Exam 1: Disability and Home Care Nursing Flashcards
Disability
Having a limitation in the performance or function of everyday activity - general and broad
WHO Definition of Disability
Disability is a dynamic between a person’s health condition and their environment
Americans With Disability Act Definition of Disability
Disability is one who has physical or mental impairment that substantially inhibits one or more major life activities
Severe Disability
Varies in definition from Inability to do ADL/IADLs, needing assistive devices, requiring someone else for assistance to do basic activities
Disabilities __ among people
vary
What are some difficulties a person with a disability may have
talking
walking
hearing
seeing
climbing stairs
lifting
performing ADL/IADLs
doing school work
working a job
As __ increases so does disability prevalence
age
Many people with disabilities are still___
employed
Categories of Disability
- Developmental (Birth to 22 yo)
- Acquired (any age)
- Age Associated
Developmental Disabilities
Disabilities influencing individuals from BIRTH TO AGE 22
Impairment from something like birth trauma, serious illness, injury, etc
Models of Disability
Medical
Rehabilitation
Social
Biopsychosocial
Functional
Interface
Medical Model of Disability
Equates people who are disabled with their disabilities and views disabilities as a problem of the person, a disease, trauma, or other health conditions that requires medical care in the form of individual treatment by professionals
Experts/Authorities: Health Care Providers
Management is aimed at curing or adjusting and behavior change
Promotes passivity and dependency
Views people with disability as tragic
Rehabilitation Model of Disability
Sees disability as a deficiency that needs rehabilitation specialists or other professionals to fix
Disabled people seen as having failed if unable to overcome disability
Social Model of Disability
“Barriers or Disability Model”
Views disability as socially constructed and a political issue that is a result of social and physical barriers in the environment
The perspective is disability can be overcome by removal of the barriers
Biopsychosocial Model of Disability
Integrates medical and social models to address perspectives of health from a biologic, individual, and social perspective
Suggests the disabling condition, rather than the person and the experience of the person, remains the construct
Functional Model of Disability
WHO: ICF
Considers disability as an umbrella term for impairment, activity limitations, participation restrictions, and interaction with environmental factors
Addresses components of health rather than disease consequences
Interface Model of Disability
Based on life exp. of the person with disability and sees disability at the intersection (interface) of medical diagnosis and environmental barriers
Person with a disability defines the problems and seeks or directs solutions
Regarding disability, it is important to do what for the individual
individualize the care plan to them
ask how they like their care, what assistive devices do they need, what are their needs, what are their preferences
General Nursing Role and Ways to Individualize Care for those who are Disabled
Majority live at home - start there
Learn preferences, assistive devices
Teach and promote patient safety
Teach and use communication strategies
Teach and promote independence
Types of Illnesses
Acute
Chronic
Acute Illness
curable, relatively short disease course allowing for recovery in a short period of time
Chronic Illness (CI)
refers to human experience of living with a chronic condition or disease - also includes individual’s perceptions of having a chronic disease and how they respond to it
Has irreversible alterations and there is not a complete cure for chronic illness
Individual needs long term support or care
Care and Support / Issues persist 3 mo +
Causes for Chronic Illness
Genetics
Injury
Behavior
CI can affect…
ALL ages, races, SES, and cultures
We find that as SES decreases…
incidence of CI increases (d/t being uninsured and underinsured)
Th leading cause of death in almost every country is
CI (7/10 of the leading causes of death in US are CIs)
What are the implications of increasing CI rate
rise in cost of healthcare - more than 4 out of 5 dollars spent on CIs
Most CIs are ___
preventable!
Why is CI prevalence rising?
People live longer d/t technology
Mortality decreased for acute conditions
Acute conditions increase rate of getting CI
Repeated scenario - unhealthy lifestyle behaviors, smoking, vaping, chronic stress
Diagnosis - done earlier and more effectively now
Examples of CI
Crohn’s Disease
Ulcerative Colitis
Cancer
Addison’s Disease
Cirrhosis
and more…
Characteristics of CI
Phases of the disease: Remissions, Relapses, Exacerbations - unpredictable
Psychological and Social Impact - anger, depression, isolation, role changes
Financial Impact
Therapeutic Regimen - may not adhere to it
Individual Responsibility - may not adhere or want to
Domino Effect
Collaboration - of healthcare team, family, pts, etc needed to treat
Uncertainty - do not know outcomes of the illness
What domino effect occurs from CI?
One CI often leads to another one
What is our role in the care of CI as nurses?
