Nursing 261 Exam 1

paternalism

Acting upon one's own idea of what is the best for another person without consulting that other person. Is often justified by the assertion that there persons affected will be better off or protected from harm. (Seat Belt)

advocacy

An ethical concept for nursing practice and refers to providing support for a patient's rights or best interests. The focus of the client advocacy role is to respect client decisions and enhance client autonomy. Nurses take responsibility to protect the legal and ethical rights of patients

(6) Describe the strategies of nurses that address health concerns of emerging populations.

Be a motivational factor to influence attitude change, financial advocacy by professionals in the health field, private and public action at all levels to reduce social and environmental health hazards. - Need to become responsive to the cultural values of different people and to realize how it can make healthcare better. Need to be knowledgeable and culturally competent. Need to give care that is respectful of and responsive to diversity. Three different healing systems: Self, professional, and folk. Some nurses use assessment guides for specific cultural assessments (Andrews and Boyle transcultural nursing assessment guide) - The quest to deliver culturally competent care has provided the impetus for nursing faculty to require transcultural courses in the nursing curriculum to facilitate awareness and understanding of cultural diversity. - -Nurses have responsibilities to be aware of specific health needs and respond to illness in all populations. - -Additionally, nurses with advanced preparation have committed their time and energy to developing approaches and models for transcultural nursing.

(21) Risk factors for dysfunctional health patterns in Families:

Can be inferred from lifestyle, biological factors, environmental factors, social, psychological, cultural, and spiritual dimensions, and the health care system. Lifestyle habits, such as overeating, or drug dependency. Biological factors such as genetic inheritance, or mental retardation. Environmental factors that influence family function. Social and psychological factors such as crowding, or isolation, etc. PAGE 154

(18) Value Ethical Theory

Concerned with either discovering what humans value (descriptive) or proposing what they ought to value ( normative)

(23) Describe developmental stages of families

Developmental phases for families Couple (marriage) Childbearing family Family with preschool & school-age children Family with adolescents Family with young & middle-age adults Family with older adults

veracity

Devotion to the truth This is another principle that supports health-promotion activities. People whose health is in question are to varying degrees reliant upon the person who possesses the knowledge and skills to bring these to bear on their behalf. It is in giving people information about their health care needs facilitates autonomous choice and enhances personal decision-making.

(3) Secondary Prevention

Early diagnosis and prompt treatment: case-finding measures (individual and mass screening surveys), selective examinations to cure and prevent disease process, prevent spread of disease, prevent complications and sequelae, Shorten period of disability. Disability limitations- adequate treatment to arrest disease process and prevent further complications and sequelae, provision of facilities to limit disability and prevent death

Elimination (Gordon's functional health pattern)

Excretory function (bladder, bowel, and skin)

Activity-exercise (Gordon's functional health pattern)

Exercise, activity, leisure, and recreation

justice

Fairness and treating people equally. Nurse provides the same level of care regardless of their socioeconomic background. Equalizing benefits across society, regardless of being worthy.

Ericksons Infancy

First year of life Trust vs Mistrust Rapid steady growth; reflexive to purposeful behavior Caregiver-child bonding based on personal interactions Environment provides sensory stimulus for learning

(4) Discuss the nurse's role in health prevention and assessment of individuals

Focus on wellness, assist to maintain/obtain optimal health, assessment of strengths, not just deficits, accomplished through the nursing process. The role of the nurse is to focus on their strengths, so that they're empowered to change their behavior and improve their own health.

Nutritional-metabolic (Gordon's functional health pattern)

Food and fluid consumption relative to metabolic needs and indicators of locals nutrient supply

social justice

Good for all, we can have equal services for all, but it doesn't mean we're all going to reach the same outcome. If we want the same outcomes we need to vary the amount of resources we give. -Includes formal or informal systems within a society that are concerned with disparities in socioeconomic conditions leading to poor health and fairness in the distribution of goods such as health, education, food, and shelter.

