chronic illness Final Exam Flashcards
Evidence based care improves
quality, safety, patient outcomes, nurse satisfaction, and reduced cost
Steps to EBP
- ask a clinical question in PICOT format
- search for the most relevant and best evidence
- Critically appraise the evidence you gather
- Integrate all evidence with your clinical expertise and patient preferences and values
- Evaluate the outcomes of practice decisions or changes using evidence
- Share the outcomes of EBP changes with others
PICOT
patient population of interest, intervention of interest, comparison of interest, outcome, time
Expert Opinion
evidence from the opinion of authorities and/or reports of expert committees
Case-Controlled Studies/Case Series
identifies patients who have the outcome of interest (cases) and control patients, and looks for exposure of interest
Cohort Study
identifies 2 groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and follows these cohorts forward for the outcome of interest
RCTs
randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.
Critically Appraised Articles
authors evaluate and synopsize individual research studies
Critically Appraised Topic
authors evaluate and synthesize multiple research studies – check and balances system – a group of individuals look over the article and decide if it’s a good study
Systematic Reviews
authors have systematically searched for, appraised, and summarized all of the literature for a specific topic
Meta-Analysis
a systematic review that uses quantitative methods to summarize the results
in step three: Critically appraise the evidence you gather
you must determine
value
feasibility
usefulness of the evidence
Validity
the degree to which methods are really measuring the concepts they are supposed to measure
Reliability
the accuracy and consistency of information obtained in a study
Bias
an influence that results in an error in an inference or estimate
bias can effect
the quality of evidence and the validity of the study
Quantitative Nursing Research
The study of nursing phenomena that offers PRECISE measurement and quantification
Focuses on numerical data, statistical analysis, and controls to eliminate bias in findings
Qualitative Nursing Research
The study of phenomena that are difficult to quantify or categorize such as patients’ perceptions of illness or quality of life
Describes information obtained in a nonnumeric form
examples of vulnerable populations
Older adults Homeless Immigrant populations Children Severe mental illness Terminally ill or physically disabled
Concepts to Consider when Conducting Research in Special Populations…
powerlessness, vulnerability, self-concept, hardiness, resilience, wellness, quality of life
Informed consent means that participants:
have adequate information about the research
can comprehend that information
have free choice in deciding whether to participate in or withdraw from the study
Informed consent protects the rights of the research participant by meeting the rights to:
Self-determination
Privacy
Full disclosure
Beneficence encompasses three duties
The duty to protect from (a) harm and (b) exploitation, and (c) duty to balance risks and benefits
Researchers must protect study participants from all types of harm including
Physical, Psychological, Delayed effects of research that may be harmful
In general, research with vulnerable groups should be undertaken only when
- The risk/benefit ratio is low OR
2. There is no alternative
An explicit health policy can achieve several things:
- Defines a vision for the future
- Outlines priorities and the expected roles of different groups
- Builds consensus
- Informs people
six steps of policy analysis
- define and analyze problem
- policy alternatives
- evaluate criteria
- assessment of alternatives
- stakeholders
- recommendations
policy problem
existence of an unsatisfactory set of conditions for which relief is sought
policy alternatives
no change, incremental change, comprehensive change
incremental change
May be more feasible, but may not fully resolve the problem
Comprehensive/Major change
What alternative would provide EVERYTHING needed to resolve the problem?
evaluation criteria for policy
effectiveness, efficiency, equity, liberty, feasibility, acceptability
access to health services requires
- Gaining entry into the health care system (usually through insurance coverage)
- Accessing a location where needed health care services are provided (geographic availability)
- Finding a health care provider whom the patient trusts and can communicate with
Access to health care impacts one’s
overall physical, social, and mental health status and quality of life
healthy people 2020 Focuses on 3 components of access to care
- Insurance coverage
- Health services
- Timeliness of care
5 ways to improve access to health care are:
- Retain Medicaid expansion and implement expansion in more states
- Retain ACA reforms and stabilize individual insurance marketplaces
- Address clinical workforce shortages
- Telehealth and remote patient monitoring
- Increase efficiency of existing workforce
health promotion
is a basic nursing function. we do this through:
- individual counseling
- public health education programs
- provision of health service
primary prevention
intervening before health effects occur
Vaccinations
Altering risky behaviors (poor eating habits, tobacco use)
secondary prevention
screening to identify disease in the earliest stages, before the onset of signs and symptoms
Mammography
Regular blood pressure testing
tertiary prevention
managing disease post diagnosis to slow or stop disease progression
Rehabilitation
Chemotherapy
disparity
differences in the presence of disease, health outcomes, or access to health care between population groups
inequity
unnecessary and avoidable differences in health that are considered unfair and unjust
5 Overarching recommendations for health promotion and disease prevention in vulnerable populations:
- Promote health equity across racial, ethnic, and socioeconomic lines
Embed health equity into practices and policies - Provide federal resources to support state, local community-based prevention strategies
Reimburse community-based prevention - Tackle inequities of money, resources, etc.
