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Nursing 301 > Midterm #1 > Flashcards

Midterm #1 Flashcards

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1
Q

Layers of the skin

A

Outer Epidermis & Stratus Corneum (hair/sebaceous glands/sweat glands pass through this layer but originate in dermis)
Dermis (contains capillary network)
Subcutaneous Tissue

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2
Q

5 Functions of the skin

A 
Protection
Thermoregulation
Elimination of wastes
Synthesis of Vit.D
Sesnation/communication
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3
Q

Risk factors affecting skin

A 
Age
Dryness
Nutrition/Hydration
Disease
Environment
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4
Q

Age related changes in the skin

A 
Increased dryness
Decreased sebum
Epidermal thinness
Loss of elasticity
Decreased tissue tolerance
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5
Q

What is pressure?

Interventions for pressure.

A

Direct force on an area

Interventions:
"offloading"
Turn Q2h
Position bed at 30 degrees
Pillows between bony prominence's
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6
Q

What is friction?

Where does damage occur?

A

Rubbing of one surface against another
Skin damage occurs to epidermal/upper dermal layers
Elbows/heels at greater risk
Looks like a blister or an abrasion

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7
Q

What is shearing?

Where does damage occur?

A

Underlying bones and soft tissues above them move in opposite directions

Damage occurs at deep fascia level over-top bony areas

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8
Q

How does moisture cause skin breakdown?

Interventions?

A

Interferes with the process of wound healing
Decreases the resiliency of the epidermis to external forces.

Interventions:
Use moisture barrier/absorbent pads
Keep moist skin surfaces apart
Do NOT use Telfa

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9
Q

How does protein promote healing?

A

Used to build new tissue
Makes skin strong to prevent trauma
Prevents infection

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10
Q

How does Zinc help with healing?

A

Builds & binds tissue to give it strength

Helps fight infection

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11
Q

How do carbohydrates aid healing?

A

Source of energy for body & collagen formation

Prevents protein from being used as source of energy

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12
Q

How do fats aid healing?

A

Source of energy for the body

Helps absorb vitamins

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13
Q

How do fluids aid healing?

A

Prevents dehydration by replacing the fluid lost in wound drainage

Maintains adequate circulation of blood and nutrients to the wound

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14
Q

Vits A/C role in wound healing

A

Promotes strength

Helps fight infection

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15
Q

Interventions for dry skin

A 
skin cleanser with pH 4-7
Liquid soap vs bar
no rinse cleanser
daily moisturizing 
protect skin with barrier ointment
promote nutrition/hydration
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16
Q

How can wounds be classified?

A 
according to cause:
abrasion
incision
laceration
open
incision
contusion
penetrating
puncture
septic etc.
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17
Q

Difference between acute and chronic wounds.

Healability? Host?

A

Acute: heal within 12 weeks, usually a health host

Chronic: will take longer than 12 weeks - usually months to years, usually underlying conditions & may never heal if underlying pathology never corrected.

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18
Q

What does wound healing depend on?

A

Type of damage done, and type of tissue damaged

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19
Q

Phases of wound healing

A

1) Hemostasis
2) Inflammation
3) Proliferation
4) Remodeling/maturation

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20
Q

Hemostasis

A

Day 0

clotting cascade initiated in response to stem blood loss

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21
Q

Inflammation

A

Day 0-4

characterized by heat, swelling, redness, pain, loss of function at wound site

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22
Q

Proliferation

A

Day 4-21
involves granulation/angiogenesis/epithelialization
quick phase when no infection present

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23
Q

Proliferation– Granulation

A

Day 3-14

granulation tissue forms: combo of fibroblasts/inflammatory cells/new capillaries/fibronectin/hyularonic acid

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24
Q

Proliferation – Angiogenesis

A

new blood vessels form from pre-existing vessels

Collagen increases from day 3 to 3 months
Fibroplasia occurs parallel to revascularization
Endothelial cells migrate forming capillary buds then loops

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25
Q

3 types of healing

A

Primary: healing from internal layers outwards, wound held together
Secondary: healing from wound base/walls up, open wound
Delayed primary: pt. given antibiotics if high risk of infection which delays healing

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26
Q

8 considerations when assessing wound

A
  • braden scale
  • holistic approach
  • patient hx/medications
  • cause of wound
  • duration of wound (acute/chronic)
  • healability (goal of wound)
  • multidisciplinary approach
  • accessibility of wound care products
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27
Q

Braden scale- risk assessment

6 subscales

A 
sensory perception
activity
mobility
moisture
nutrition
friction & shear
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28
Q

How to determine wound goal

A

Is it healable or non-healable?