(5) Describe the health concerns and issues of emerging populations:

Hispanic population is larger than any other population, in 2050 most of population will not be white. Age proportion in the future will be different. - Stress from rapidly changing and fast-paced society presents psychological and spiritually poor health habits. PTSD is more common, obesity is attributed to lack of exercise and increased food proportion sizes, more abuse of tobacco, drugs, and alcohol. A substantial change in wellness is occurring (infectious disease and acute disease used to cause major death in 20th century but today death is caused by chronic conditions like heart disease, stroke, and cancer. Diagnosis and treatment used to help but can't now. - Include minorities and homeless people. - Arab americans: limited health-related information and a scarcity of scholarship, suffer chronic health problems such as diabetes and coronary heart disease, mental health and role of acculturation, don't get help when needed, too many adolescent waterpipe tobacco smoking, no access to culturally suitable and current care, barriers like religious values, cultural norms related to modesty, gender issues with same sex health professionals, use of folk remedies, and stress assimilation - Asains or pacific islanders: Carry disease from country, infrequent medical visits as a result of language/cultural barriers, lack of health insurance, fear of transportation, caner/heart disease/ unintentional injuries/ stroke. Increased rate of HIV/AIDS, - Latino/Hispanic: is often associated with factors such as language/cultural barriers, lack of access to preventative care, and lack of health insurance. Heart disease, cancer, HIV/AIDS, stroke and diabetes. Lack of racial and ethnic diversity in leadership and workforce of healthcare, lack of interpreter services, lack of or inadequate culturally appropriate health care resources - Blacks- social/economic/ and environmental factors. High rates of infant mortality and maternal mortality, living in poverty. Malnutrition, anemia, and lead poisoning, uncollected garbage, abandoned buildings for illegal activity, HIV/AIDS, obesity, diabetes, heart disease, and hypertension, severe high blood pressure. - Native Americans- Social/ economic. Cultural barriers, geographic isolation, inadequate sewage disposal, and low income. Heart disease/ cancer/ accidents/ diabetes/ stroke. Difficult life situations and stress can cause desperation/ family dissolution/ alcohol abuse. Difficult access to healthcare, poor health, limited healthcare options. - Homeless: Poor health is cause and effect of homelessness. Behavioral/ social/ environmental. Higher risk of exposure to disease, violence, unsanitary conditions, malnutrition, stress, and addictive substances. Heart disease, cancer, liver disease, kidney disease, skin infections, HIV/AIDS, pneumonia, and TB. Stress, depression, and mental health. Do not have health insurance and some places refuse to treat homeless people, lack of knowledge regarding where to receive treatment, lack of access to transportation, and lack of identification. - Currently, emerging populations include ethnic minorities and persons who are homeless. The increasing population of immigrants has been a significant contributor to the presence of increasing numbers of major ethnic groups in the US. - The increasing populations of ethnic groups are one of many factors producing disparities in health status and access to the health care system in the US. - -These disparities in the health care system may cause increase in social costs attributable to the lost productivity or use of health care services among the ethnic minority populations. - -They are Minorities, homeless, LGBTQ

Health perception-health management (Gordon's functional health pattern)

Individual's perceived health and well-being and how health is managed

(19) Erickson's developmental stages

Infancy, Early childhood, late childhood, early adolescence, adolescence, early adulthood, middle adulthood, maturity

(1) Illness

Is composed of the subjective experience of the individual and the physical manifestation of disease. • Social constructs in which people are an imbalanced, unsustainable relationship with their environment and are failing to survive and create a higher quality in life. • Mismatch btwn a person's needs and the resources available to meet those needs. Signals individual and populations presently imbalanced. Illness is psychological, spiritual, and social components. A person can have a disease without feeling ill (somatic hypertension), and a person can feel ill, without having a diagnoseable disease (stress)

self-determination

Is part of their inherent human dignity. The Code of Ethics for Nurses calls us to practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

(13) Discuss concept of therapeutic use of self

Is the application of one's cognitions, perceptions, and behaviors to create interpersonal encounters that promote health in another person, family, group, or community. Without self-awareness and clarification of values, therapeutic use of self is impaired. Impacted by values and communication

beneficence

Is the quality or state of doing or producing "good." It presents us with the duty to maximize the benefits of actions while minimizing harms.

Erickson's Young Adult

Late teens - mid 30's Intimacy vs Isolation Physical growth completed Focus on personal and social tasks such as career choice, social and personal relationships, self-concept, and adult relationship with family Health Concerns: Accidents, violence, STI's, job & family stress, unhealthy lifestyle practices (alcohol, smoking). Need to learn self-breast or testicular exam.

