Exam 1 Flashcards
(211 cards)
1
Q
Colonial period of nursing
A
informal care, no hospitals
2
Q
first hospital in the US
A
pennsylvania hospital
3
Q
Shattuck report
A
1st attempt to organize public health in the US
By the massachusetts sanitary commission
4
Q
Nightingale major contributions
A
Value of aseptic technique
Nursing research contributions
Nursing education
Kept records and recorded outcomes and stats
Helped soldiers on the battlefield and realized lack of sanitation killed them more than injuries
5
Q
Wald and brewster
A
Wald developed a practice for public health nursing
Both developed the henry street settlement
6
Q
Henry street settlement
A
Well baby care
Health education
Disease prevention
Treatment of minor illnesses
Sliding scale payments
7
Q
Lina rogers
A
Henry street nurse
First NYC school nurse
Did simple treatments
Focused on home visits and providing services like food and clothes
Significant research reducing absenteeism
Made formal protocols for diseases and did documentation of interventions to show that school nurses were effective
8
Q
Wald and dr lee
A
Encouraged metropolitan life insurance company to use visiting nurse organizations to provide care for sick policyholders
9
Q
Mary Beckinridge
A
Established the frontier nursing service providing nursing care to remote, disadvantaged families in the Kentucky mountains
10
Q
Quad council
A
Four national nursing organizations:
ANA
American public health association
Association of state and territorial directors of nursing
They looked to get a voice for public health nursing
11
Q
American public health association
A
Established to facilitate interdisciplinary efforts and promote practical application of public hygiene
12
Q
American red cross rural nursing service
A
Initiated home nursing care in areas outside larger cities
13
Q
Sheppard towner act
A
Expanded community health nursing roles for maternal and child health
14
Q
Lilian wald
A
First president of national organization for public health nursing
15
Q
Population
A
A collection of individuals who share one or more personal or environmental characteristics
16
Q
Subpopulation
A
Subsets of the population who share similar characteristics
17
Q
Aggregate
A
A group of people sharing common characteristics or concerns
Typically referred to more as a subpopulation but can also be from a population as a whole
18
Q
What is public/community health
A
Scientific discipline including the study of epidemiology, statistics, and assessment
19
Q
Community health vs public health
A
Public health: a more generalized focus on health promotion for the population as a whole
Community health: a broader focus on multiple individuals, families, and groups. Care is provided in the community like home, work, or school rather than a hospital
20
Q
Goal of public and community health
A
To prevent disease and preserve, promote, restore, and protect health for the community and the population within it
21
Q
Public health ethic***
A
The greatest good for the greatest number
22
Q
Public health core functions
A
Assessment
Policy development
Assurance
23
Q
Assessment
A
Monitor health
Diagnose and investigate
Collect and release data to monitor population health status
Identify community health problems by including community members in assessment
Diagnose and investigate health problems and potential hazards
Use information and translate into education
24
Q
Policy development
A
Mobilize community partnerships
Develop policies that support the health of the population
Use evidence to make policy decisions
Inform, educate, and empower about health issues
Foster partnerships to solve health problems
25
Assurance
Enforce laws
Link to/provide care
Assure competent workforce
Evaluate
Provide community oriented health services
Provide essential health services to EVERYONE
enforce health and safety laws and regulations
26
Community based vs community oriented
Community based: nurses focus on illness care of individuals and families across the lifespan. Goal is to manage acute and chronic illnesses (like treating a wound for a patient)
Community oriented: focus on healthcare of communities or populations, these people are usually well but have some kind of risk. Goal is to preserve, protect, promote, and maintain health. Focus is health promotion and education, disease prevention, and coordination of services. Example is nurse taking BP screenings determining why the problem exists
27
Validity
Accuracy
High probability of correct classification of persons tested
Sensitivity: how accurately the test identifies people with condition
Specificity: how accurately the test identifies people without the condition
28
Reliability
Precision
Results are consistent from place to place, time to time, and person to person
29
Reliability and validity relationship
Screening tools can be reliable but not valid or reliable and valid but if its not reliable it wont be valid
30
Healthy people
A comprehensive set of national health goals for the decade
31
Parish nursing was established by
Granger Westberg
32
Parish nursing
Faith based nursing
Consists of specialized nurses who respond to health and wellness needs of populations of faith communities and are partners with the church in fulfilling the mission of the faith ministry
33
Faith communities
Groups of people who gather in churches, cathedrals, synagogues, or mosques and acknowledge common faith traditions
34
Health ministries
Includes activities and programs in faith communities are organized around health across the lifespan
Promote wholeness in health, emphasize health promotion and disease prevention within the context of linking healing with the person’s faith belief and level of spiritual maturity
35
Scope and standards of parish nursing