Healable: good blood supply, healthy host
Non-healable: poor blood supply, unhealty host
Complete vascular assessments such as ABPI

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29
Q

What to do if wound non-healable

A

Treat as palliative wound: pain management, prevent infection, manage odour

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30
Q

Types of wound classifications

A

partial thickness: epidermis & parts of dermis, superficial & painful, healing by regeneration

full thickness: epiderms & dermis destroyed, damage to underlying structurs, heal by granulation, loss of normal function

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31
Q

How do wounds impact the cost of health care

A 
Increased:
nursing care
hospital time
supplies/equipment
sepsis
mortality
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32
Q

National pressure ulcer advisory panel stages (NPAUP)

A 
Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
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33
Q

Stage 1

A

Non-blanchable erythema (redness)

Area may be painful/firm/soft/warm/cool compared to surrounding areas

Difficult to detect in individuals with dark skin tones
“at risk” persons

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34
Q

Stage 2

A

Partial thickness - through epidermis and into dermis

Shallow crater with pink wound bed- no slough

May have serum-filled blister

This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.

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35
Q

Stage 3

A

Full thickness- through epidermis/dermis and into subcutaneous tissue

May extend down to but not through underlying fascia (bone/tendon/muscle)

Slough, undermining, tunneling may be present

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36
Q

Stage 4

A

Full thickness with exposed bone/tendon/muscle

Eschar (leathery, grey, hard to touch)

Slough, undermining, tunneling

Infection may be present

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37
Q

Unstageable

A

Full thickness – depth unknown because unable to visualize full extent of damage d/t slough & eschar in wound bed

slough/eschar needs to be removed to expose base of wound

Infection may be present

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38
Q

Difference between contamination and infection

A

Contamination: presence of non-replication bacteria which does not effect wound healing

Colonization: presence of replicating bacteria, but do not effect wound healing

Critical colonization (aka local infection): wound has stopped healing d/t bioburden but may not show S&S of infection

Infection: when microorganisms invade tissue and triggers host response

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39
Q

wound infection equation

A

virulence x # of microorganisms/ host resistance

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40
Q

3 types of inflammatory responses

A

acute: dramatic
chronic: prolongs– damaging to host
stunned wound: dormant– little or no response after trying multiple products

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41
Q

S&S of infected CHRONIC wound

A 
delayed healing
increased exudate
foul odour
new areas of slough/breakdown
bright red tissue
undermining/bridging
probe to bone
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42
Q

wound assessment

A

location
measurements (cms, done weekly)
under-mining/tunnelling/sinus tract
base of wound (reveals health status)
granulation tissue
exudate (amount, colour, consistency, odour)
odour
periwound (erythema, maceration, induration)
edema (generalized, localized, pitting/non-pitting)
pain

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43
Q

When does undermining occur?

A

with pressure ulcers & is complicated by shearing

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44
Q

3 types of wound pain

A

non-cyclic acute wound pain: e.g. debridement

cyclic acute wound pain: e.g. daily dressing changes/turning/positioning/mobilization

chronic wound pain: persistent, no apparent mediating factors

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45
Q

interventions for non-healing wound

A
  • consider other factors such as infection/inadequate nutrition, trauma, pathology
  • educate
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46
Q

9 principles of wound management

A

1) risk assessment
2) wound assessment
3) debridement
4) identify & eliminate infection
5) eliminate dead space
6) absorb extra exudate
7) promote moist wound healing
8) thermal insulation
9) protect healing wound and surrounding skin

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47
Q

types of debridement

A

surgical/sharp
chemical
mechanical
autolytic

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48
Q

Autolytic debridement

type of dressings?

A

inflammatory response
use of WBC’s/enzymes

use dressings that donate/maintain moisture

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49
Q

Mechanical debridement

type of dressings?