(10) Differentiate between how healthcare is financed (private and federal programs: Medicare, Medicaid, etc.)

Medicare: It is a federal health insurance program that finances medical care for people older than 65, disabled individuals who are entitled to social security benefits, and people with end-stage renal disease requiring dialysis or a kidney transplant. There are 4 parts in there medicare plan: Medicare Part A, B, C, and D. Medicare Part A: -Hospital insurance, most people don't have to pay a premium for this because they already paid it when their spouse was working. If you have never worked or aren't married to someone who paid it already then you would have to pay. Financed largely through mandatory tax of 2.9%. -You are subject to a deductible and copayments, which may be difficult for many older adults to manage as a result of fixed incomes Medicare Part B:Medical visits, anything outside of the hospital, premiums are incurred for this insurance, it's based of the income you make. Considered a co-insurance. It is supplementary voluntary medical insurance financed through a combination of general tax revenues and premiums paid by beneficiaries. Medicaid: It is not available for everyone, have to meet an income requirement to be eligible. Usually for the poor or disabled. It's a federal program that is run through the state There are almost 20 different plans in this insurance. -They pay health care providers directly if they participate in this insurance program. It is an assistance program, commonly referred to as welfare, managed jointly by the federal and state governments to provide partial or full payment of medical costs for an individual - only for individuals with income levels 133% to 400%. -Medicaid pays the Medicare premiums, deductibles, and coinsurance for some individuals Private Insurance: You can get it through an employer. Individualized based on what that employer wants, you can chose from options. Fee for service- is when you go see a practitioner, when they charge the insurance company for your service. Third-party payer- an insurance company who pays a bill to the provider on behalf of someone else.

maleficence

Nurses and other health professionals can do harm inadvertently through such behaviors such as ignorance or incompetence. Ex: doing PT with a patient and they fall and fracture their arm due to undetected blockage in the heart.

(9) Role of a nurse as an advocate:

Nurses help individuals obtain what they are entitled to receive through the health care system, try to make the system more responsive to individual and community needs, and help persons develop the skills they need to help themselves. -help people get the care that they're entitled to receive, ex: (a patient who has asthma) a nurse makes sure that the patient gets what they're entitled to by following their asthma plan

(4) Discuss the nurse's role in health prevention and assessment of communities.

Nurses supply educational information to at-risk communities to develop heal-oriented skills, attitudes, and related behavioral changes.

Stages of Change Theory:

Pre-Contemplation, Contemplation, Planning/Preparation, Action, Maintenance

(3) Compare the three levels of prevention.

Prevention: averting the development of disease in the future. Three levels are primary, secondary, and tertiary.

Role of public health:

Promote and protect health of people and communities Encourage healthy behaviors Set safety standards for workers Develop school nutrition programs Track disease outbreaks Reduce health disparities

(14) Characteristics of a therapeutic relationship

Purposeful communication-asking purposeful questions in a way that we get maximum information. Trying to reach a certain goal Rapport- building harmony and an affinity between people in a relationship, developing an atmosphere where the patients concerns are of interest to the nurse. Being genuine, and open Trust-a necessary component of any helping relationship. Based on sense of safety,honesty, and reliability. Empathy- the ability to understand another's feelings without losing personal identity and perspective. Goal directed-a helping relationship exists solely to meet some need or to promote the growth of the recipient.

(7) Vulnerable populations

Residents of rural areas, undocumented immigrants, low-income individuals, racial/ethical minorities, people with no health insurance coverage, people with chronic conditions, people with language or cultural barriers, physically disabled or handicapped, terminally/mentally ill, People with HIV/AIDS, alcohol or substance abusers, homeless individuals, individuals who don't speak English, low education levels, anyone lacking health literacy.... individuals and groups at risk for health disparity are considered _____________________________. Examples include: residents of rural areas, undocumented immigrants, low-income individuals and families, racial and ethnic minorities, people with no health insurance coverage, the terminally or mentally ill, persons with HIV/AIDS, alcohol or substance abusers, etc.