Minimum of BSN with content in community nursing OR masters with specialization in public health, holistic nursing, or mental health nursing
Valid state license
3-5 years professional nursing experience
Evidence of mature faith
Completion of extensive continuing education or designated coursework in parish nursing preparation
Knowledge of health assets in a community
36
Congregation-based model of parish nursing
Nurse is usually autonomous
Development of parish/health ministry program arises from individual community of faith
Nurse is accountable to congregation and its governing body
37
Institution-based model of parish nursing
Includes greater collaboration and partnerships
The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions
38
Main difference between congregational and institutional parish nursing
One is institution governing a body, other is a nurse who is more accountable to themselves and their practice
39
Roles and responsibilities of a parish nurse
Personal health counselor
Health educator
Liaison
Facilitator
Pastoral care provider
Provider of services to vulnerable populations
Integrator of faith and health
Health advocate
Referral agent
Coordinator of volunteers
Accessing and developing support groups
40
5 practice models of home care nursing
Population-focused care
Transitional care in the home
Home based primary care
Home health
Hospice
41
Population focused home care
Directed towards needs of specific groups of people, including those with high-risk health needs
Include structured approaches to regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching
42
Transitional care in the home
Designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another
These programs facilitate a smooth and coordinated health care experience for clients receiving health services across sites of care
These programs involve assessment, planning, teaching, making referrals, and following up on referrals by nurses at each stage of care to foster independence and self-care
43
Home based primary care
Emphasis on delivering primary care in the homes of people who have difficulty going to a primary care clinic, community center, or physicians office because of functional or other health problems
Nurses provide health education in addition to primary care services including health assessment, medication management, referrals, case management, and screening for new health problems
44
Home health nurse requirements
RN with BSN
Palliative care and ?? Care certification for hospice
45
Scope of practice for home health nurse
Direct care: includes actual physical aspects of care
Indirect care: activities a nurse does on behalf of the client to improve or coordinate care (advocating, making sure doctor comes in, etc)
46
Home care nurse roles
Clinician
Case manager
Client advocate
Educator
Mentor
Researcher
Administrator
Consultant
47
What requirements must exist for medicare to pay for home care
Services must be reasonable and necessary
Client must be homebound
Care delivered to the client is skilled care
Services must be intermittent and part time
Plan of care must be entered into specific medicare forms
48
Skilled care
IV or IM injections
Enteral feedings
NG or trach aspiration
Catheter insertion and care
Treatment of ulcers or skin disorders
Heat treatments
Initial phases of administration of medical gasses
Rehab procedures including related teaching
49
OASIS
Measures outcomes for quality improvement and client satisfaction with care
50
Hospice
6 months or less, terminal phase of disease
Treatments are considered futile and cause more damage than good
An interdisciplinary team provides care encompassing the individual patient's and their family's holistic needs.
Goal: comfort care through pain and symptom management, psychosocial and spiritual support because curative treatment modalities are no longer beneficial
treatment side effects outweigh the quality of the patient’s end-of-life
51
What is a terminal illness
Time left is measured in months, not years
52
Palliative care
For anyone with a serious illness at any stage, the earlier the better
Also known as supportive care
Does NOT replace primary care, it works with them for a more holistic approach
Focus is caring for pain, symptoms, side effects for treatment, and stress, goes in adjunct to curative care modalities
Allows people who are "upstream" of a 6 month or less terminal prognosis to receive services
53
Nursing care when death is imminent
Most Americans want to die at home, not in a hospital
Help families and patients make decisions about the level of care
Educate about dying
54
Artificial nutrition and dehydration at EOL
The administration of artificial nutrition and hydration is a medical treatment, and a client can accept or reject it.
If you’re actively dying you can’t metabolize, and that’s painful if we’re feeding them
55
CPR at EOL
Deciding to put a do not resuscitate or DNR order in place usually involves the client, his or her family, the nurse, the physician, and others on the healthcare team
Educate family about what CPR is really like
56
Euthanasia and physician assisted suicide
Active euthanasia is the practice of ending the life of a terminally ill client at the request of the client to limit suffering
57
Death with dignity
A nationwide movement based on the Oregon Death and Dignity Act
Allows terminally ill residents of Oregon to end their lives through the voluntary self-administration of lethal medications prescribed by a physician for that purpose.
Oregon was the first state to pass legislation focusing on aiding in dying for the terminally ill.
58
Cultural and religious issues at EOL
Sensitivity and empathy are essential when caring for a dying person from a different culture.
