Ch. 3 and Ch. 4 Flashcards
what is community based health care?
focuses on health promotion
- care that is occurred outside the hospital
- provide acute and chronic conditions
- health foundation is the foundation of primary, secondary, and tertiary care
1st: we want to encourage health promotion, 2nd: we want to prevent the disease, 3rd: if necessary, go to a primary/secondary/tertiary care
what is Health People 2020?
the purpose is to establish goals for the United States population
- ex: decreases the % of people in the population who smoke
what is the purpose of the Health People 2020 goals?
for people to live longer, improve the quality of life, and eliminate health disparities
- ex: decrease the amount of people smoking will lead to less likely getting lung cancer and will have a longer lifespan
how are Health People 2020 goals made up?
Components of improved health care
Assessment of health care needs
- ex: look at infections or diseases within that certain population, crashes caused by teen drivers, teen pregnancies, looking at policies (Flint Michigan: lead in the water)
Access to care
- ex: prenatal care programs
what is social determinants of health
1st: look at Biology and Genetics
- certain sex and certain age groups are risked for medical problems
- ex: older males are more at risk for clots in their lungs
what is individual behaviors?
smoking, drugs, alcohol, unprotected sex are related to adverse medical problems
what are social environments?
Income
- ex: if you don’t have health insurance you will have a lower life span
what is a physical environment?
if a person lives in a crowded condition, they would be at risk for tuberculosis
what is health services?
having access to healthcare
Many older homes in a neighborhood are undergoing a lot of restoration. Lead paint was used to paint the homes when they were built. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?
A: Individual behaviors
B: Social environment
C: Physical environment
D: Health service
C: Physical environment
what is health care disparities?
A preventable health promotion that you will find in a group of people
- ex: In OB, there is a higher infant mortality rate for A.A babies
- poverty and inadequate access to prenatal care and healthcare
- behavioral problems: when women smoke while pregnant, the baby can die in its sleep (SIDS)
It is important to allow all populations to have:
Access care
- ex: prenatal care
Quality care
Equity care
what is community oriented nursing?
Community health nursing
Public health nursing
- Focuses on a certain population
- ex: High risk babies, ethnic groups (Native Americans) elderly
Want a bachelor’s degree, if wanting to specialize you need a master’s degree
what is an example of how you use Public Health Nursing?
Looking at a population of school kids
- The nurse will gather data based on statistics on playground injuries, lobby the community to encourage them to use shock absorbency material instead of concrete
Focus on the specific population, collect data, change the situation)
A community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.)
A. Decrease the incidence of asthma attacks in the community
B. Increase patients’ ability to self-manage their asthma
C. Treat acute asthma in the hospital
D. Provide asthma education programs for the teachers in the local schools
E. Provide scheduled immunizations to people who come to the clinic
A. Decrease the incidence of asthma attacks in the community
B. Increase patients’ ability to self-manage their asthma
D. Provide asthma education programs for the teachers in the local schools
what is the nursing practice in community health?
Expert community health nurses
- has an advanced degree: masters degree or higher
Understand the needs of a population or community
Use critical thinking skills to apply knowledge
Understand resources
- ex: when dealing with kids: schools are the best resource
Build relationships within the community
Are responsive to changes in the community
what is community based nursing?
Purpose: to reduce healthcare costs
- ex: homes and clinics
Need minimum 2 years of experience
Involves acute and chronic care
Provides services to enhance individuals capacity for self care
- provide services to where people live, work, and where you socialize
Promotes autonomy in decision making
The nurse caring for a refugee community identifies that the children are under vaccinated, and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.)
A. Raising awareness about community resources for the children
B. Teaching the community about health promotion and illness prevention
C. Promoting autonomy in decision making about health practices
D. Improving the health care of the community’s children
E. Participating in professional development activities to maintain nursing competency
A. Raising awareness about community resources for the children
B. Teaching the community about health promotion and illness prevention
C. Promoting autonomy in decision making about health practices
D. Improving the health care of the community’s children
what are vulnerable populations?
A group of patients with excessive risk factors
Limited access to health care
Depend on others for care
what are examples of vulnerable populations?
Immigrant populations
Poverty and homelessness
Patients who are abused
People living with substance abuse and mental illness
Older adults
what makes immigrant populations vulnerable?
A language barrier
May not have insurance
May or may not have transportation to a clinic
May use nontraditional healing practices (herbs)
what makes poverty/homelessness populations vulnerable?
Don’t have access for food or don’t have ways to store it if they do
When there is a healthcare problem, they go straight to the ER
what makes patients who are abused vulnerable?
You are a mandated reporter to report if you see:
- elderly abuse (65+)
- child abuse (younger than 18)
- disability abuse
what makes people living with substance abuse and mental illness vulnerable?