1 EDUCATE ON PREVENTATIVE MEASURES
Address gaps in care
Prevention
Support
Trajectory Model of Chronic Illness
A model used to describe the role of nurses during the trajectory of chronic illness
Medical Model + Nursing Wellness and Self Care Models = Trajectory Model of Chronic Illness
Stages of the Trajectory Model of CI
- Pretrajectory
- Trajectory
- Stable
- Unstable
- Acute
- Crisis
- Comeback
- Downward
- Dying
*phases do not need to be in order
Nursing Process with Trajectory Model
Assessment –> Nursing Dx priotizing potential problems and tackling them –> Goals (plan) that are realistic and collaborate with everyone –> Interventions –> Evaluation - determine if the nursing dx is better worse or the same
Pre-trajectory Phase
Patient does not have CI yet, but they could be headed that way d/t risk factors that contribute to CI
ex: Pre-diabetic
The pre-trajectory phase is all about what level of prevention?
Secondary Prevention
They have already been screened for risk factors
Goals and Interventions revolve around what in the pre-trajectory phase?
- Testing
- Counseling
- Education
*include caregiver too
Trajectory Phase
Pt starts seeing s/s chronic illness - they get a work up and are formally diagnosed with the CI/CC
Family members may have feelings too - anger, apathy, blaming loved one, concern
Goals and Interventions revolves around what in the Trajectory Phase
- Explanation/Educate
- Emotional Support
Reinforce provider given education, diagnosis and treatment regimen
Refer to community resources
Advocate and support pt and family
Stable Phase
When s/s of CI are under control via meds, lifestyle mods, or a little of both ; has adapted to the disability and any disability they can start adapting to their daily routines
CI is managed at home in this phase and the Family may feel relief from stability, being at home, and no crisis is occurring - may be uncertain of disease but still know and find comfort in stability
Caregiver may be involved or person may have full autonomy
Goals and Interventions revolve around what in the Stable Phase
- Positive Behaviors
- Health Promotion
- Health Promoting Behaviors
Reinforce and encourage behaviors and provide education and encouragement in participation in health activities
Unstable Phase
Pt experiences setback - a relapse or exacerbation where illness may re-activate
Has difficulty carrying out ADLs, but diagnostic testing and changes to treatment may need to occur
This can be managed outpatient, but may need healthcare team intervention
May cause uncertainty
Goals and Interventions revolve around what in the Unstable Phase
- Guidance and Support
- Education
Reinforce previous teaching, get them to cont. compliance, reinforce care, provide education on details why exacerbation occurred
Acute Phase
Like unstable phase, but is a sudden sever onset of symptoms
Here the individual will need to be hospitalized and ADLs are interrupted
Family may be fearful of what could occur and about long-term concerns
N Dx: risk for caregiver strain or role strain
Goals and Interventions revolves around what in the Acute Phase
- Direct Care
- Support
Get them stabilized, support family caregivers and pt
Crisis Care
Sudden crisis occurs where critical life threatening event occurs
Event is immediate and emergent treatment
ADLs completely suspended
Family dynamic in state of crisis and suspension due to uncertainty on what will occur
Goals and Interventions revolves around what in the Crisis Phase
- Direct Care
- Collaboration w/ Healthcare Team
- Stabilize
Straightforward - physio stabilization of pt and collaboration with healthcare team
Direct care and stabilizing the most
Comeback Phase
Gradual recovery of the ACUTE phase
May see new or worsened disabilities
May also see some need for rehabilitation following CRISIS phase - may not be able to immediately go home
May see some family relief, but caregiver role strain persists
Goals and Interventions revolve around what in the Comeback Phase
- Coordination of Care
- Adaptation
Arrange needed surfaces to return pt to prior level of independence or function
Also coord care and adaptation due to potentially new acquired disability from acute or crisis phase
give positive reinforcement for reaching goals too
Downward Phase
Rapid or Overall General Worsening of Illness - Physical Decline occurs over time and may increase disability
ADLs alter on each downward step the pt takes
Pts can linger a very long time and need palliative care
Have longer than 6 mo or uncertainty of amount left to live
Important to know where patient is in this phase and how family may be grieving and how they are doing
lots of uncertainty in this phase
Goals and Interventions revolve around what in the Downward Phase
- Home Care
- New Treatment Plan
3.. End of Life Planning
Support by nurses, PT, Social workers all coming into the home to maintain QOL
Should start discussing end of life planning
Home care will last until when there is determined to only be 6 mo left to live (then hospice comes in)
Dying Phase
Last Phase where death is imminent in 6 mo or less
Hospice steps in
Gradual loss of fxn, complete ADL withdrawal, hospice nurse visits more frequently, discuss end of life care
Family a& Caregiver Distress and Grieving
Some pts will accept this phase but their families may not
Goals and Interventions revolve around what in the Dying Phase
- Direct Care
- Comfort
- Support
Prime focus: Let pt die with comfort and dignity - the hallmark of the phase
Support family and caregivers because they may not be ready for this phase
Home care gives clients and families a chance to get what?