A

Irrigate the wound bed

Wet to dry dressings

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50
Q

Surgical & sharp debridement

A

Pt. under local or general anesthesia
aggressive tx

sharp debridement: removal of loosely adherent, non-viable tissue with sterile scissors or scapel

Sterile

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51
Q

Chemical/enzymatic debridement examples

A

Biotherapy (maggots)

Dakin’s solution (bleach and chlorine)

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52
Q

how are dressings selected

A

based on 9 prinicples of wound-care

the goal of the wound (healibility)

the form & function of the dressing

**moisture-> if it’s dry add moisture, if it’s wet manage moisture

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53
Q

Examples of dressing forms

A 
hydrogels
foams
absorbents
anti-microbials
negative pressure therapy
treatment cream
skin barriers
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54
Q

5 common functions of dressings

A 
absorbent
to add/retain moisture
antimicrobial
barrier
non-adherent
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55
Q

skin prep purpose?

A

to protect peri-wound skin from maceration/tape tears

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56
Q

skin barrier ointment purpose?

A

to protect perio-wound skin from maceration

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57
Q

When would moisture management be contraindictated

A

based on healability (if non-healing wound may result in maceration??)

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58
Q

What is the moisture vapor transmission rate?

aka?

A

when a dressing is <840g/m squared per 24h

aka moisture retentive dressings

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59
Q

moisture retentive dressing purpose

A

acts as an exogenous barrier for water vapor loss from a wound when stratum corneum not intact

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60
Q

purpose of hydrogels

A

for dry wounds when healability determined

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61
Q

purpose of transparent film dressings

A

for minor abrasions & friction (not for skin tears/blisters)

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62
Q

purpose of hydrocolloids

A

stage II or partial thickness wounds with minimal exudate

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63
Q

Purpose of foams

A

for small-moderate drainage on wound with/without border

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64
Q

purpose of absorbents

A

for moderate-large amount of drainage

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65
Q

purpose of absorbent antimicrobial dressings

A

for critically colonized/infected wounds or for prevention of infected wounds

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66
Q

purpose of anti-microbial/ odour control dressings

A

for infection and for odour control

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67
Q

purpose of non-adherents

A

for fragile wound bases e.g. skin tears

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68
Q

purpose of composites

A

e.g. all dress: for lightly exudating wounds

dressing of choice over hydrogels

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69
Q

purpose of antiseptic poviodine

A

antimicrobial protection

to stabilize/maintain non-healable wounds

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70
Q

Protease modulating matrix dressings

A

e.g. promogran

collagen matrix dressing that attracts cells & supports tissue growth

transforms into soft gel on wound bed

used for foot ulcers, venous&pressure ulcers etc.

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71
Q

4 concepts that impact our ability to transition?

A

vulnerability
powerlessness
empowerment
resilience

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72
Q

What is vulnerability?

A

“to wound” (latin)

capable of being physically or emotionally wounded

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73
Q

what increases vulnerability?

A

the longer the exposure to any kind of risk –> the more vulnerable

e.g. aboriginals, women, mental health illness (astigmatism), teen pregnancy ETC.

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74
Q

Predisposing factors for vulnerability

A
  • Very old/very young ages
  • Lower socioeconomic status
  • Developmental transitions (chronicity, dependency, social isolation)
  • Multiple chronic illnesses
  • Undergoing crises (disease/violence/gender worldwide)
  • Language
  • Level of education
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75
Q

Impact of vulnerability on HC

A
  • Increases costs
  • Increases workload/demand
  • High complexity of care (mental as well as physical)
  • Holistic approach
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76
Q

What are the 6 dimensions of vulnerability?

A
  • limited control (e.g. HC- not being able to provide care to everyone we want to)
  • victimization (feeling blamed for situations outside of control)
  • disenfranchisement (feeling separated from mainstream/majority e.g. women voting)
  • disadvantaged status (no social support)
  • powerlessness (no control/choice)
  • health risk (family situation, health history, baseline, violence, childhood risk factors*)

LVD-PHD

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77
Q

Assessing for RISK in the vulnerable..

What to assess?

A

Family situation
Childhood risks
Youth at risk

Violence
Delinquent behaviour
Suicidal behaviour
Coping mechanisms

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78
Q

What is the cycle of vulnerability?