Homeless and people living in poverty
Risk for abuse and assault
what makes older adults vulnerable?
they have chronic diseases (heart problems, hypertension, diabetes) have a higher demand for health services
Vulnerable populations of patients are those who are more likely to develop health problems as a result of:
A. living at home.
B. abusive habits. (drugs/alcohol)
C. citizenship.
D. middle age.
B. abusive habits (drugs/alcohol)
What factor results in vulnerable populations being more likely to develop health problems?
A. The ability to use available resources to find housing
B. Adequate transportation to the grocery store and community clinics
C. Availability of others to help provide care
D. Limited access to health care services
D. Limited access to health care services
A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the need to provide further teaching? (false statement)
A. “Many patients with mental illness do not have a permanent home.”
B. “Unemployment is a common problem experienced by people with a mental illness.”
C. “The majority of patients with mental illnesses live in long-term care settings.”
D. “Patients with mental illnesses are often at a higher risk for abuse and assault.”
C. “The majority of patient’s with mental illnesses live in long term care settings.”
what is a caregiver?
Any kind of skills you do in the hospital you can do at home
- administer IV fluids, administer medications, changing dressings
what is a case manager?
Coordinate resources and services
- ex: office of aging, meals on wheels (service), a nurse to see her
what is a change agent?
- A patient is not going to their visits after they have been discharged from the hospital
- It is important to follow up with the patient to see why they aren’t going: if the clinic is too far, or they don’t have transportation
- Find a doctor office close to the patient or help coordinate transportation
what is a patient advocate?
Advocate: we are the patients voice when the patient can’t speak, we speak for them
- ex: a patient is dying of cancer: present both healthcare options: hospice or being at home
Let the patient make the decision
Whatever the patient wants, we support their decision
what is collaborator?
Working with other disciplines
- ex: working with a pastor, a social worker, physical therapist
what is a counselor?
Help patients identify the problem
Help develop different actions the patient would take
- ex: if someone is a victim of domestic violence; we would help develop different actions the patient could take (stay in a shelter)
what is an educator?
Teaching
- ex: prenatal classes, childbirth classes, infant care and child safety, and cancer screening
what is epidemiologist?
Look at the incidence, the distribution, and control of diseases
- ex: working at a school, someone contracted active tuberculosis, we need to see how they contracted it (if it was at home, school, or in the community)
A community health nurse conducts a community assessment focused on adolescent health behaviors. The nurse determines that a large number of adolescent’s smoke. Designing a smoking cessation program at the youth community center is an example of which nursing role?
A. Educator
B. Counselor
C. Collaborator
D. Case manager
B. Counselor
A nurse in a community health clinic reviews screening results from students in a local high school during the most recent academic year. The nurse discovers a 10% increase in the number of positive tuberculosis (TB) skin tests when comparing these numbers to the previous year. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse was acting in which nursing role(s)? (Select all that apply.)
A. Epidemiologist
B. Counselor
C. Collaborator
D. Case manager
E. Caregiver
A. Epidemiologist
C. Collaborator
what is community assessment?
Data collection on the population
Monitor health problems
Make information available to the community
- Structure of locale
- Name of community or neighborhood
- Geographical boundaries
- Emergency services (police, fire)
- Water and sanitation (Michigan had lead in the water)
- Housing
- Economic status: (the average household income and # of residence on public assistance)
- Transportation: (need transportation to get to resources- trains, taxis, busses)
- Safety: crime rates
- People
- Age and sex distribution- how many males/females
- Growth trends: (is there an increase in Geriatrics population- need to make sure resources/services are available)
- Density: a rural or urban area
- Education level: teach at an 8th-grade level
- Predominant ethnic and religious groups
- Social systems: what supports the people
- Education, Communication, and welfare system: (schools, universities, how do these communities communicate, how many people on welfare)
- Government
- Volunteer programs
- Health system: (do they have free health clinics, is there enough clinics in that area)
In identifying needs for health policy and health program development and services, a community assessment focuses on which of the following elements?
A. Structure
B. People
C. Social systems
D. All of the above
D. All of the above
The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
1. Structure or locale
2. Social systems
3. Population
- Structure or locale
- Population
- Social systems
What is changing patient’s health?
Knowledgeable about community resources (office of aging)
Collaborate with patients and their health care provider to provide patient- centered care
- Refer to a wound clinic and need to follow up
- The cheapest supplies they can purchase
Use evidence based practice
- using research
- ex: a certain ethnic group within that community has a high rate of childhood obesity
Understand your patient’s lives
- developing caring relationships with the patients, family, and communities
what is theory?
