N322 Midterm Flashcards
-Care for sick individuals and families
-Not a specialty
-Emphasis is acute and chronic care
-May be associate’s degree or diploma prepared
-Settings: school, occupational health, faith communities, primary care, home care
-Illness Care
-One on one
-Focus is secondary & tertiary prevention
Community Based Learning
-Is a specialty (includes public health nursing)
-Emphasis on health of the community & population
-Individual is seen as part of larger social system
-Settings: government/official agencies (e.g. county health department)
-Healthcare occurs in community agencies, one-on-one, groups, and organizations
-Focus is primary & secondary prevention
Community Oriented Nursing
Core: community itself, values/beliefs, culture, history of area
Physical environment
Education
Safety & transportation
Politics & government
Health & social services
Communication
Economics
Community Assessment Wheel
Core is exposed to stressors that may tear down the health of the population
Lines of resistance to those stressors- how the community protects itself against those stressors
Community As Partner Model
A collection of people who share one or more personal or environmental characteristics and are loosely associated with one another
Population/Aggregate
A collection of people who interact with one another & whose common interests form a basis for a sense of unity or belonging
Community
Core function of public health
Systematic data collection on the population; monitor for existing health problems
Assessment
Core function of public health
Inform, educate, and empower people regarding health issues
Develop and support local, state, national, and international legislation that support and promote the health & wellbeing of the population
Use a scientific knowledge base to make policy decisions
Mobilize partnerships
Policy Development
Core function of public health
Make sure that essential community oriented health services are available
Enforce laws and regulations that protect health and ensure safety
Link health services
Assurance
If the care the infant receives is consistent, predictable, and reliable, a sense of trust develops which is transferrable to other relationships, allowing a sense of security when feeling threatened
A sense of hope develops from successful completion of this stage
Trust vs Mistrust (Infancy: 0-18 months)
Intelligence demonstrated through motor activity
Knowledge of the world is based on physical experience
Object permanence, memory, and causality begin to develop around 7 months
May experience separation anxiety
Sensorimotor Stage (Infancy: 0-24 months)
Cephalocaudal development
Innate reflexes
Physical development (Infancy)
Developing physical coordination, starting to walk and talk
Can undress, build a tower of 4 blocks, scribbles
Can run, walk up & down stairs, push & pull toys
Physical development (Toddlers: 1-3 years)
Skills and abilities emerge that illustrate the child’s growing sense of independence and autonomy
Success = confidence and security
Failure = feelings of inadequacy, over-dependence, lack of self esteem, feelings of shame and doubt
Autonomy vs Shame & Doubt (Toddlers: 18-36 months)
An action is wrong if one gets punished for it
Preconventional (Toddler)
Children think in images and symbols
Symbolic play: imaginary friends or social play with roles assigned
Egocentrism: unaware that other viewpoints exist
Animism: inanimate objects are capable of actions and have lifelike qualities
Transductive Reasoning: does not understand cause and effect (reasons from specific to specific; draws relationships btwn unrelated events)
Preoperational (Spans ages 2-7 years)
Can manage scissors, buttons, toothbrush, eating utensils, draws a 6-part person, square, cross, circle, starting to learn to tie shoes
High curiosity and imagination, prone to fears, learns through play
Physical development (Preschoolers)
Child regularly interacts with other children
Play is pivotal (plan activities, make up games, initiate activities with others)
Success = sense of initiative and feeling secure in ability to lead others and make decisions
Failure = developing a sense of guilt
Initiative vs Guilt (Preschoolers: 3-5 years)