A

predisposing factors
no effective intervention
poor health outcomes
worsening situation

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79
Q

Considerations when assessing vulnerability

A
  • It can be biased
  • If identified inappropriately, interventions may worsen the situation
  • focus on both strengths & limitations to help adapt to change
  • involve family- holistic approach
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80
Q

physiological effects of vulnerability

A

stress/anxiety -> GI symptoms, decreased appetite, fatigue etc.

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81
Q

psychological effects of vulnerability

A

oppression
feeling helpless, fearful, angry
uncertainty, loss of control
powerlessness, desperation

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82
Q

social effects of vulnerability

A

stimatization
social isolation
stereotyping
marginalization

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83
Q

What is an important aspect of overcoming transitions

A

power & empowerement

84
Q

what is powerlessness

A

the perception that one lacks the ability to affect an outcome

85
Q

HC providers with powerlessness

A

may result in an imbalance (HC providers more power than client)
Decisions may be forced on cflient

86
Q

Nursing dx for powerlessness

A

low self-esteem
self-harm
ineffective coping mechanism
social isolation

87
Q

Interventions for powerlessness

A

provide info

promote self-care
encourage effective coping mechanisms

assess & utilize strengths
set mutual goals
be realistic

88
Q

power definition

A

“to be able” (latin)

89
Q

What is empowerement?

A

to encourage participation of others in decision making

to take action in an environment with equal power

90
Q

interventions for empowerement?

A

provide info so they can actively make decision
delinquish role
promote independence

set realistic mutual goals
consider patient preferences

value our patients experiential knowledge**
ensure the patients value their life experiences

91
Q

What is resiliency

A

Adaptive, stress resistant personality that permits one to thrive in spite of adversity

more than just springing back to previous state- involves adjustment, adaption, and transformation in response to changes. When adapting we often will change the environment.

92
Q

What are some inherent qualities of resilience?

A 
Flexibility
Adaptability
Optimisim
Self respect**
Autonomy
Coping strategies
Meaninfulness of life experiences
93
Q

Why is resilience unique

A

it is a characteristic OR a state

process of coping

types: physical, emotional, or resiliency to change
dimensions: may have spiritual/religious

94
Q

Internal factors that increase resiliency

A
  • sense of responsibility
  • hx of success
  • positive self-esteem
  • problem-solving/reading skills
  • feeling in control over life
  • future plans/goals
95
Q

External factors that increase resiliency

family/support

A

good relationship with parents/children

effective parenting skills –> structure/rules within house, responsibilities for everyone in the house

good family coping
family hardiness
strong extended family network

96
Q

4 characteristics of a resilient individual

A

positive
good self-esteem
hopeful
realistic

97
Q

What is hope?

A

it is the recognizition of possibilities
it is believing in a life worth living both in the present/future

it is unique to each individual
but universal to all

98
Q

3 levels of hope

A

Level 1: superficial wishes (asking for something for X-mas)

Level 2: involves hope for relationships, self-improvement and self-accomplishments (getting a new job- anxiety if not achieved, relief if achieved)

Level 3: hope arises from suffering, personal trial, or state of captivity (recovering form the loss of a loved one)

99
Q

6 critical elements of hope

A
  • sense of possible
  • avoiding absolutes (all or nothing)
  • freedome of choice
  • purpose & meaning of life
  • Optimism
  • psychological well-being and coping

ETC.

100
Q

what is despair

A

aka “giving up”

101
Q

when does despair occur?

A

when goals/path towards goals are lost

relief not happening

102
Q

what does despair lead to

A

hopelessness

103
Q

Miller’s Hope/Despair model

A

HOPE

  • establish goals
  • focus on past success
  • plan for alternative actions
  • motivates self to succeed

DESPAIR

  • unable to set goals
  • unachieved outcomes=personal failure
  • verbalizes self-doubt
  • gives up
104
Q

How does despair trigger hoplessness?