Every single nursing course talks about theory
Theory, research/evidence based practice and nursing practices are all interrelated
Nursing is a science (use research and evidence based practice) art (caring)
what is the nursing theory?
a theory explains, describes, predicts nursing care, and prescribes (what we need to do)
who is Dorothea Orem?
She believed that if patients who participate in self care will improve their health outcomes
- What we do for the patient is what they are unable to do (if a patient just had surgery, we will help bathe them, until they can do it themselves)
what are components of a theory?
Phenomenon: Dorothea looked at self care, caring (Watson) if we demonstrate caring behaviors it will reflect to patients and families, how patients respond to stress when dealing with serious problems (Newman)
Concepts: can be abstract (something you can’t touch)
- ex: coping
Concrete: (what you can touch) Florence Nightingale talks about nutrition (you can touch food)
you can manipulate the environment; we can help improve patients outcomes
what is conceptional?
Open the dictionary and write down the definition for the word
- pain: physical discomfort
what is operational?
How we measure a concept
- walk in a patient room and ask what their pain is from 0-10
what is assumptions?
Things we take for granted
- ex: Watson has a theory for caring: if we demonstrate caring behaviors to the patients and families it will improve the health outcomes
what is domain?
the perspective of that discipline or how we view that discipline
what is paradigm?
our believes of that discipline
what is conceptual framework?
a visualization of how all the concepts is related
what is a nursing metaparadigm?
the beliefs of our profession
what is health?
defined different from each person
what is environment/situation?
will influence the patient’s health
- ex: a kid found out she has diabetes: she will act different at school then at home
The components of the nursing metaparadigm include:
A. Person, health, environment, and theory.
B. Health, theory, concepts, and environment.
C. Nurses, physicians, health, and patient needs.
D. Person, health, environment, and nursing
D. Person, health, environment, and nursing
who was the fist nursing theorist?
Florence Nightingale
- how we can manipulate the environment to improve patients health
- nutrition, noise influences healing (appropriate noise: green, if it is getting too loud: yellow, if it is to loud: red)
what is the curriculum era: 1900-1940s?
This is when they found out theory is important and that we need to start adding it to the curriculum
what is the research era: 1950-1970s?
started to conduct research
what is the graduate education era: 1950-1970s?
Started publishing research in journals, start having nursing conferences
The first doctoral program was a PhD
what is the theory era: 1980-1990s?
Started providing evidence-based practice and started implanting it into clinical practice
what is the theory utilization era: 2000s- today?
every nursing course uses theory
what is grand theory?
Abstract, broad in scope, complex
- focuses on people, nursing, health and environment
- Florence Nightingale is a grand theory
what is middle range theory?
limited in scope and less abstract
- a concept that is used in nursing practice
- ex: Watson theory of caring
what is practice theory?
Narrow in scope and focus
- when we bring theory to the bedside
- pain management with patient who had heart surgery
what is descriptive theory?
Growth and development theories (need for geriatric, OB and peds)
First level of theory development
what is prescriptive theory?
Where we test a nursing intervention
- ex: research study using mediation for migraine headaches (one group would use mediation for migraine headaches while the other uses alternative therapy)
what is theory based nursing practice?
Shows how nursing is different than other disciplines
Generates knowledge for our practice and supports evidence based practice
Nursing process is NOT a theory, it provides a systematic way of providing care
Nursing process is central to nursing practice. Nursing practice:
A. is a theory.
B is derived from a theory.
C. is not adaptable to all patients.
D. generates knowledge for use in practice.
B. is derived from a theory
Maslow’s hierarchy of human needs
1st: to meet their physiological needs
- the patient has an open airway, the patient is breathing, the patient has a pulse
2nd: Safety: preventing falls
3rd: Social needs: need love and belonging
4th: Need to meet the patient self-esteem and actualization: if a patient is in pain after surgery, you can NOT teach the patient
what is stress/adaption?
how to cope and adapt with illness
what is developmental theory?
Growth and developmental theories
- ex: a 12 year old who just had a baby will be treated different than a 35 year old who just had a baby
what is biomedical theory?
theories that cause disease
what is psychosocial theory?
nursing is very holistic (we look at psychological problems, at culture, spirituality, developmental theories)
- ex: Jehovah witness does not accept blood transfusion
what is educational theory?
teaching learning theories
what is leadership/management theories?
theories change theory
- ex: difficult to change nurses from paper to electronics
Using Maslow’s hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing.
A. Self-actualization
B. Air, water, and nutrition
C. Safety
D. Esteem and self-esteem needs
B. Air, water, and nutrition
Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse?
A. Biomedical
B. Leadership
C. Psychosocial
D. Developmental
C. Psychosocial
what is the system theory?