Each person is unique, with cultural preferences that influence the specialized needs of the client, the family, and their caregivers
59
Samuel Williams
publicly advocated using morphine and other drugs for euthanasia
60
Jack Kevorkian
First assisted suicide
61
Brittney Maynard
Actually went through with euthanasia
62
Process for approving euthanasia
Diagnosis, 2 physicians required, first oral request, forms and eligibility, 15+ day wait, 2nd oral request, prescription written
63
EOL symptoms
A buildup of saliva and oropharyngeal
Changes in respiratory patterns
Skin may appear dusky or gray and feel cold or clammy
Eyes may appear discolored, deeper set, or bruised
64
Grief vs mourning
Grief—emotion felt after the loss
Mourning—recovery from the loss
65
Types of pain during dying process
Nociceptive – caused by damage to body tissues and usually described as sharp, aching, or throbbing pain
Two types of nociceptive pain:
Somatic – comes from the skin, muscles, and soft tissue
Visceral – comes from the internal organs (liver metastasis)
Neuropathic – occurs when there is nerve damage (not only from dying, also meds and therapy)
66
ADA
Americans with disabilities act
Federal legislation requiring schools to make provisions for those with various challenges
Lets more people participate in school
67
IDEA
Individuals with disabilities education act
Federal law to protect the rights of students with disabilities
Ensures that everyone receives a free, appropriate public education regardless of ability
68
IEP
plans for education accommodations for disabled children
69
IHP
plans for the health needs of disabled children in school
70
American academy of pediatrics says school nurses should
Ensure that children get the health care they need, including emergency care
Ensure that the nurse keeps track of the STATE- required vaccinations (no shots, no school legislation)
Ensure that the nurse carries out the required screening of the children based on STATE law
Ensure that children with health problems can learn in classroom
71
Credentials of school nurses
be registered nurses with a bachelor’s degree in nursing and special certification in school nursing.
There are no general laws regarding the educational background of school nurses
72
Immunizations and school
States decide which vaccines are mandated
Nurses in schools should inform parents that if they don’t have health care insurance, they may qualify for programs that provide immunizations free
No shots, no school legislation
73
The community school model
The future of school nursing - provides a prevention framework linking the community and school.
Collaborative design using resources in a community to provide structured preventive services such as after-school programs, parent outreach, and crisis intervention
74
Ada Mayo Stewart
1st industrial/occupational nurse, learned languages to help others in the factory and made home visits by bicycle to check on sick and injured workers and their families.
75
OSHA act
protects workers against personal injury or illness resulting from hazardous working conditions
76
Occupational nurse responsibilities
Education
Early detection
Restoration of health
77
Education in occupational nursing
good nutrition, knowledge of health hazards, identifying workplace hazards, and providing information on immunizations, use of protective equipment, smoking cessation, and disaster planning (primary)
78
Early detection in occupational nursing
through health surveillance and screening, prompt treatment, counseling and referral, and prevention of further limitations (secondary).
79
Restoration of health in occupational nursing
through rehabilitation strategies and limited duty programs for those injured (tertiary).
80
epidemiological triangle
infectious agents, susceptible hosts (ppl at risk) and environmental characteristics
81
Ergonomics
the study of the relationship between people and their working environment
82
How do host factors affect susceptibility to illness/injury in the workplace
Worker characteristics, such as job inexperience, age, and pregnancy
83
How do agent factors affect susceptibility to illness/injury in the workplace
Biological agents (viruses, bacteria, fungi, blood-borne, airborne pathogens)
Chemical agents (asbestos, smoke)
Mechanical agents (musculoskeletal or other strains from repetitive motions, poor workstation-worker fit, lifting heavy loads)
Physical agents (temperature extremes, vibrations, noise, radiation, lighting)
Psychological agents (threats to psychological or social well-being resulting in work-related stress, burnout, violence).
84
How does environment affect susceptibility to illness/injury in the workplace
Physical factors (heat, odor, ventilation, pollution)
Social factors (sanitation, housing conditions, overcrowding, illiteracy)
Psychological factors (addictions, stress).
85
High risk groups for occupational injury
NEW WORKERS!!
Older population due to decreased sensory ability and chronic issues, women in childbearing age (hormonal), high risk factors
86
Potential problems in the workplace
Longer hours, shift work, reduced job security, part-time and temporary work, multiple jobs
Older workforce, more diverse
New chemicals, materials, equipment
More women workers
Occupational injuries
87
Occupational health history
The characteristics of the workers' present jobs
A chronological record of past work
An occupational exposure inventory
A list of other exposures in the home and community
88
Workplace walkthrough
A complete survey of the workplace, inside and outside
The presence of hazards
The location of entries and exits
The availability of emergency equipment
Potential trouble spots
89
OSHA
A Federal agency that establishes standards and is charged with improving worker health and safety
safe patient handling (ergonomics), blood exposure, hazardous waste, workplace violence, sharps safety, and infectious disease
Sets guidelines
90
NIOSH
The branch of the US public health service that investigates workplace illness, accidents, and hazards
Checks when something happens
91
Workers' compensation acts
State-level legislation regulating financial compensation to workers suffering injuries or illness resulting from the workplace
92
Superfund amendment and reauthorization act (SARA)
Provides:
emergency planning and notification to protect the public in the event of a release of hazardous chemicals
specific information on hazardous chemicals used, stored, or manufactured in communities throughout the U.S.
training for all first responders who may become involved in a hazardous material incident
Companies do bad harmful things which cause health problems. This deems areas unsafe to be around and try to have remediation to remove these chemicals
93
Occupational Health Risks for Nurses
Ergonomic Injuries
ANA’s Handle With Care campaign
ANA- Workplace Health and Safety Guide For Nurses
Bloodborne Pathogen Exposure
94
Bloodborne pathogen exposure acts
OSHA 1991 issued the blood-borne pathogens standard to protect health care workers–focuses on direct health hazards
The Needle-stick Safety and Prevention Act–never cap a needle!
