Lecture 2 + NSC 2 Flashcards
What is the Nursing Metaparadigm?
Person - Environment - Health - Nursing
the global concepts that identify the phenomenon of central interest to a discipline, the global propositions that describe the concepts, and the global propositions that state the relation between or among concepts
What is the definition of Health ?
Health is an objective process characterized by functional stability, balance & integrity – is it a positive term or a negative term?
Wellness is a subjective experience
Consider: when health and wellness are put on a continuum with illness/death at one end and health/maximum at the other, one is negative (absence of health), one is positive, health has a negative connotation.
BUT if health is positively defined, illness is separate but interrelated. CAN BE BOTH AT THE SAME TIME
Are ‘illness’ and ‘disease’ interchangeable terms?
Disease is an objective state of ill health, the pathology of which can be detected by medical science.
Illness is a subjective experience of loss of health
What is Nightingales Belief ?
Health: Being well or using each person’s power to their full extent – Maintenance of health through prevention of illness and environmental control – Health began at home – Disease was a reparative process
Power of person across the lifespan to be engaged in keeping well - Disease as a reparative process, with an effort to be made by the body to seek harmony and to gain a spiritual perspective- assist nature to repair the patient
What are the social Determinants of Health ?
the economic and social conditions that shape the health of the individual, community, and jurisdictions as a whole….[and] determine the extent to which a person possesses the physical, personal and social resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment …Raphael, 2009, as cited in text
What are some aspects of Nursing in Canada ?
Essential part of the Canadian health care system - Largest group of health care professionals & invaluable to the health of Canadians - Nursing services are necessary for every client seeking care - Since late 1990’s Canadian workforce size has been stable, approx. 88.2 regulated nurses for 10,000 population
What are the different levels of Healthcare ?
-
Federal Level – Health Canada
- Health protection (Food standards & safety, drug regulation; environmental health)
- Medical services (Health care to Inuit/native, International, immigrants)
- Health Services and promotion (Research CIHR; preventive health services, community and mental health)
- Fitness and amateur sport
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Provincial level
- Health Care financing
- Organization of Services
- Hospitals
- Physician’s services
- Public health
- Home care
- Long term care
- Mental health
- Ambulance care
- Standards setting (health professions), vital statistics
- Health Care financing
What are the different Sectors in Health Care ?
- Community sector: Public Health, Physician Offices,community Health Care Centers & Clinics, Assisted-living Facilities, Home Care, Adult Daycare Centres, Community & voluntary agencies, Occupational Health, Hospice/palliative Care, Parish Nursing
- Instituitional Sector: Hospitals, Long term care facilties, psychiatrc facilites, rehabilitation centres
What are the levels of Health Care ?
- Health Promotion: enabling clients to increase control over and improve health. Provision of wellness services, anti-smoking education, improving self-esteem in adolescents.
- Disease and Injury Prevetion: prevention services to reduce risk of illness & injury. Examples include immunization, car seat clinics, screening (breast screening), environmental action groups.
- Diagnosis & Treatment: recognizing and treating clients’ exiting health problems. 3 sub-levels exist: Primary care- 1st contact with primary health provider that leads to a decision regarding course of action to resolve any actual or potential health problems. Coordinates care between other levels of healthcare providers. May be an MD, NP. OB-GYN, geriatrician and/or pediatricians. Secondary care: hospital or home, requires specialized medical care- seeking definitive diagnosis or diagnostic review. i.e. a cardiologist or neurologist. Tertiary care: specialized & highly technical care for complex or unusual health problems-regional, teaching, university or specialized hospitals. Quarternary care: extension of tertiary care which is even more specialized and rare i.e. experimental medicine and procedures and/or highly uncommon and specialized surgeries
- Rehabilitation: restoration to fullest physical, mental, social, vocational functioning possible. Nurses work in conjunction with physiotherapy, occupational therapy, speech therapy and social workers.
- Supportive Care: health personal & social services who provide care to clients who have prolonged disabilities, who do not function independently or who have terminal disease. Respite care allows for the provision of relief time for caregivers.
What are the aspects of Primary Health Care ?
- Prevents people from becoming ill or injured
- Enables self-care
- Optimizes health care provider expertise
- Enables health care workers to treat acute & episodic illness
- Coordinates for efficiency & access
- Recognizes factors external to health care system that affect health
What is the nursing Process ?
- A problem-solving approach to identifying, diagnosing & treating the health issues of clients/persons
- Fundamental to how nurses practice
- Orderly, systematic
- Not linear, but overlapping & interrelated
- Dynamic, interactive process, nurse moves back & forth between the steps
According to RNAO, whar is person and family centred care ?
It is important to acknowledge that person- and family-centred care focuses on the whole person as a unique individual and not just on their illness or disease. By viewing the individual through this lens, health-care providers come to know and understand the person’s life story, experience of health, the role of family in the person’s life, and the role they may play in supporting the person to achieve health.
This guideline provides best practice recommendations in three main areas:
- Practice recommendations are directed primarily to those who provide direct care to persons in health-system settings and in the community.
- Education recommendations are directed to those responsible for staff and student education.
- System, organization, and policy recommendations apply to managers, administrators, policy-makers, nursing regulatory bodies, academic institutions, and government bodies.
Recommendations for educators:
Educate health-care providers at a minimum on the following attributes of person- and family-centred care to improve the person’s clinical outcomes and satisfaction with care:
1) Empowerment;
2) Communication; and
3) Shared decision making .
…and to use this guideline when teaching students.
What is Assessment ?
Deliberate and systematic collection of data
Current health status
Past health status
Functional status
Present and past coping strategies
Collection and verification of data
Analysis of data to identify collaborative problems, clients goals and develop plan of care
What is Data Gathering ?
- Phases of interview:
- Orientation phase: Nurse collects background information from previous charts and other sources - Ensure environment is conducive- Arrange seating - Allow adequate time - Nurse introduces self - Identifies purpose of interview - Ensure confidentiality of information - Provide for patient needs before starting
- Working phase: data gathering, utilizing both open-ended and closed questions to facilitate process
- Termination phase: summary, identifying next steps, client questions
What are the goals of the interview ?
- Gathering complete health data
- Establishing rapport and trust
- Teaching client about health state
- Continuity of therapeutic relationship
- Begin teaching about health promotion and prevention (we will touch on education later in the term)
What are the two types of Data Collected ?
- Objective data: observable and measurable facts (Signs)
- Subjective data: information that only the client feels and can describe (Symptoms)
What are the pulse points ?
Adult: most common sites used radial and apical. If the radial pulse is abnormal, intermittent or inaccessible then the apical pulse must be assessed. The apical pulse is located 4th to 5th intercostal space left side of chest midclavicular line, it is assessed using the stethoscope. Apical pulse is assessed in clients taking medication for cardiac function as it is more reliable. Other peripheral pulses are not routinely assessed unless part of a complete physical, when surgery or treatment has impaired blood flow to a body part or clinical indications of impaired peripheral blood flow.
Carotid pulse is used in emergencies
Infants and children: brachial or apical are preferred sites as other peripheral pulses are deep and difficult to palpate accurately.
Stroke volume: 60-70 mL of blood enters aorta with each ventricular contraction.
Cardiac output: volume of blood pumped by the heart during 1 minute.
What is abnormal Blood pressure ?
Hypertension: Common alteration- Asymptomatic - Diagnosis: average of 3 or more readings- diastolic 85-89 mm Hg or systolic 130-139 mm Hg - Diastolic >90 - Systolic >140
Hypotension: Systolic BP < 90 mmHg - May be normal for some - Causes: dilation of arteries in the vascular bed, blood loss, failure of heart muscle to pump adequately.
White Coat Syndrome: hypertension in health care provider office
Masked Hypertension: normal on exam, but high at home
