ex. Told only 6 months to live. Sometimes more grief before than after)

CULTURAL DIVERSITY

•Varying cultures •Racial and ethnic origin •Religion •Physical size, age, and gender •Sexual orientation •Disability •Socioeconomic and occupational status •Geographical location

Loss

•When someone or something of value experiences change or is no longer accessible resulting in diminishing or removing of its value •Actual loss - Recognizable to the person experiencing the loss, as well as, other people •Perceived loss - Recognizable to the person experiencing the loss but not to others (not visible to others. Ex. You're retiring and feel loss of role while others view it as positive) •Anticipatory loss - When a person experiences a reaction to loss that has not occurred yet •Necessary loss - Related to changes in the life cycle that can be anticipated (happen to us all) •Developmental or maturational loss - Normal and expected, results from the normal life transitions in the developmental process of life, and results in the development of coping skills (ex. Parents had one when you go to college) •Situational loss - Unanticipated and caused by an external event (ex. Losing home to fire, doesn't happen to everyone) -Losing obj, person, that way smth was