Hepatitis B vaccine–needs to be offered for free (not required to take it though)
95
Case management--interdisciplinary care
Various members of the health care team, not just nurses, contribute their expertise to client management
96
Who generally receives case management services
Adults with high-cost chronic illnesses
Older adults
Mothers and newborns
Children and their parents
97
Case management practice settings
Hospitals
Insurance companies – auto, disability
Private corporations
Managed care organizations
Home health & mental health agencies
Independent case management companies
98
Medicare
a federally funded program (medicaid is state)
**The patient must be homebound to qualify for Medicare home care assistance
99
Holistic assessment of a child
Home life
Mental health
School
Nutrition
Developmental milestones
Self esteem
Elimination (trauma=reverting and wetting)
100
Health concerns of children
Perinatal conditions & congenital anomalies
Sudden unexplained infant death (SUID)
includes sudden infant death syndrome (SIDS)
Motor vehicle and other unintentional injuries
Infant mortality is associated with maternal health, socioeconomic status, and access to medical care.
101
Adolescent health concerns
Suicide
Motor vehicle crashes, including those caused by drinking, driving, and texting
Substance use and abuse
Smoking
Sexually transmitted infections, including HIV
Teen and unplanned pregnancies
Homelessness
102
Screenings for children
Height and weight
Vision and hearing
Dental Health (costly and not always covered)
Cholesterol & triglyceride levels
Nutrition assessment
Physical activity assessment (make sure children aren’t sedentary [iPads and games])
Immunization status (Check CDC website for current administration schedules)
At birth: hemoglobinopathy, phenylalanine level, T4, TSH
Lead exposure
103
Screenings for adolescents
Height and weight
Vision and hearing
Dental Health
Cholesterol & triglyceride levels
Nutrition assessment
Physical activity assessment
Immunization status
Rubella serology (especially females) and immunization history
Substance use disorders, including tobacco
Mental health screenings
104
SIDS
The sudden, unexplained death of a baby younger than one year of age that doesn't have a known cause even after a complete investigation.
This investigation includes performing a complete autopsy, examining the death scene, and reviewing the clinical history.
SIDS is the leading cause of death among babies between 1 month and one year of age
105
SIDS recommendations
Always place baby on back to sleep at night and for naps
Chose a firm and flat sleep surface, no blankets
Breastfeed your baby
Share a room with your baby
Do not put soft objects, toys, crib bumpers, or loose bedding under the baby, over the baby, or anywhere near the baby
No mesh bumpers
106
Obesity can lead to
Obesity in adulthood
An increased prevalence of hypertension
menstrual problems
bone and joint difficulties
respiratory problems
psychosocial problems
Interventions are for whole family, not just child
107
Who is more likely to be hospitalized or die from asthma
Low-income and minority groups
108
Most common cause of school absences
Asthma
109
Common asthma triggers
Indoor allergens, such as dust mites, mold, and pet dander or fur
Outdoor allergens, such as pollens and mold, chemical irritants, wood smoke
Emotional stress
Physical activity, although with treatment, you or your child should still be able to stay active
Infections, such as colds, the flu, or COVID-19
Certain medicines, such as aspirin, which may cause serious breathing problems in people with asthma that are difficult to treat
Poor air quality or very cold air
Cockroaches and pests, including their droppings or body parts, due to certain proteins in their droppings and saliva
110
Number one cause of death in children up to 21
Accidents
Theyre small with premature motor skills
Firearms are now the leading cause of death by accident
111
Susceptibility to injuries (infants)
at risk because of small size and immature motor skills
112
Susceptibility to injuries (toddlers and preschoolers)
high level of activity and increasing motor skills, inquisitive, immature logic abilities (no sense of consequence, impulsive, very active)
113
Susceptibility to injuries (school age children)
have the lowest injury rate; sports and athletic-related injuries
114
Susceptibility to injuries (school age adolescents)
high injury rate, risk takers, intentional injuries, weapons, substance abuse, suicide, youth gangs (injury rates higher for males), don’t understand risks (think they’re invincible and bad things won’t happen to them)
115
Acute illness in children
Caused primarily by infection
Most are self-limited
Nurses can teach about:
home care
infection control
the importance of maintaining routine immunization- successful in preventing selected diseases
116
Alterations in behavior for children
Eating disorders
Attention problems- ADD/ADHD
Substance abuse
Elimination problems
Conduct disorders- delinquency, bullying
Sleep disorders
School maladaptation
117
Adolescents and smoking
IMPACTS BRAIN DEVELOPMENT
When you start young it's hard to stop neuroreceptors from wanting nic
SMOKING HAS BEEN IDENTIFIED AS THE MOST IMPORTANT PREVENTABLE CAUSE OF MORBIDITY AND MORTALITY IN THE U.S.