health care in their usual environment, where they may feel more comfortable and where it may be easier to learn and practice how to make health related lifestyle changes
For homebound clients __ __may be a necessity
home care
Home care wasnt covered by insurance until ___
1965
Research shows what can speed recovery
home care / comfort in their own home
Home Care
includes disease prevention, health promotion and episode illness related services provided to people in their places of resident
Is an approach to care provided in people’s homes because theory or research suggests this is the optimum location for certain health and nursing services
includes PREVENTION and is EPISODIC (not permanent)
Home care is usually only how long?
2 months with maybe some recertification before looking at other things
Home care is part of a continuum where clients have the opportunity to do what
live and move through the experiences of subacute, chronic, and end-of-life care.
Care given in the home care setting is often managed and directed by a __
RN (but other members do get involved interdisciplinarily)
Care given in home care settings is __ in nature
interdisciplinary
With caregiving it is essential to…
work with the family in the provision of care to an individual client
Family is defined by …
the individual and includes any caregiver or significant person who assists the client in need of care at home
does not have to be blood related - could even teach caregiver IV therapy and wound care
Family caregiving includes…
assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments
A caregiver is defined as __ and __
willing and able
Nurses practice ___ in the home setting
autonomously (little structure so have to have competence and creativity)
Troubles with Working Home Care
- Home lacks many institutional resources - nurse should be organized, adaptable, and be interpersonally savvy to meet needs
- Nurse is a guest and needs the trust and partnership with the client and family
- Client safety is of utmost concern just like any other setting
Role and Scope of the Home Practice Nurse According to the Nursing Process
Assessment - collect data about home care client
Diagnosis - through analysis of data
Outcome ID - helps home care nurses ID nurse sensitive measures
Planning - in the form of nurse sensitive interventions directed to the Identified outcomes
Implementation - identified nurse centered actions in collab with client and families
Evaluation - was outcome accomplished through nurse sensitive interventions
Scope of Practice - Direct Care
refers to the actual physical aspects of nursing care - anything requiring physical contact and face to face interaction
skilled needs - anything a nurse would have to do in person
Examples of Direct Care
Performing a physical assessment on the client
Changing a dressing on a wound
Giving medication by injection
inserting an indwelling catheter
Providing IV therapy
teaching clients/family how to perform a task
Do we give oral meds in home care
no its not direct c are - the pt is independent and should and can take care of that themselves - but we may do IM SQ IV injections and therapy
Scope of Practice - Indirect Care
activities a nurse does on behalf of client to improve or coordinate care
Examples of Indirect Care
Consulting with other nurses and health providers in a multidisciplinary approach to care
Organizing and participating in client care team conferences
Advocating for clients with the health care system and insurers
Supervising home health aides
Obtaining results of diagnostic tests
Documenting care
Nursing Roles in Home care
Clinician
Case manager
Client advocate
Educator
Mentor
Researcher
Administrator
Consultant
What are the steps of a Home Visit
- Initiating the visit
- Preparation (equipment, directions, personal safety)
- Actual visit and Assessment (medication error risk, fall risk abuse and neglect risk)
- Post visit planning
What are some Reimbursement mechanisms for Home Care
- Medicare and Medicaid are principal funding sources with 3rd party health insurances providing another major source
- Budgeted funds for public health from taxes covers preventive home care visits to the clients of public health agencies
- Other home care services (health education, risk reduction, case management, primary case) may be reimbursed from a variety of sources like program funds, grants, contracts or third party billing
___ and ___ are the principal funding sources of home care
Medicare and Medicaid
How does the Federal Govt maintain cost effectiveness of home care
They instituted a prospective payment system in response to rising costs and increased number of agencies
This prevents fraudulent use of Medicare funding
Evaluation shows this system has increased efficiencies and reduced certain costs and that it has generally not been associated with declines in care quality