(3) Tertiary Prevention

Restoration and rehabilitation: Provision of hospital and communities facilities of retraining and education to maximize use of remaining capacities, education of public and industry to use rehabilitated persons to fullest possible extent, selective placement, work therapy in hospital, use of sheltered colony.

(21) Risk factors for dysfunctional health patterns in communities:

Risk-factor theory identifies human characteristics and behaviors that increase the likelihood of the manifestation of health problems. Risk factors associated with disease, illness, and death rates, although not casually associated, predict the likelihood of a particular adverse health condition in communities of interest. They include a combination of demographic,psychological, physiological, and environmental characteristics.

(19) Gordon's functional health pattern

Said that we all have functional patterns that interact with each other. It allows us to focus on the individual as a whole and not just their disease. Rationale: Centers on health, focuses on nursing knowledge, provides structure and flexibility. It focuses on 5 areas: pattern, individual-environmental, age-developmental, functional, and cultural. (We look at the environment, how does it influence the patient. Takes in consideration your age development orientation, where they're in their developmental aging. What am I looking at functional ability? How I walk, how I get up and down the stairs, am I able to do proper hygiene on myself?)

Self-perception-self-concept (Gordon's functional health pattern)

Self-concept pattern and perceptions of self (body comfort, body image, and feeling state); self-conception and self-esteem

Cognitive-perceptual (Gordon's functional health pattern)

Sensory, perceptual, and cognitive patterns

trust

Service professions such as nursing, medicine, and teaching are in part defined by their relationship to those in need of services. The professional has the knowledge and skills to meet an individual's needs or the needs of a group. The potential recipients of services lack the knowledge or ability to anticipate or meet their own needs but believe that the professional will keep their best interests as the primary goal and will strive to meet their needs.

Sleep-rest (Gordon's functional health pattern)

Sleep, rest, and relaxation

(18) Utilitarian Theory

Such theories have a tendency to privilege the good of the group over the needs of individuals. Assesses an action in terms of its consequences or outcomes; i.e., the net benefits and costs to all stakeholders on an individual level. It strives to achieve the greatest good for the greatest number while creating the least amount of harm or preventing the greatest amount of suffering

(19) Maslows Hierachy of Needs

Suggests five interdependent levels of basic human needs (motivators) that must be satisfied in a strict sequence starting with the lowest level. 1. BASE- Physiological (breathing, food, water, sex, sleep, homeostasis, excretion) 2. safety (security of body, employment, resources mortality, of the family, of health, or property) , 3. love/belonging ( friendship, family, sexual intimacy) 4.self-esteem (self-esteem, confidence, achievement, respect for/by others) 5.self-actualization (morality, creativity, problem solving, lack of prejudice, acceptance of facts)

confidentiality

The ability to maintain privacy in one's life is an expression of autonomy. The right to limit the access of your personal information to anyone but yourself, and because of that it limits who we can give information to (HIPPA). We guard patient ______________________.

nonmaleficence

The duty to do no harm. The basis for most nursing codes of ethics. It prohibits clinicians from harming those for whom they provide services. It means that in planning activities on an individual or societal level, possible harms must be minimized.

(9) Role of a nurse as an care manager:

The nurse's role as this is prevent duplication of services, maintain quality and safety, and reduce costs. This role depends on collaborative relationship among this individual, other nurses and physicians, the patient/ their family, and other people who work with the patient. The wishes of the individual and family need to be made clear to this role of a nurse. Communication is key -prevents the duplication of services. Ex: an insurance nurse is responsible is to make sure the patient has what they're entitled to but, also that the patient is not seeing two pulmonologist, to make sure there's no duplication of services.

(24) Discuss underlying concepts of family theories

The purpose of theory is to help us predict behaviors, helps us predict what people will do, also helps us categorize behaviors. They are usually founded on lots of research. The whole is more than the sum or its parts, the family is more than the individual pieces. Change in one part or member of the family results in changes in the family as a whole. Interrelated elements and structure Patterns of interaction Boundaries (open to closed) Functions by the "Composition Law" The Whole is more than the sum of its parts Shaped by messages and rules Comprised of subsystems

(12) Communication barriers

These barriers can originate with the nurse, the individual, or both. Diagnosing the source of the communication breakdown, taking steps to correct it, and using knowledge too the communication process and appropriate therapeutic techniques are the nurse's responsibility. Belittling the others feelings, Disagreeing with the patient/family, Defending, Making stereotyped comments, Changing the subject, Giving literal response, Using clichés, Giving advice, Giving approval, Requesting and explanation, Agreeing with the other person, Expressing disapproval, Challenging

(11) Discuss how the Affordable Care Act has impacted vulnerable populations.