Children exposed to secondhand smoke have more ear and upper respiratory infections
Become politically active in banning tobacco and nicotine ads
118
Health concerns in women
Reproductive health
Menopause–side effects of hormonal changes
Osteoporosis in older women bc hormones
Breast Cancer
Female genital mutilation–not common in US but important in global health concept
Heart disease
Diabetes
Health disparities among special groups of women- women of color, incarcerated women, lesbians, women with disabilities, older women
119
Health concerns in men
More reluctant to receive health care
Increases risk and severity of disease
Prostate cancer
Erectile dysfunction
Colon cancer
Mental health- alcohol, depression and suicide
Hair loss
Gynecomastia
Heart disease
Diabetes
120
Screenings and preventative services for women
Height/weight
Vital signs
Immunizations
Cholesterol
Dental
Colon cancer (over 45)
Skin cancer
Diabetes
Pap
Mammogram/sonogram
121
Screenings and preventative services for men
Height/weight
Vital signs
Immunizations
Cholesterol
Dental
Skin cancer
Colon cancer (over 45)
Diabetes
122
Coronary heart disease
Responsible for most deaths and includes myocardial infarction, acute ischemic heart disease, angina pectoris, and atherosclerosis
123
Complications of diabetes
retinopathy, kidney disease, heart disease, stroke, amputations, neuropathy, and dental disease
Increased incidence of gestational diabetes
124
Primary prevention for diabetes
Education about nutrition, obesity, smoking, and physical activity
125
Secondary prevention for diabetes
screening with finger-stick blood glucose tests, glucose tolerance tests, thorough history and physical exam
126
Tertiary prevention for diabetes
reduce disease complications, modification of diet medications, and monitor blood glucose levels
127
Aging
the total of all changes that occur in an individual over time
128
Ageism
prejudices related to elders, leading to health disparities
129
Gerontology
the specialized study of the processes of growing old
130
Geriatrics
the study of disease in old age
131
Gerontological nursing
a nursing specialty concerned with managing the care of elders
132
Physiological changes in elderly
diminished physiological reserve, decrease in homeostatic mechanisms, and a decline in immunological response
133
Psychological changes in elderly
Slower reaction speed and psychomotor response
134
Sociological changes in elderly
changing social dynamics (friends and support system start dying)
135
Spiritual changes in elderly
may have increased spiritual awareness and consciousness especially near EOL
136
The five I's of elderly care (issues)
Intellectual impairment, immobility, instability, incontinence, and iatrogenic drug reactions (doctors don’t talk to each other)
137
The three Ds of elderly
dementia, depression, and delirium
138
TLC in caring for elderly
T = training in care techniques, safe medication use, recognition of abnormalities, and available resources
L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs
C = care for the caregiver through sleep, exercise, nutrition, rest, support and financial aid
139
Vial of L.I.F.E.
Kit including:
medical conditions, current medications, emergency contacts, insurance, and hospital preference. (It is important to keep the form up to date.)
5 inch plastic vial that holds important forms and stays on top shelf in fridge door
A Wallet Card.
A Vial of L.I.F.E. sticker - to be placed on the front door of your home or an adjacent window.
A Vial of L.I.F.E. magnet - to be placed on your refrigerator.
The sticker and magnet inform emergency responders that you have a completed Vial of L.I.F.E.
Instructions regarding the use of the Vial of L.I.F.E
140
Culture
knowledge, values, practices, customs, traditions, and beliefs of a group
141
Immigrant
a person who has moved to another country (or community) to be closer to family, new job/school, natural disasters, war, persecution, war, civil unrest
May be permanent or temporary
Health exp may improve or get worse
142
Legal immigrant
not a citizen but allowed to live and work in the U.S. Also known as lawful permanent residents.