Many theories are based on the systems theory
The family is considered a system (when something affects one person in the family, it will affect all members)
- ex: if a mom gets cancer, the whole family will be impacted
The nursing process is a system: providing systematic care
Goal of the nursing process: to organize and develop the patient centered care
what is input?
collecting the subjective and objective data of the patient
- ex: if a patient comes in and has elevated blood pressure
what is output?
the end product of the system, whether the health care problem improves, gets worse, or stays the same
Nursing theories provide nurses with perspectives from which to:
A. analyze patient data.
B. predict phenomena. (Predict nursing care)
C. formulate legislation.
D. link science to nursing. (Theories link nursing to science)
A. analyze patient data
what is Nightingale’s environmental theory?
Focus on the environment, nutrition, noise, if we manipulate the environment, we can improve health care
what is Peplau’s Interpersonal theory?
Focuses on relationship with the nurse, patient, and families
what is preorientation?
Gather the information from the patient (listen to report, and review your patients chart)
what is orientation?
whatever that problem is you will be working with that problem
-ex: diabetic: will teach them how to give them insulin
Defining the problem and start thinking what to do with that patient during that day
what is working phase (therapeutic activity)?
when you put your plan into action
what is resolution (termination of relationship)
when we terminate the relationship when we first meet them
- Introduce yourself, set the boundaries of the relationship (state your name, and when you will be with them)
what does a counselor do?
identifies problems
what does resource do?
looking at services
what is a surrogate?
possible solutions
- ex: a victim of domestic violence: stay with a family member, a shelter (solutions)
what is Orem’s self care deficit nursing theory?
Identifies a nurse theorist for a job interview and how you can use this in a critical practice
Orem believes in self care: we will take care of the patient when they are unable to
what is Leininger’s culture care theory?
Has to deal with culture
How culture deals with health
- ex: a person who is Irish is very stoic (no facial expression) : look at blood pressure, pulse, and see if respirations are elevated
- middle eastern is very vocal about pain
What is Henderson’s theory?
What we will help the patient with 14 activities until they can do it on their own
- ex: how to provide hygiene until the patient can do it own their own
what is Neuman’s theory?
Looks about stressors
How patients are very sick we need to help them cope about the stress of their disease
Focusing on wellness and prevention of diseases
what is Roy’s theory?
Teaches a patient how to adapt to changes
- ex: a man who has an amputated arm: we will help him adapt to the physiological changes, dress changes, IV push medication, adapt to his self- concept, his role function, independence
Patients who have devasted health problems
A nurse ensures that each patient’s room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist’s work is the nurse practicing in this example?
A. Henderson
B. Orem
C. King
D. Nightingale
D. Nightingale
The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient can begin performing these activities. The nurse in this situation is applying the theory developed by:
A. Johnson.
B. Orem.
C. Roy.
D. Peplau.
B. Orem.
A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories?
A. Roy
B. Watson
C. Johnson
D. Benner
A. Roy
Bill reads about the concept of culturally specific nursing care. The theory that integrates patients’ cultural traditions, values and beliefs into care plans is
Leininger
Susan quizzes Bill about the core concept of Peplau’s theory. Peplau’s theory has only three phases, including orientation, working, and resolution.
A. True
B. False
B. False
what is the link between theory and knowledge development?
Our nursing knowledge is based on theory and clinical practice
To improve your knowledge about theory is reading, through class discussion, observing
- clinical knowledge: going to clinical
what is the relationship between nursing theory and nursing research?
Theory is the building blocks on how we get more evidence based practice
Theory generating research focuses on relationships
- ex: look at the relationship of sadness with parents with kids that have disabilities
Theory testing research describes
- ex: if a patient had to describe their pain with heart disease
Theory is essential to nursing practice because it: (Select all that apply.)
A. Contributes to nursing knowledge.
B. Predicts patient behaviors in situations.
C. Provides a means of assessing patient vital signs.
D. Guides nursing practice.
E. Formulates health care legislation.
F. Explains relationships between concepts
A. Contributes to nursing knowledge.
B. Predicts patient behaviors in situations.
D. Guides nursing practice.
F. Explains relationships between concepts
Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.)
A. Nursing theory differentiates nursing from other disciplines.
B. Nursing theories are standardized and do not change over time.
C. Integrating theory into practice promotes coordinated care delivery.
D. Nursing knowledge is generated by theory.
E. The theory of nursing process is used in planning patient care.
F. Evidence-based practice results from theory-testing research.
A. Nursing theory differentiates nursing from other disciplines.
C. Integrating theory into practice promotes coordinated care delivery.
D. Nursing knowledge is generated by theory.
F. Evidence-based practice results from theory-testing research.