Avoids punishment and has self-interest orientation (self-centered)
Decisions based on pleasing others and avoiding punishment
Preconventional (Preschooler)
Fine motor skills continue to improve
Play cards and board games
Can jump rope, ride bike, and roller skate
Physical development (School Age: 6-12 years)
Success leads to a sense of competence
Expanding relationships outside the nuclear family
Peer groups become important
Important event is SCHOOL. Learning to cope with academic and social challenges
Gaining awareness of their uniqueness
Industry vs. Inferiority (School Age: 5-12 years)
Ability to understand conservation
Intelligence is demonstrated through logical and systematic manipulation of symbols related to concrete objects
Thinking is less egocentric and operational
Concrete Operational (School Age)
Avoids punishment and has self-interest orientation
or
Behavior is guided by approval/disapproval from social norms, rules, and expectations. Developing internal standards (conscience)
Some preconventional/Some conventional (School Age)
Puberty
Attempts new sports; driving a motor vehicle
Physical development (Adolescence: 12-18 years)
Learns new roles that will be adopted as an adult
Self-identity develops
Body image extremely important
Identity vs. Role Confusion (Adolescence)
Intelligence is demonstrated through logical use of symbols related to abstract concepts
Thinking may be egocentric in early adolescence due to increased independent thinking
Formal Operational (Adolescence)
Behavior is guided by approval/disapproval from social norms, rules, and expectations. Recognizes importance of obeying laws from social conventions. Violating a law is morally wrong
Conventional (Adolescence)
Contribute to student development and readiness for learning
Health and safety promotion
Actual and potential problem intervention
Chronic healthcare management
Collaborate with school professionals
Help families to access, coordinate, and manage healthcare for their child
School Nurse Role
Health information is kept private unless explicit written permission for its disclosure is given
Health Insurance Portability & Accountability Act (HIPAA)
Enables parents to get access to child’s educational and health records
Enables dissemination of student health information with educational staff on a “need to know” basis
Family Educational Rights and Privacy Act (FERPA)
School nurse record containing demographic information, parent’s contact information, anthropomorphic info, medication info
Cumulative Health Record
School nurse records of visits, medication, treatments, record of day-to-day visits
Notes
Same thing as a care plan but taking into consideration school environment, school schedule, and school professionals who may be working with the student at any time
Individualized Healthcare Plan
Simplified step-by-step plan built by school nurses for other staff to outline their role in an emergency; typically written for students with significant health problems (e.g. seizure disorders, or severe anaphylactic reactions)
Emergency Care Plan
Plan for educational success for students with disabilities or medical conditions/
Accommodates students’ disabilities by changing the school environment
IEP/504 Accommodations
Created by the school nurse after significant injuries occur
Purpose is to have a medical person write a full report about the incident
Sent to insurance companies and the district office
Accident Reports
Concerned with the detection and intervention into the cause, risk factors, and precursors of disease
3 levels: primary, secondary, tertiary
Prevention
No one is sick, preventing disease from occurring
Less costly that treating disease (secondary & tertiary prevention)
Goal: to prevent disease from occurring
Implemented while individuals are healthy and have not yet developed disease
Aimed at susceptible individuals who have no discernible disease/pathology
Ex: education, safe sex, IMMUNIZATIONS, etc.
Primary Prevention
Disease has occurred and we are trying to find it early, hopefully before symptoms appear
Aim is to either reverse the process (cure) or reduce the severity of the disease
Goal: detect disease in its early stages
Ex: vision/hearing screenings, pap smears, BP screenings, etc.