- Improve access to quality education
- Invest in early childhood
Dr. Samuel Hahnemann came up with
Like cures Like” aka “The Principle of Similars”
examples of CAM
Acupuncture Aromatherapy Herbalism Homeopathy Hypnosis Massage Meditation Reflexology Reiki
Categories of CAM Therapies
Natural Products:
Herbs, vitamins, minerals, probiotics
Mind-Body Practice:
Acupuncture, massage therapy, meditation, movement therapies, spinal manipulation, yoga
Other:
Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy
conventional medicine
Treats human body in parts, not a whole
“Rescue Medicine”
Disease-based model
Complementary & Alternative Medicine
Approach to treatment is focused primarily on proactive measures
Treats the condition, not the symptoms
Integrative Medicine
The fusion of conventional medical practice and practices of complementary and alternative medicine.
CAM Principles of Care
Health & healing are related to a harmony of mind, body, & spirit
The body has the ability to heal itself
Basic positive health practices build the foundation of healing
Approaches to healing are individualized
Individuals are responsible for their own healing
Homeopathic Medicine: Patient Teaching
It is important to educate our patient’s on homeopathic medications that have been shown to interact with other drugs
CAM Therapies for emphysema
Nebulized glutathione (mother of all antioxidants)
CAM Therapies for cardiovascular disease
Co-enzyme Q10 – as we age Q10 decreases.
CAM Therapies for peripheral neuropathy
B vitamins (B12)
ALA (Alpha-lipoic acid)
Acupuncture
CAM Therapies for Parkinson’s disease
Amino acids (Tyrosine, Phenylalanine, Tryptophan) B vitamins (B6 & Thiamine) Glutathione
Black Cohosh (used for menopause to treat hot flashes) can have interactions with
Increased risk of liver toxicity if taken with atorvastatin, acetaminophen, or alcohol
Coenzyme Q10 should not be used with
anticoagulant drugs, decreases effectiveness of the anticoagulant and increases the risk of clots
Echinacea (stimulates immune system) interacts with
Slows caffeine breakdown leading to jitteriness, HA, or insomnia
Evening Primrose Oil (fatty acids used by the body for growth) should not be taken with
Increases risk of seizures in patient’s taking anti-convulsants
St. John’s Wort (used for symptoms of depression) Contraindicated when
Contraindicated when used concomitantly with SSRIs, MAOIs, tricyclic antidepressants, warfarin, and birth control
hospice care
Used for terminally ill patients when treatment is no longer curative during the last 6 months of life, assuming the disease takes its natural course
palliative care
Addresses the patient’s physical, emotional, and spiritual needs (just like hospice), however palliative care is also focused on relieving symptoms associated with the patient’s condition while receiving active treatment
Hospice and insurance
paid in full by the Medicare Hospice Benefit and by Medicaid Hospice Benefit. Most insurances and VA also cover in full or with minimal co-pays
palliative care and insurance
paid by Medicare, Medicaid, and most private insurances IF the patient meets criteria
physical changes during end of life
Incontinence Loss of appetite Semi consciousness Dysphagia Changes in respiratory pattern -Cheyne Stoke Mottled skin
nursing management during end of life
Comfort -Pain management Oral care – sponge swabs -Keeps oral mucosa moist Positioning -Raising bed to semi fowlers Terminal respiratory secretions (“Death Rattle”) -Scopalamine Warm blankets Family support