A 
through:
enduring
uncertainty
suffering
acceptance

(cyclic relationship between all)

105
Q

enduring

A

begins with awareness of something without fully understanding it

involves:
suspending emotions
using energy to “keep self-together”
attempt to remain in control

106
Q

uncertainty

A

recognition that the event has occurred

involves:
ready to make goals but not sure where to start
inability to determine benefits/draw-backs of alternatives

107
Q

suffering

A

acknowledgement: reality sets in leading to feelings of blackness/despair
- support groups beneficial at this time

108
Q

acceptance

A

accept the situation

hope for a new path/new goal

109
Q

Side effects of hoplessness/despair

A
  • increased sx/illness/disability
  • weakness
  • decreased concentration
  • fluctuating moods
  • insomnia
  • suicide
  • inability to deal with info re: illness
110
Q

5 strategies to maintain hope

A
  • develop relationship with caregiver/create family bonds
  • be in control
  • be determined
  • accomplish goals
  • spirituality
111
Q

Anatomy of the brain in relation to hope

A
  • anterior hypothalamus: calms emotions and increases body’s immunity
  • posterior hypothalamus: fight/flight produces cells to work in immunity
  • neuropeptides: translates emotions into bodily events e.g. crying, butterflies
  • psychoneuroimmunology: study of how psychological states influence disease (through nervous, endocrine, and immune systmes)
112
Q

Nursing interventions for hope

A

relinquish control
create therapeutic relationships & connect
identify mutual/realistic goals & modify PRN
effective coping strategies & guard against despair
reality surveillance (clues that hope is in reach)
share experiences

113
Q

Crucial elements of a psychiatric assessment

A

mental status assessment (MSA)

psychosocial assessment

114
Q

What is mental status?

A

a persons emotional/cognitive functioning

optimal when satisfied with work/relationships/self
becomes an issue when ADL’s impacted

115
Q

what is an essential aspect in assessments?

A

communication skills

116
Q

what does a mental status assessment include:

A
  • Presenting problem & history of present illness
  • Mood/affect
  • Past health history/family history
  • Identifying characteristics (appearance, tattoos, sex, age, race, birth marks etc.)
  • Physiological data
  • Psychosocial data
  • Developmental data
  • MSE & possibly other diagnostics (MMSE, GAF, DSM-5)
117
Q

Physiological data

A

are the mental issues impacting the patients body? (stress/anxiety increasing GI symptoms, increased pain, lack of sleep,libido etc.)

118
Q

Psychosocial & behavioural data

A

Assess for changes in mood, concentration, memory (give pt. three words and ask them to repeat thewords at end of assessment)

Assess any worries/concerns/judement&insight

social supports
coping mechanisms (+/-)
 family dynamics
cultural norms
values & beliefs
spiritual
work-related issues
119
Q

Developmental data

A

developmental stage, growth, maturation level, school level, best/worst subjects, grades, learning styles, relationships with teachers/peers

120
Q

Presenting problem

A

Why this person, at this time, with this problem?
What has changed from baseline

Assess:
Stressors
Sequence of events
Aggravate/alleviate situation
Impact on life
Inisght (awareness of illness)
Source of referral (how the pt. was brought in)
121
Q

Mood

A

Subjective
Use scale 1-10 re: how they are feeling
Why is there is a difference between days

Assess:
Quality
Intensity
Reactivity to external factors
Variation
Stability
122
Q

Affect

A

Objective
Look for incongruencies between mood & affect

Assess:
Quality
Intensity/degree
Reactivity/variability
Stability (how long to rebound?)
Appropriateness
123
Q

Why assess the patients past medical history/family history

A

contributes to patients coping strategies

may be less anxious re: hospitalization with the more visits

124
Q

How to increase insight (awareness of illness)

A

education
experience
support
decrease stigmas

125
Q

What does a MSE include?

A 
Appearance
Attitude
Speech
Mood & affect
Perceptions
Thoughts
Sensorium/cognition
Judgement 
Insight
Reliability

*see notes

126
Q

what is a MMSE

disadvantage?

A

concentrates only on COGNITIVE functioning, NOT mood, thought processes, or ADL’s

written in english, be aware of language barriers!