Secondary Prevention
Trying to limit the amount of disease or disability a person experiences
Symptom management/reduction
Goal: to improve the course of disease, reduce disability, or rehabilitate
Aimed at people with clinically apparent disease
Expectation that these individuals will not return to their pre-illness level of functioning but can work toward highest level of functioning
Ex: physical therapy, support groups, rehab/suboxone clinics
Tertiary Prevention
The use of electronic information and telecommunication technologies to support and promote long-distance clinical healthcare
Can be real-time, two-way communication OR
Asynchronous communication that is stored using technology, and then forwarded to provider at a later time
Telehealth
Medicare (federal) reimbursement for telehealth services has increased since the Affordable Care Act
NYS has increased reimbursement for services through Medicaid (state) & commercial health insurance
Real-time and asynchronous ARE included in coverage
Telephone, electronic messaging, and facsimile transmissions ARE NOT reimbursed through Medicaid
Paying for Telehealth
Looks at individual, social, and physical environmental factors that influence a person’s health promoting behaviors, or lack thereof
Many levels of influence, or social environments that enhance/deter behavior
How family, friends, & communities influence the food you eat, activities you engage in, and opportunity for health promoting behaviors
Be aware of which influences are/are not within individual control
Eliminates victim blaming bc poor health is not viewed as a personal failure
Ecological Model for Health Promotion
Changes in the social environment will produce changes in individuals
Support of the individual in the population is essential for implementing environmental change
Assumption of Ecological Model
Ecological Model of Health Promotion Key Factors
The first level includes characteristics of the individual; can work to change an individual to achieve health outcomes
Nursing interventions aimed at changing the individual rather than modifying the social environment
Attempt to change the individual through education, counseling, mass media campaigns, or incentives
Intrapersonal Factors
Ecological Model of Health Promotion Key Factors
The factors include the social networks that provide emotional support, information, access to new social contracts, and social roles
Goal: change the nature of the existing social relationships
Targets of the Interventions: change norms of groups, increase accessibility to favorable groups, create alternative networks
Interpersonal Factors
Ecological Model of Health Promotion Key Factors
Social institutions with organizational characteristics and formal/informal rules & regulations for operations (schools & worksites)
Health behaviors are influenced by worksites, schools, places of worship, etc. (access to food, availability of exercise equipment, stress management policies)
Beneficial bc access to large # of people & social support for behavioral change
Challenging bc health of workers may not be part of mission statement & employers may not feel employee health is their responsibility
Goal: change “corporate culture” & include health related norms/values as part of mission & philosophy
Organizational/Institutional Factors
Ecological Model of Health Promotion Key Factors
Looks at relationships among organizations, institutions, and informal networks within defined boundaries; power structures in community, community health problems, and allocation of resources
Target of intervention: increase coordination among community organizations and coalition building
Include representation rom disadvantaged population on community boards; community organizing strategies
Community Factors
Ecological Model of Health Promotion Key Factors
Local, state, and national laws and policies (policies that restrict behaviors; behavioral incentives)
Allocation of programmatic resources and federal restrictions on how funds can be allocated
Public advocacy; encourage citizen participation in political process (voting & lobbying)
REMEMBER: The MOST effective way to change someone’s behavior is to regulate it
Public Policy Factors
Drastic inequalities in health from impoverished to wealthy countries
Health is very sensitive to social environment
Goal: Improve social and physical environments to promote optimal health
Economic stability
Education
Health/Healthcare
Neighborhood & Built Environment
Social/Community Context
Social Determinants of Health
Provides science-based, 10-year national objectives for improving the health of all Americans
Encourage collaborations across communities
Empower individuals toward making informed health decisions
Measure the impact of prevention activities
Healthy People
Started with 1979 Surgeon General’s Report
Jurisdiction: USDHHS
1990: Promoting Health/Disease: Objectives for the Nation
2000: National Health Promotion & Disease Prevention Objectives
2010: Objectives for Improving Health
2020: New topic areas & progress reports
History of Healthy People
Vision: a society in which all people can achieve their full potential for health & wellbeing across the lifespan