This is why the Affordable Care Act was passed, to covered those who aren't insured, with the anticipation that we would be increasing the number of people who are insured. By doing so, because it's free for the uninsured, we have to increase the cost to someone else. We haven't increased capacity in the system for these people. Now we have an over-capacity in the system. Providers won't see people with specific insurance. When we need to have a medical home- family practice that they go to to seek medical care, the purpose of the medical home is to decrease the number of visits to the ER, get to know a provider who knows their history, charts.

(18) Duty-based theory:

Those of various religions depend more on adherence to duties than on good consequences. Individuals are view as having certain duties that cannot be circumvented, even if deliberately avoiding the duty would result in good outcomes. Immanuel Kant believed that our moral reasoning has been proposed as a model for health promotion. He believed that lying is always wrong even if on some occasions it produces a good outcome.

(17) informed consent

To research, treatments, or health-promotion endeavors is a process of ensuring that a person has all of the appropriate information necessary to reach a decision about participation that facilitates autonomous action. A person with substantial understanding, and without substantial control by others, intentionally authorizes a professional to intervene on his or her behalf.

(16) autonomy

Two types: the extent of individual autonomy. The freedom of action. May be limited by the duty of protecting the health and safety of society. Freedom to choose without coercion, informed consent to treatment, interventions, and health-promotion efforts. Nurses and other health care professionals have a responsibility to speak up on behalf of people whose rights have been compromised or endangered. It requires that we permit individuals to make their own decision, even when these decisions seem to others to be ill-informed. Refers to self determination and the right to make one's own decisions

(12) Why is effective communication important as a nurse?

Understanding what makes communication effective improves the nurse's ability to assess needs and to intervene successfully to promote individual's health. Implementing these steps to functional communication between nurses and individuals, and between nurses and other care providers, is essential to ensure patient safety and quality care.

(12) Effective Communication

Use broad opening statements, Use general leads, Reflecting, Share observations, Acknowledge the other's feelings, Silence, Giving information, Clarifying, Verbalize implied thoughts and feelings, Exploring Presenting reality, Voicing doubt, Suggesting collaboration, Validating Listening (recipriocity) Flexibility Silence Humor Touch Space

(18)Descriptive ethical based theories:

Values based on observations of human behavior over time and in different settings. DO NOT tell us what actions we ought to take and NOT directive. they merely tell us how people act toward each other and their environments and what they seem to believe are good or moral actions.

Values-beliefs (Gordon's functional health pattern)

Values, beliefs (spiritual also), or goals that guide choices or decisions.

(8) Differentiate between the functions and responsibilities of the private and PUBLIC sectors of the healthcare system.

contains official and voluntary public health concerned with environmental risks, infectious diseases, address children and mothers, treats chronic disease, substance abuse, mental illness, teen pregnancy, LTC, epidemics of violence and/or AIDS/HIV, bioterrorism, and disaster prep

(7) Health disparities

defined by healthy people 2020, "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage" and "health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on racial or ethnic group." Represent a lack of essary costs and diminish the quality of life for persons seeking care -When a specific service isn't available, -Inequities lead to increased disparities -It includes disparities in health and in health care. A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage, and they adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health, or other characteristics historically linked to discrimination or exclusion. -They represent a lack of efficiency within the health care system and account for unnecessary costs and diminish the quality of life for persons seeking care.

Coping-stress tolerance (Gordon's functional health pattern)

general coping patterns and effectiveness in stress tolerance

(14) Strategies to promote a therapeutic relationship

genuineness, open, concerned, trusting the individual, clearly defining relationship, being consistent, being empathetic

(7) Health equity

is the accomplishment of the highest level of health for all people. Attaining this requires valuing everyone equally with societal efforts to deal with preventable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities -An individual's ability to achieve good health could be affected because of race or ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic location. -When a specific service isn't available, inequities lead to increased disparities.