127
Q

global assessment of functioning scale (GAF)

A

examines symptom severity, and ADL’s on a hypothetical continuum of mental illness

no longer on the DSM-5 classification

128
Q

What is suicide

A

voluntary & intentional act of killing onself

action not an illness!

aggression directed inwards

129
Q

what is parasuicide

A

gestures/attempts that are unsuccessful

130
Q

what is suicidal ideation

A

thinking about and planning one’s own death

131
Q

risks for suicide

A

youth (d/t life experience & bullying)
elderly (high stressors)
women 4x more likely to attempt suicide
men 3x more likely to complete suicide

family hx of suicide
family dyfunction
childhood trauma
lack of support
recent losses
alcohol & substance abuse
chronicity
psychiatric disorders
132
Q

What are the 5 levels of suicide behaviour

A

1) ideation: thought & plan of committing suicide
2) threats: statement of intention
3) gestures: acts it out but doesn’t complete (writing letter)
4) attempts: physically follow through will plan (cutting self)
5) completed suicide

133
Q

Suicide assessment

A

ongoing process that involves nursing intuition!

  • Behaviour: IS PATH WARM?
  • Hx: from patient, family/friends, previous attempts/gestures
  • MSE
  • Physical exam (S&S of substance abuse/previous attempts, medical conditions)
134
Q

IS PATH WARM

A 
Ideation
Substance abuse
Purpose
Anxiety
Trapped
Hoplessness
Withdrawal
Anger
Recklessness
Mood changes
135
Q

how to determine level of lethality

A

imminence + intent + patient’s level of hopelessness

136
Q

Imminence

A

Does the patient have a time period, specific plan, access to plan, and admission of wanting to die?

137
Q

Ideation vs. intent

A

Is is conscious or unconscious? e.g. youth participating in high risk behaviour

138
Q

Severity index for suicide risk

A

can be SI, moderate, advanced, severe

139
Q

Nursing Dx/goal

A

Dx: Risk for suicide/self-directed violence

Pt. will verbalize absence of SI, and self-work in 2 weeks

140
Q

Nursing interventions for suicide

A 
SAFETY:
remove hazards
roommate
search belonging for sharp objects
search visitors
close observation
COPING:
identify strengths
offer support & resources
increase independence
be realistic
141
Q

Difference between violence and suicide

A

violence is directed outwards, suicide is directed inwards

142
Q

What is anger

A

and affective state in attempt to warn/intimidate threats

143
Q

Difference between anger and aggression

A

anger is the feeling, aggression is the behaviour

144
Q

Risks for anger/violence/aggression

A 
family hx of anger/violence/aggression
personal hx of "               "
alcohol/drug use --> poor coping mechanisms
mental illness
medical illness
145
Q

What can violence/aggression lead to

A 
Injury to self/others
Distrust
Guilt
Isolation
Judgement
Crime
146
Q

S&S of violent behaviour

A

** history of assualtive behaviour

increased motor activity (pacing, restless)

verbalized threats (response to threats/hallucinations/delusions)

intensified affect (jumpy)

alcohol/substance use (intoxication or withdrawal)

organic brain syndrome

147
Q

What is organic brain syndrome

A

changes in brain structure on CT which can cause alterations such as…

LOC changes
disorientation
impaired memory
hallucinations
abnormal motor movements (tics, jerks)
148
Q

4 levels of crisis development

A

1) anxiety (changes in behaviour, restlessness, muttering to self, wringing hands)
2) defensive/anger and hostility (verbal/non-verbal cues)
3) acting out (loss of control, physical abuse)
4) tension reduction (emotionally drained, remorseful, apologetic, withdrawn)

149
Q

How to respond level 1 Anxiety

A

Supportive approach!

active listen - validate- reassure
non-judgemental
provide helpful actions

150
Q

How to respond to level 2 Defensive

A

Directive approach!

offer information
limit choices
be clear, concise, simple
consequences to person
remain calm
151
Q

How to respond to level 3 Acting out

A

Non-violent approach!

offer PRN
activate seclusion

152
Q

How to respond to level 4 Tension

A

Therapeutic approach!

Reflect
Consequences

153
Q

Voluntary admission procedure

A

can voluntarily admit self if over age 16

Form 1 - request for admission, Dr. and director must agree to admission

Form 2 - Consent for treatment

Can discharge self at any time

154
Q

3 types of involuntary admission

A

3 different ways:

  • Through Dr.’s medical certificate
  • Through police
  • Through order by judge
155
Q

Involuntary admission procedure

A

Form 4: to treat pt. for 48h (completed by Dr.)