Mission: to promote, strengthen, and evaluate the nation’s efforts to improve the health and wellbeing of all people
Healthy People 2030
Genes and biology (sex, age, family Hx, inherited disease)
Health behaviors (diet, exercise, substance abuse, hygiene practices)
Health services/Medical care (cost, access to quality healthcare, language barrier, insurance status)
Social environment/characteristics (discrimination, socioeconomic status, pollution, quality of schools)
Policy making (laws and regulations at local, state, and federal level)
Determinants of Health
Unless a person sees some value in making a behavior change, there will be no reason to consider the change
Premise: in order for disease prevention & health promotion activities to be successful –> the client has to be willing to participate & health is highly values
Health Belief Model
Based on the understanding that a person will take health-related action if that person:
Feels that a negative health condition can be avoided
Has a positive expectation that by taking a recommended action, a negative health condition can be avoided
Believes that a recommended health action can be successfully accomplished
HBM Core Assumptions
Main variable of HBM
The degree to which a person believes he/she is at risk for a particular disease or health problem
Perceived susceptibility
Main variable of HBM
The perceived consequences of getting the disease
Modifying factors:
Demographic variables
Sociopsychological variables
Structural variables
Perceived severity
Main variable of HBM
Perceived problems to overcome in changing the behavior
Perceived barriers
Main variable of HBM
Perception that there are benefits to be gained from changing the behavior
Perceived benefits
Mass media campaigns
Advice from others
Reminder cards from primary care providers
Illness of family members or friends
Newspaper or magazine articles
Cues to Action (HBM)
Consists of components of perceived benefits or preventive action minus perceived barriers to preventive action
Likelihood = Benefits - Barriers
*Think good - bad
Likelihood of Action (HBM)
Theory based on a person’s expectation relative to a specific course of action
Deals with belief that one can accomplish a specific action
Involves strategies such as modeling, demonstration, and verbal reinforcement
Self-Efficacy (HBM)
Theory consisting of processes of change that predict successful behavior changes
Stages:
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
*Relapse
Transtheoretical Model of Change
First stage of Transtheoretical model
The subject has no intention of changing behavior in the foreseeable future
People in this stage tend to be unaware that they have a problem and are resistant to efforts to modify a behavior
Precontemplation
Intervention to help transition from precontemplation to contemplation
Finding and learning new facts, ideas, and tips that support healthy behavior change
Consciousness raising
Intervention to help transition from precontemplation to contemplation
Experiencing the negative emotions (fear, anxiety, worry) that go along with unhealthy behavioral risks
Dramatic Relief
Intervention to help transition from precontemplation to contemplation
Realizing negative impact of unhealthy behavior or positive impact of healthy behavior on one’s proximal social and physical environment
Environmental-Reevaluation
Second stage of Transtheoretical model
Subjects are aware that they have a problem and are seriously thinking about resolving it, but they have not yet made a commitment to take action in the near future
Contemplation
Intervention to help transition from contemplation to preparation
Realizing that the behavioral change is an important part of one’s identity as a person
Self-Reevaluation
Third stage of Transtheoretical model
This is the stage of decision-making; the person has made the commitment to take action within the next 30 days and is already making small behavioral changes
Preparation
Intervention to help transition from preparation to action
Making a firm commitment to change
Self-liberation
Fourth stage of Transtheoretical model
Subjects make notable efforts to change
Classified in this stage if the person has modified the target behavior to an acceptable criterion
Action
Intervention to help transition from action to maintenance
Contingency management
Increase the rewards for the positive behavioral change & decrease rewards of the unhealthy behavior
Reinforcement Management
Intervention to help transition from action to maintenance
Seeking and using social support for the healthy behavioral change
Helping relationships
Intervention to help transition from action to maintenance
Substituting healthy alternative behaviors and cognitions for the unhealthy behavior
Counterconditioning
Intervention to help transition from action to maintenance
Removing reminders or cues to engage in the unhealthy behavior and adding cues or reminders to engage in the healthy behavior
Stimulus Control
Intervention to help transition from action to maintenance
Realizing that the social norms are changing in the direction of supporting the healthy behavioral change
Social Liberation
Fifth stage of Transtheoretical model
Subjects are working to stabilize their behavior change and avoid relapse