The trend is that more immigrants are “low-skill” workers, competing with native low-skill workers for jobs
143
Nonimmigrants
admitted to the U.S. for a limited duration and specific purpose (i.e., students, tourists visas)
144
Unauthorized immigrant
may have crossed the border illegally or legal permission expired; eligible only for emergency medical services
145
Refugee
a person forced to involuntary move because of security concerns or persecution AND crosses an international border
145
Internally displaced person
a person forced to involuntary move because of security concerns or persecution BUT does NOT cross an international border
146
1965 Amendment of the immigration and nationality act
Changed the quota system that discriminated against individuals from southern and eastern Europe
Used to be very tight, only certain number of immigrants allowed
147
Refugee act of 1980
Provided a uniform procedure for admission into the US for refugees
148
1986 immigration reform and control act
Permitted illegal aliens already living in the US to apply for legal status they met the requirements
People who may be here illegally or whose permission ran out maybe didn’t go for citizenship because it’s so hard
Consider language barriers, cultural between immigrant and HCP (can lead to breaks or disagreements in care), lack of knowledge in certain populations, traditional healing, controversial
149
Race
A category of humankind sharing distinctive physical traits
At a glance, Africans, Asians, and Europeans can be easily distinguished due to apparent differences
Skin color is always the most defining characteristic of race
Physical traits of race: Hair, Eyes, Bone structure
Other characteristics of race that are not physical:
Medical differences, Climate adaptation, Origins of race
150
Ethnicity
Defined as belonging to a social group that has a common national or cultural tradition
Commonly recognized American ethnic groups:
American Indians, Latinos, Chinese, African Americans, European Americans
Biological race and ethnicity are NOT the same
In some cases, ethnicity involves loose group identity with barely any common cultural traditions
In most cases, though, ethnic groups are tight-knit subcultures with shared linguistics and traditions
151
nationality
Defined as: belonging to a particular nation
Where one is born and/or holds citizenship
Nationality is more about where you are located than who you are
152
Four principles of culture in nursing
Care is designed for the specific client.
Care is based on the uniqueness of the person’s culture and includes cultural norms and values.
Care includes self-employment strategies to facilitate client decision- making regarding health behavior.
Care is provided with sensitivity and based on clients' cultural uniqueness
153
Two principles of cultural competence
maintain a broad, objective, and open attitude toward individuals and their cultures;
avoid seeing all individuals as alike
154
5 constructs of cultural competence
Cultural Awareness – self- examination of one’s beliefs and values
Cultural Knowledge – learning about other cultures and ethnic groups
Cultural Skill – using cultural awareness and knowledge together to meet the needs of patients
Cultural Encounter – when nurses seek opportunities to engage in cross- cultural interactions
Cultural Desire – when the nurse has genuine motivation to provide culturally competent care
155
5 dimensions of cultural competence
Cultural Preservation –supporting and facilitating the use of scientifically supported cultural practices along with those from the biomedical healthcare system
Cultural Accommodation – supporting and facilitating clients' use of cultural practices when not deemed harmful.
Cultural Repatterning – working with clients to help them reorder, change, or modify cultural practices when deemed harmful
Cultural Brokering – advocating mediating, negotiating, and intervening between the client and biomedical healthcare culture on behalf of the client
156
Stereotyping
attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences
157
Prejudice
having a deeply held reaction, often negative, about another group or person.
158
Ethnocentrism
the belief that one group determines the standards for behavior by which other groups are to be judged
159
Cultural imposition
the process of imposing one’s values on others
160
Cultural conflict
a perceived threat that may arise from a misunderstanding of expectations between the nurse and client when either is not aware of cultural differences
161
Questions when asking about culture
Can you tell me where your family is from?
Do you practice a particular religious faith?
Is there anything special we need to know about your food preferences?
What do you think helps you stay healthy?
162
Community health nursing focuses
health promotion, disease prevention, and quality of life.
Quality healthcare service access for all
Improved environments that allow residents to thrive
163
Status in community nursing
The focus is on disease and death data
Examples – morbidity, mortality, life expectancy, social, education, crime
164
Structure in community nursing
The focus is on the services and resources in a community, and their utilization patterns
Examples - presence of healthcare facilities, service types and patterns of use, demographic data
Accessibility, availability, affordability
Are they actually being used properly
165
Process in community nursing
The focus is on effective community functioning and problem-solving
Can they identify problems? What problem solving mechanisms does the community have
Examples - relationships, communication (let community know what’s happening!), commitment to, and participation in health
166
Communities involve...