(3) Primary Prevention

prevention precedes disease or dysfunction. This is therapeutic in that it includes health as beneficial to well-being. Includes health promotion, such as health education about risk factors for heart disease. And specific protection: immunizations against hep b. Its purpose is to decrease the vulnerability of the individual or population to disease or disfunction. Interventions: encourage individuals and groups to become more aware of the means of improving health and the actions they can take at primary and optimal health level. Can also include advocating for policies that promote health in community and electing public officials who enact legislation to protect public health. Health promotion: Health education, good standard of nutrition, attention to personality development, provision of adequate housing, reaction, and agreeable working conditions; marriage counseling and sex education, genetic screening, periodic selective examinations Specific Protection: Use of specific immunizations, attention to personal hygiene, use of environmental sanitation, protection against occupational hazards, protection from accidents, use of specific nutrients, protect from carcinogens, avoidance of allergens

Roles-relationships (Gordon's functional health pattern)

role engagements and relationships

Sexuality-reproductive (Gordon's functional health pattern)

satisfaction and dissatisfaction with sexuality and reproduction

(1) Disease

"without ease" The failure of a person's adaptive mechanisms to counteract stimuli and stresses adequately, resulting in functional or structural disturbances. • Ecological concept which uses multiple factors to determine cause of disease rather than describing one single cause. This multifactual approach increases chances of discovering multiple points of intervention to improve health.

(9) Role of a nurse as an consultant

- Nurses may provide knowledge about health promotion and disease prevention to individuals and groups as this role. All nurses need to develop consultation skills that can be integrated into practice and allow the individual nurse to take advantage of opportunities to provide support on an individual level. - an individual who has specialized knowledge and they use that knowledge to provide a service to someone. Ex: that nurse can sit on a board of directors and use that knowledge to guide that meeting, might be brought in to consult with a group of nurses because they're specialized

(22) Apply the nursing process to assessment of individuals

-Assessment - Collection and Analysis of Data; Problem identification (ex: Nursing Diagnosis) and Identification of contributing factors -Planning -Goals -Interventions -Implementation -Evaluation (Gather subjective information- what the patient says. Gather objective information, what I observe, hear, and sense. We use this information to identify contributing factors, look at their environment, their ambulatory ability, focus on the functional ability rather than their medical diagnosis Allows us to focus our efforts so that this patients problem improves by implementing our interventions Then we go back and evaluate This is a cyclical process, we go back and assess the situation again)

(22) Apply the nursing process to assessment of families

-Assessment: Analyze data using family life cycle approach. Functional, potentially dysfunctional, or dysfunctional .Nursing diagnosis based on developmental needs (Why and when? Family is experiencing emotional, physical, or spiritual suffering or disruption caused by a family crisis (acute or chronic illness, injury or death) or a developmental milestone (birth or youngest child leaves home) Family defines an illness or problem as a family issue Child or adolescent is identified by family as having difficulties (bullying, fear of cancer treatment) Family is experiencing issues that jeopardize family relationships (addictions) Family member is admitted to psychiatric hospital Child is admitted to the hospital) -Planning:Promote health and prevent dysfunction; Immunization schedules, growth & development milestones, nutrition requirements. Goals reflect functioning at a higher level of health Implementation: needs to happen with the family, they have to meet expectations, sometimes we have to be firm for them to understand they need to do specific things to get the results they need. Evaluation- how much movement have they made moving toward their goal Families have imbedded issues that will not change overnight, are they making advancements toward their goal even if it's a small step?

(2) Outline the overarching goals for Healthy People 2020.

-Attain high-quality, longer livers free of preventable disease, disability, injury, and premature death. -Achieve health equity, eliminate disparities, and improve the health of all groups. -Create social and physical environments that promote good health for all. -Promote quality of life, healthy development, and healthy behaviors across all life stages. Its about health prevention and health promotion.