In general, it’s sustaining action for at least 6 months
Maintenance
Sixth stage of Transtheoretical model
Applies only to some behaviors, especially the addictions
Individual does not have any temptations
May not be appropriate for some behaviors such as cancer screening & dietary fat reduction
Termination
Not a real stage of Transtheoretical model
People must learn to treat this as a limited minor setback rather than a defeat; strategies need to be implemented to get the person to return to contemplation, preparation, or action stages
Relapse
Child development
Economic stability
Emergency preparedness
Environmental health
Overweight & obesity
Vaccination
Healthy People 2030 Overarching Goals for Children
Cancer
Adolescent development
Family planning
LGBTQ+
STIs
Sleep
Healthy People 2030 Overarching Goals for Adolescents
Means completely accidental; the outcome was not anticipated
Ex: riding bike w/o helmet and getting head injury
Ex: driving drunk and getting into car accident
Intent is NOT to get hurt
Unintentional Injury
Involves activity with intent to cause harm
Ex: carrying a weapon (assumption is that you will use it)
Intentional Injury
The more assets a young person has, the fewer risky behaviors they are likely to engage in and the more positive outcomes they will experience
Focuses on ALL children (not just those at risk for negative outcomes)
Emphasizes a community approach to promoting adolescent health
Developmental Assets Framework
Adolescent perceptions of their parents knowledge of who they are spending their time with
Less perceived monitoring has been associated with a higher degree of participation in risky behaviors
Parental Monitoring
Negative effects on physical & mental health
Impacts home, school, neighborhoods, and communities
Greater risk for poor academic achievement, school drop-out, abuse & neglect, behavioral and socio-emotional problems, physical health problems, and developmental delays
All may contribute to lower life expectancy
Poverty in Children
Prevention of childhood injuries
Substance abuse prevention education
Disease prevention education
Efforts to prevent suicide and other mental health problems
Required vaccinations
Primary Prevention in Schools
Nursing care for emergencies in the school
Emergency equipment in school nurse’s office
Giving medication in school
Screening for lice
Identification of child abuse/neglect
Communicating with healthcare providers
Addressing violence at school
School crisis teams- responding to disasters
Secondary Prevention in Schools
Individual Education Plan
Asthma assistance
Diabetes mellitus care
Autism assistance
ADHD care
Special needs in the school
DNR orders
Homebound children
Pregnant teens and teen mothers
Tertiary Prevention in Schools
Young adults: 19-39 years
Important life events are spousal and family relationships
Success = strong relationships
Failure = loneliness & isolation
Intimacy vs. Isolation
Middle adults: 40-64 years
Important life events are work and parenting tasks
Success = feelings of usefulness and accomplishment
Failure = shallow involvement in the world
Generativity vs. Stagnation
Older adults: 65+ years
Important life event is reflection on life
Success = fulfillment and feelings of wisdom
Failure = regret, bitterness, and despair
Ego Integrity vs. Despair
Intelligence is demonstrated through logical use of symbols related to abstract concepts; Only about 35% of high school graduates obtain this stage
Many people don’t think formally
Formal Operations (adulthood)
Individuals behave according to approval/disapproval from others as it reflects society’s accordance with perceived role
Trying to live up to expectations
“Golden rule”
Judge morality of actions based on its consequences in terms of a person’s relationships, respect, and gratitude
Desire to maintain rules and authority
Stage 3: Interpersonal Accord and Conformity Driven (conventional)
Important to obey laws and social conventions
A central ideal or ideals often prescribe what is right/wrong
Sense of obligation and duty to uphold laws and rules
Stage 4: Authority and Social Order Obedience Driven (conventional)
Individuals are viewed as holding different opinions and values
Laws are regarded as social contracts rather than rigid dictum
Laws that don’t promote general welfare should be changed when necessary for the greater good
Stage 5: Social Contract Driven (post-conventional)
Moral reasoning is based on abstract reasoning using ethical principles
Laws are valid only insofar as they are grounded in justice and that a commitment to justice carries with it an obligation to disobey unjust laws
One acts bc it is right, not bc it’s instrumental, expected, legal, or previously agreed upon
Stage 6: Universal Ethical Principles Driven
Eating disorders, reproductive health, gestational diabetes, menopause, breast cancer, osteoporosis
Women’s Health Concerns
Prostate cancer, testicular cancer, erectile dysfunction
Men’s Health Concerns
T= training in care techniques, safe medication use, recognition of abnormalities, and available resources
L= Leaving care situation periodically for respite and reevaluation and to maintain normal living needs
C= Care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management
Family Caregiver Burnout (TLC)