People
Place/environment
Function (social systems/services that a community may rely on
Health systems, socioeconomic systems (social determinants of health and economics)
Resources and structure
Police, politics
What do they need and what is available)
167
Nursing process
Assessment–allow us to critically think about a community and make inferences about what’s going on. We aim to gain or collect data and it clarifies any need for change
Identification of Problems
Planning
Implementation
Evaluation
168
Assessment in community nursing
Data Collection and Interpretation
Clarify need for change
Primary data
Secondary data
Data Gathering
Data generation
Data analysis
169
Data gathering, generation, analysis
Data Gathering: Process of obtaining existing, readily available data
Data generation: Process of developing data that does not already exist
Data analysis: Seeks to make sense of the data gathered and generated
Theme with all interviews
170
Windshield survey
A systematic assessment is performed while the nurse travels through the community
Requires the use of all the senses
An example of a comprehensive windshield survey
Looks at people, race/ethnicity, subgroups, evidence of morbidity, borders, geographical features, housing, social business
171
Community as partner model
Assessment Wheel – core element (community members), eight subsystems
Recreation
Education
Safety and transportation
Communication
Economics
Physical environment
Politics and government
Health and social services
172
Functional health status approach
The functional health status approach evaluates health patterns in the community
It looks at functional health patterns:
Configurations of behaviors that occur sequentially across time
Example: Gordon’s Functional Health Assessment
health perception/health management, nutritional-metabolic, elimination, activity/exercise, cognitive-perceptual, sleep/rest, self-perception/self-concept, roles-relationships, sexuality/reproductive, coping/stress, values, and beliefs
173
windshield survey components
People
Place
Housing
Social systems
174
3 required components of a community nursing diagnosis
Risk of (specific problem)
Among (specific population – who is affected)
Related to (characteristics of the community; strengths and weaknesses in the community that influence the problem or risk)
175
Goals
long-term, broad statements of desired outcomes. Should address the client’s overall learning (like full mobility in a hip replacement patient. Early ambulation, small goals)
176
Objectives
short-term, MEASURABLE, timely statements indicating how you will achieve the broad goal
Use concrete, proveable terminology (recall instead of know)
177
Implementation
This phase includes the work and activities aimed at achieving the goals and objectives
An active phase
The efforts may be made by the person or group who established the goals and objectives, or they may be shared with or even delegated to others
Includes change agent and change partner
178
Change agent
gathering and analyzing facts and implementing programs
179
Change partner
Assisting from the outside looking in
activities including enabler-catalyst, teaching problem-solving skills, and acting as an activist advocate
180
Evaluation
Appraisal of the effects of some organized activity or program
This may include the design and conduct of evaluation research
OR
It may involve the process of assessing progress by contrasting the objectives and the results
Look at weakest phases of implementation and change it up
Can occur during implementation
Must begin in the planning phase of the nursing process
Need to know how you’re going to evaluate, usually set by objectives
181
Health education program
Identify needs
Establish goals and objectives
Select appropriate methods
Consider needed educational principles
Design (carefully create the program)
Implement program
Evaluate the process
182
Learners accept information based on
...what they know
...what they believe (biggest barrier, people won't believe you because they’re stuck in their ways)
...the culture in which they are born and raised
...their generational experience
...how they process the information they receive
183
Cognitive domain
Break down material into parts to understand the individual components. Form new elements to develop solutions to problems. Judge the usefulness of the new material and compare it to goals and objectives
Thoughts/thinking
Memorizing, reasoning, algorithms, pneumonic, not actually application etc
184
Affective domain
Learning occurs and involves emotion, feelings, or affect. Molded by family, friends, peers, and experiences. Influenced by imitation, role models, and conditioning. Difficult to change and takes patience. Often needs reinforcement
Emotions/feelings
Appreciation, motivation, etc.
“If she can do it, I can do it”
185
Psychomotor domain
Being able to learn by doing; using psychomotor skills to manipulate, touch, or use hands-on learning. Move from the simple to the complex where the learner:
must be capable of skill
must have a sensory image of how to perform the skill (such as instruction sheet and practice)
186
Why use nursing theories in community nursing
They provide the basis for care of the community and family. Theories help guide nurses in the delivery of care
187
Change theories of focus
Pender’s Health Promotion Model
Health Belief Model
Social Cognitive Theory
Transtheoretical Model (TTM) or Stages of Change (SOC)
188
Why do we care about health promotion and community education?
To elicit behavior change
To increase positive health outcomes
Decrease risk and disease onset
Protect health
189
3 factors driving US healthcare costs
Specialty drugs–accounts for ⅓ of prescription drug spending.
Chronic diseases–takes up 86% of healthcare costs, has modifiable risk factors
Lifestyle–duh. Affects patient, and lower class bc they can’t afford it and will feel the disparities, and middle class, and nurses since hospital is spreading itself thin
190
Pender's health promotion model
Identifies factors that influence health behaviors
Understands each person has unique personal characteristics and experiences that affect subsequent actions
Health-promoting behaviors are the desired behavioral outcome of this model
Includes predicting factors and explanatory constructs of health behavior
perceived benefits, barriers, and self- efficacy; behavioral emotions; and interpersonal and situational influencers
191
Health belief model
Used to predict or explain behaviors
Presumes that preventative health actions are taken mainly to prevent disease
Emphasizes change at the individual level
Original Four Key Constructs:
“Threats” - Perceived susceptibility and perceived severity
“Net benefits” – perceived benefits and perceived barriers
Added Constructs
Cues to Action - a stimulus to undertake behavior
Self-efficacy - or confidence in one's ability to perform an action (can I actually exercise every day to lose weight)
192
TTM or SOC
A behavior change model that explains an individual’s readiness to change their behaviors
Everyone is in different steps
Prochaska & Diclemente (1983) described this model as a sequential approach to behavior change
Different stages (can exit and enter at any stage)
193
Stages of TTM/SOC
Precontemplation – no intent to take action to change, just starting to think about it (Maybe one day but idk)
Contemplation – intentions to take action to change and plan to change in the future (not ready yet but maybe next week I’ll cut down)
Preparation (determination) – intention to take action to change and some steps have been taken (I’m ready to stop smoking! But I’ll do it slowly)
Action – behavior has been changed for a short time (its been a few days and I haven’t smoked!)