(4) Discuss the nurse's role in health prevention and assessment of families

-Collaborate with the family about their goals, they have to be involved -Focus on patterns with behavior and patterns with that family that could potentially change for this family -Be the role model -You are role modeling planning, interventions, and change in family process -The nurse acts as the hub of resources for that family, they're the ones that need to make the referrals for other services for that patient -The nurse is going to assess what tools this patient will need to be mobile -We are guiding their decision making, not doing the decision making for that individual

(22) Apply the nursing process to assessment of communities

-Community-based nursing: focuses on the individual needs of the clients -Public health nursing: focuses on a population, disease controls, vaccination polls Windshield survey- walking through town Various perspectives: Systems ( connects and integrates community data) Have both structure and function Developmental (form a basis to identify groups with potential health concerns) Risk-factor Analysis of data: Epidemiological approach Analyze data statistically Observe for patterns Theory application Nursing diagnosis Focused on change of risk factors Planning -Short, intermediate, and long-term goals -Collaborative/multidisciplinary -Community-based -Prioritize problems -Identify nursing specific actions -Must consider stages of change (pre-contemplation, contemplation, planning/preparation, action, maintenance)

(9) Role of a nurse as an educator

-It is important for nurses to be good teachers. To teach effectively, they nurse must know essential facts about how people learn and the teaching-learning process. Selection of the methods most likely to succeed involves the establishment of teacher-learner goals. -Health education is one of the primary prevention techniques avail;e to avoid the major causes of disability and death today. - We're educated to asses, plan, implement. We're constantly teaching

(9) Role of a nurse as an deliverer of services

-The core role of the nurse is this role, such as health education, flu shots, and counseling in health promotion. Visible, direct delivery of nursing care is the foundation for the public image of nursing - a number of services that are given broadly, not just in the hospital setting

(9) Role of a nurse as an healer

-This requires the nurse to help individuals integrate and balance the various parts of their lives. This resides in the ability to glimpse or intuit the "interior" of an individual, to sense and identify what is important to that other person, and to incorporate the specific insight into a care plan that helps that person develop his or her own capacity to get better. -when you therapeutically use yourself to help a patient heal, open communication, facilitation that relationship between the nurse and their client

(9) Role of a nurse as an researcher

-To provide optimal health care, nurses need to use evidence-based findings as their foundation for clinical decision-making. Nurses need to recognize that research is important as a basis for their practice and that they need to participate in the research process. -We are educated on how to research that might be applicable to our practice, the interpretation of those findings that we apply so we can help change our practice.

Erickson's Toddler

1 - 3 years Autonomy vs Shame & Doubt Gross to fine psychomotor skill development Egocentric - no right or wrong Wants independence; fears separation Health Concerns: Accidents (ingestion, drowning), ear and upper respiratory infections.

(20) Apply Gordon's functional health patterns to assessment of communities.

1. Health perception-health management pattern identifies data about community health status, health-promotion and disease-prevention, and community members perceptions of health. (focus groups, mortality and morbidity stats can provide measurement of data) 2. Nutritional-Metabolic Pattern- identifies data relevant to community consumption habits as reflected in accessibility or availability of food stores and subsidized food programs. Collect data from walking through community, must provide info on: grocery stores, fast-food establishments, ethnic shopping facilities, and street venders. get info from govt programs, soup kitchens, food donations 3. Elimination Pattern- identifies environmental factors including exposure to pollutants through soil, water, air and food. Two categories: Physical: geological, geographical, climatic, meteorological Biological: living things such as plants, animals and waste products, disease agents, microbial pathogens, and toxic substances Observation, focus groups, and interviews. 4. Activity-exercise pattern- identifies physical activities and recreational options in the community. Observation, focus groups, and interviews. 5. Sleep-rest pattern- identifies a community's rhythm of sleeping, resting, and relaxing. Observation, focus groups, and interviews. 6. Cognitive-perception pattern- identifies information about problem-solving and decision making within the community. Bargaining and convincing people to comply bc loyalty. Observation, focus groups, and interviews. 7. Self-perception- self-concept pattern: identifies self-worth and personal identity of communities. Characteristics: image, status, and perceived competency. Housing conditions, buildings, clealiness.. school systems, crime rates, accidents, and opinions. Competency with social and political and community spirit. Observation, focus groups, and interviews. 8. The roles-relationship pattern- identifies communication styles along with formal and informal relationships. Use of media and mass info programs improve communication, flow of health info, and number of community members reaches. interviews, TV, internet, and newpaper 9. Sexual-Reproductive pattern- identifies reproductive data of communities, which is reflected in live birth stats, mothers' age, ethnicity, and marital status. patterns are shown in premature birth rates, low birth weight, or deaths, existing health services, health education, and community health stats, sex ed in school, levels of abuse, number of sex-related crimes. Minutes of meetings, health records, statistical data, and public documents 10. Coping-stress tolerance pattern- identifies the communities ability to cope or adapt. Efforts to obtain goods from environment, contain from environment, and retain goods within community play big role on health. Coping patterns aim to retain health protection services (immunizations and good health facilities), strict zoning laws and housing codes. expendable goods in the community include industrial and human wastes. minutes of meetings, public documents, health surveys, statistical data, and health records 11. Values-beliefs pattern- identifies community values and beliefs. Provides clues for health-promotion and protection. Focus groups, interviews with key members or health professional