Second certificate to be completed within 48h by a different physician (to hold patient for up to one month from admission date)

to extend past one month, Form 6 is a renewal form that can hold pt. for additional month

156
Q

Involuntary admission criteria

A

MUST meet all 4:

  • has mental illness that impairs ability to react to others/environment
  • requires psychiatric tx
  • requires care/supervision to prevent harm to self/others
  • is not suitable as a voluntary
157
Q

Rights for involuntary patients

A

they must be verbally informed & given form 13

Form 13 includes: 
hospital name/location
reason why pt. admitted
the right to contact lawyer or advocate
the right to apply for panel hearing
the right for regular reviews by Dr.
the right for second opinion
the right to apply to court for discharge
158
Q

What is a review panel hearing

A

3+ people who decide whether pt. should be discharged from involuntary status

once requested, has to be done within 14 days

159
Q

Purpose of extended leave

A

so patient can have long-term support following discharge

Form 20

160
Q

What is collaboration?

A

teams work together to explore different persectives and search for solutions that go beyond what they thought was possible

161
Q

5 Characteristics of collaborative practice

A

it is an outcome
shared power

involves interaction
working towards common goal
trusting

162
Q

What is intersectoral collaboration?

A

projects that involve various levels of decision making
involves three levels: micro, meso, macro

health groups & other groups that normally are not involved with health, but have an impact on health, work together to improve health outcomes

163
Q

Levels of intersectoral collaboration

A

Micro: the individual and their desired care population

Meso: community and the private sector

Macro: central and local government agencies

164
Q

4 main concepts of collaboration

A

Sharing
Partnership
Interdependency
Power

165
Q

What is sharing?

what does it involve

A

making sure everyone is heard

involves:
multidisciplinary
responsibilities
decision-making

HC philosophy/values
data/planning/intervention

e.g. collective problem solving

166
Q

What is partnership?

what does it involve

A

authentic/constructive relationships – there because you want to be there

involves:
honest communication
mutual respect/trust
common goals
assertiveness/cooperation

*if no interactive engagement then no partnership can be formed

167
Q

What is interdependency

what does it result in

A

everyone working together (not autonomy)

results in synergy effect: come to better conclusion when work all together, involves interdependence.

the whole is greater than the sum of its parts

168
Q

Power in collaboration

A

power&information shared between all team members

based on knowledge/experiences that is relate able to everyone

power is the product of relationships and interactions!

169
Q

Examples of 3 accents that lead to attributions

A

knowing own role/expertise –> willing participation & team approach

based on knowledge/expertise not title/role –> power shared

good communication skills, respect & trust lead to non-heirarchical relationships

170
Q

Characteristics required to collaborate

A 
good communication/ leadership
problem solving skills
conflict management
assessment
be aware of own feelings
171
Q

Examples of collaboration in nursing

A

collaborating with pt./family about overall goals/patient care

pt. deteriorating–> call Dr. or specialist for collaboration

makes referrals to ensure contunuity of pt. care following discharge

172
Q

3 types of teams

A

1) Unidisciplinary
2) Multidisciplinary
3) Interdisciplinary

173
Q

Unidisciplinary team

A

care delivered by 1 health care professional to patient/family

174
Q

Multidisciplinary team

A

several different professionals from different expertise work independently of each other e.g. referral/consult

175
Q

Interdisciplinary team

A

HCP work together to care for patient/families

176
Q

3 Antecedents (Pre-requisites) to collaboration

A

collaboration concepts (power, sharing, interdependency, partnership)

personnel factors (individual readiness, personal confidence)

environmental factors (organizational support/structure, collaborative atmosphere, team oriented)

177
Q

CNA’s 7 essential elements for collaboration

A 
Assertiveness
Accountability
Autonomy
Cooperation
Communication
Coordination
Mutual respect/trust

AAA
CCC
M

178
Q

What are 4 requirements for inter-professional collaboration

A

focus on client
quality care & services
trust & respect
effective communication

179
Q

What is the inter-professional/professionalization paradigm shift?

A

a shift in thinking from current inter-professional practices

include other professionals input to help understand patients viewpoint

180
Q

Levels of collaboration

A

micro
meso
macro

181
Q

Micro collaboration

What can impact this level?

A
  • HCP, other providers, and patients
  • 1 team member
    i. e. mutual goal setting with pt.
What can impact this level of collaboration:
Poor understanding
Poor attitudes
Education (boundary work)
Group dynamics
182
Q

What is boundary work

A

Divisions between different fields of knowledge created

tool used by professional to promote own thoughts, does not take in other perspectives (thinks they are dumb)

183
Q

Meso collaboration

examples?

A
  • Organizations
  • Involves the community & facility

i.e. hospital board creates vision/values behind collaborative policies/programs, UFV students teaching community about heatlh

184
Q

Macro collaboration

A
  • community, regional, provincial, federal government
  • involves intersectoral collaboration
  • goal is to: create shared vision for health care delivery, create policies/programs that link health and social services, patient-centered practice
185
Q

Benefits to collaboration

A
  • better pt. outcomes
  • Health care system: less readmits, decreased staff absenteeism, less staff burn-out, decreased costs
  • Collaborative team: better coordination/cohesiveness, less burn-out, more respect
  • HCP: less burn out, provides different perspectives. improved communication, more consistent collaboration, peer feed-back, creative ideas are shared** (cross fertilization)
  • Synergy effect
186
Q

Barriers to collaboration

A
  • poor leadership skills
  • poor patient participiation
  • organizational issues (no meetings/collaboration)
  • time & cost
  • education (boundary work)
  • poor group dynamics
187
Q

Evidence for collaboration

A
  • to be successful, need support from all levels

e.g. community level needs support from regional/national level
national level needs support from community/local levels

188
Q

Medical Approach Perspective of Health

A

until 1970
Disease-Treatment model

Health= absence of disease
Focus= fixing problems as they arise
189
Q

Benefits/disadvantages of the medical approach

A

Works best for diseases that have very clear cause- treament

Disadvantages:
Very costly
Only effective for diseases
Doesn’t look at long-term health only short-term
Still present in areas that are developing

190
Q

Behavioural approach to health

A

1970-1980
Risk factor- behavioural model
*Individual responsible for health

Health= depends on lifestyle, behaviour, genetics
Focus= decrease behavioural risk factors
191
Q

Benefits/Disadvantages of the behavioural approach

A 
benefits: 
promotes physical well-being
smoking rates decreased
people started going to gym well
highlights risk factors

disadvantages:
puts blame on individuals

192
Q

Socioenvironmetal approach

A

1980’s
Health promotion/social justice model

Health= defined by social determinants
Focus= increase social resources

suggests that health related behaviors cannot be separated from the social contexts of individuals

the patient is a product from the situation that they are living in

193
Q

social determinants of health

A 
income
education
physical/social environment
employement
coping
194
Q

Advantages/disadvantages of the socioenvironmental approach

A 
Advantages:
Empowering individuals
encourages participation in community/families
encourages lifestyle improvements
more distribution of wealth
collaborative

Disadvantages:
not as much research into diseases
tons of policies
resources have to be organized

195
Q

what can a lack of material/social deprivation lead to

A

chronicity
shorter life expectancy
suicide

196
Q

income distribution

A 
middle class jobs losing more quickly
more people either in poverty or in high paying jobs
197
Q

Benefits of education/literacy

A

provides necessary skills for problem solving

provides more job opportunities –> income security

more able to access/understand health information

198
Q

Impact of physical environment on health

A 
housing location:
neighborhood safety
quality food/water
road safety
green space
community design/transportation systems

indoor environment: air quality

199
Q

Impact of social support on health

A

Help with problem solving
Provide life satisfaction
Positive role model
Minimize stress

*can have negative impact if a negative role model e.g. smoking, or if you feel need to keep up with them

200
Q

Impact of social environment on health

A
  • strength of social networks within the community/region/organizations
  • provides networking and sharing
201
Q

Impact of employement/work conditions on health

A

if unemployed = poorer health
if unsafe work conditions= poor health

work condition has direct impact on mental/social/physical health

202
Q

What are personal health pracitices

A

actions to prevent disease/promote self-care

203
Q

What impacts personal health pracitces/coping skills

A

depends on:

exposure to stressors
cultural impacts
social supports
sense of control over health/decisions

  • all dependent on socioeconomic environment
204
Q

how does health impact socioeconomic factors

A

poor health –> low socioeconomic status

and visa versa

205
Q

how does genetic factors impact socioeconomic

A

cognitive abilities, personality impacts education/income

females have lower income
males use health care services less

Nursing 301 (2 decks)

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