Maintenance – behavior has been changed and continues to be maintained for long-term (I haven’t smoked in a year!)
Relapse or Termination – a person either returns to the previous state of behavior OR person has no desire to return to prior negative behavior
194
social cognitive/learning theory
A behavior change model suggests that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behavior.
FOCUSES ON MODELING BEHAVIORS
The unique feature of SCT is the emphasis on social influence and its emphasis on external and internal social reinforcement.
SCT considers the unique way in which individuals acquire and maintain behavior, while also considering the social environment in which individuals perform the behavior.
The theory considers a person's past experiences, which factor into whether behavioral action will occur.
These past experiences influence reinforcements, expectations, and expectancies, all shaping whether a person will engage in a specific behavior and the reasons why a person engages in that behavior
195
Nightingale's environmental theory
Highlights the relationship between an individual’s environment and health.
Based on 5 points
Components of a healthy home – clean water and air, basic sanitation, cleanliness, and light.
A healthy environment promotes healing
Depicts health as a continuum.
Emphasizes preventative care.
She recommended nutritious food, beds, and appropriate bedding and personal hygiene for individuals
196
Current healthcare system pyramid
Wellness/health promotion/public health should be the foundation
Primary care
Recovery/LTC/Home care
Acute care
197
Health equality
everyone receives the same resources and opportunities regardless of circumstances and despite advantages or disadvantages that some may have
198
Health equity
considers the specific needs or circumstances of a person or group and provides the types of resources needed to be successful
199
Justice
long-term equity or treating people fairly and justly based on their circumstances
200
health inequity
a systematic difference in health outcomes between different groups of people, which can be unfair*** and avoidable. Things affect people more than others, this creates disparities
A difference in the distribution or allocation of a resource between groups
Health insurance, how is it, what does it cover, education, vaccine admin and access, fresh food, clean air
201
health disparities
a preventable difference in health that affects disadvantaged groups of people more frequently or severely than others
202
health disparities and differences
not all health differences are health disparities.
Lack of material resources and opportunities (low income has consequences bc u can’t afford stuff, can’t influence surroundings)
Social disadvantage is more broad but relates to relative position in society
Not all health differences are disparities (like worse health in elderly caused by natural aging, arm injuries in tennis players, etc)
There is a difference!!
Health risk related to sexual orientation, race, etc
203
Example of disparity and inequality
High blood pressure, a major risk factor for heart disease (disparity), is more common and not as well controlled in African American and Hispanic adults as in white adults (inequity)
204
WHO definition of sdoh
complex, integrated, and overlapping social structures and economic systems, including social environment, physical environment, and health services
circumstances in which people are born, grow up, live, work, and age, and the systems put into place to deal with illness
205
5 domains of sdoh
education access and quality
healthcare access and quality
economic stability
neighborhood and built environment
social and community context
206
social position
where you fall on the ladder of education and such. People low on the ladder will have worse access to healthcare. Also influences whether a person is at increased risk for a potential health problem and if they have resources for that risk
207
downstream thinking
Microscopic, individual, and curative focuses
Considers immediate patient-level health concerns and treatments
It does not consider sociopolitical, economic, and environmental variables that cause illness
THINK: Chronic disease treatment—emergency services, pharmacology, surgery, and dialysis
208
midstream thinking
Mid-level focus on individual intermediate determinants or material circumstances affecting health
It focuses on things like housing conditions, employment, and food insecurity at an individual level.
THINK: Modifying individual behavior—physical activity, nutrition, tobacco use, maternal health, high school graduation, and violence control
209
upstream thinking
Macroscopic, “big picture,” population or community-wide health approach
Includes primary prevention perspective
Considers determinants of health and structural determinants such as social status, income, racism, and exclusion
THINK: Addressing social determinants of health—conditions in which people are born, grow, live, work, and play
Going to cause of all problems
210
How can healthcare providers get involved with upstream approaches
Focus on those affected first, then the problem
-Why is this a problem?
-How can we help?
-Focus on change
Institutional level
-Policy -advocacy/change/development
-Understand the concept of personal responsibility