(14) Stages of a therapeutic relationship

1. Orientation or introductory phase: Ask permission to enter the relationship Address the patient in his or her surname Introduce yourself and your role Explain why the data is being collected HIPAA You are establishing trust and confidence (rapport) Gathering very personal information! 2. Working phase: Gathering information Health history forms Open-ended interview 3. Termination phase: Easy transitions the session should end gracefully. Cue the ending OR Brief interaction: Introduce self State purpose of meeting Validate understanding Clarify parameters Focus and listen Elicit significant data

Erickson's: Adolescence

13 - 21 years Identity vs Role Confusion Sexual maturation Logical decision making Internalized moral code Needs close peer relationships Health Concerns: Accidents, substance abuse, pregnancy, STI's, and eating disorders

Ericksons Preschooler

3 - 6 years Initiative vs Guilt Lower physical growth with increased muscle coordination Concrete thinking: Asks why? Fears bodily harm Pretend play; Moves from parallel play to cooperative play Health Concerns: Accidents and speech disorders

Erickson's Middle Adult

35 - 65 years Generativity vs Stagnation Physical changes: menopause and andropause Focus on family, work, aging parents (sandwich generation) Health Concerns: Health screenings (mammogram, PSA), stress reduction, healthy lifestyle strategies, and adjustment to life transitions

(8) Differentiate between the functions and responsibilities of the PRIVATE and public sectors of the healthcare system.

5 different ones: 1. Traditional insurance companies (BCBS) and for-profit commercial insurance companies 2. PPO's (brokers btwn insurers and health providers) 3. HMO's which are independent payment plans. Try to lower health care costs 4. POS plans, combine HMO with personal choice 5. Self-insurance and self-funded plans, employee takes on role or enrolle sets up a trust act. with tax savings Use fee-for-service usually.

Erickson's School-age

6 - 11 years Industry vs Inferiority Fine tuning of body systems Intense cognitive development Abstract thinking evolving Develop problem solving skill; What if? Independence; Associates with same sex peers Developing moral code of right and wrong Health Concerns: Accidents, learning disabilities, infectious disease, and cancer

Erickson's Older Adult

65 and older "Old-old" and "Frail-old": 75 and older "Elite-old": 85 and older Ego Integrity vs Despair Ageism: a concern for nurses System-wide physical changes Cognitive changes due to illness not aging Numerous lifestyle changes Goals: Remain independent, accept aging, transitions, and loss Strategies: Reminiscence or life review (storytelling), exercise, nutrition, sensory stimulation Health Concerns: Chronic illness, medications, depression, alcohol abuse, elder abuse

(21) Risk factors for dysfunctional health patterns in individuals:

A pattern dysfunction will likely occur if interventions are not made. Early identification of potential problems is possible through systematic data collection and analysis. Potential problems are not actual problems but risk states; therefore, they have no specific cause and are identified when risk factors are present. We look at the environment, how does it influence the patient. Takes in consideration your age development orientation, where they're in their developmental aging What am I looking at functional ability? How I walk, how I get up and down the stairs, am I able to do proper hygiene on myself?

(1) Disability

A person who has a physical or mental impairment that substantially limits one or more major life activity. This includes people who have a record of such an impairment, even if they do not currently have a ________________. It also includes individuals who do not have a one but are regarded as having a this

(1) Health

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity