N389 Unit 2 Flashcards
Strategies for interacting and low vision clients
- Interact with the person not their disability
- Introduce yourself by name and make eye contact when speaking
- Speak in usual conversational voice
- Address the person by name when talking in a group
- Identify yourself
- Indicate the end of a conversation
- Offer your arm, don’t grab theirs
- Don’t interfere with their belongings
- Use verbal directional cues around room, hallway, etc.
Exercise recommendations for pregnant women
Moderate exercise greater than or equal to 30 minutes per day, most days of the week;
Flexibility and balance exercises are valuable
Principles of nutrition when caring for a pregnant woman
Need folic acid, calcium, fatty acids, iron, vitamin D, iodine, supplements and vitamins
Limit caffeine
Avoid uncooked meats, unpasteurized milk, fish that contains mercury, deli meat, excessive caffeine, smoked fish, raw shellfish, raw eggs, soft cheese, pate, unwashed vegetables
Emphasize weight loss if necessary before pregnancy not during
Trends in substance abuse among adults
Blacks have lower rates of substance abuse but higher rates of alcohol dependence than whites
Minorities are perceived as having higher rates of drug addiction so are often prescribed less pain medication due to bias among health care workers
Consider opioid crisis versus crack crisis
Trends in substance abuse among adolescents
44% of HS use marijuana
Over 50% HS use alcohol
14% HS using cigarettes, steady decline, more are using e-cigs
Higher % of abuse of OTC than illicit drugs
Black teens marijuana use higher than Hispanic or whites; males more than females
White teens more likely to abuse Rx drugs; females more than males
Alcohol use in teens
Higher among white teens than Hispanic, black or Asian teens
White females were the highest (drinking more than males)
Epidemiology of occupational safety and health concerns among health care workers
More workers are injured in healthcare social social assistance industry sectors than any other
one of highest rates of work-related injuries and illnesses
Common workplace injuries
Overexertion and bodily reaction (manually lifting, moving, and repositioning patients), slips, trips and falls, contact with objects, violence, exposure to harmful substances, transportation incidents, others
Types of violence
Type 1- criminal intent
Type 2- perpetrator is customer receiving services from the company
Type 3- perpetrator is employed by the establishment
Type 4- perpetrator has a personal relationship with an employee
Occupational stress
harmful physical and emotional responses that occur when the requirements of the job don’t match capabilities, needs or resources of the worker
Occupational Safety and Health Administration
- Regulatory agency
- Protects from hazards
- Establishes and enforces protective standards
- Consultations and assistance
- Inspection
No standard specific to MC disorder hazards, workplace violence, occupational stress but citations may be issued under general duty clause
National Institute for Occupational Safety and Health
- No regulatory authority
- Conduct and fund research
- Recommendations to prevent workplace injury
- Provide training
Professional Organizations
- American Nurses Association
- ASIS
- Emergency Nurses Association
Joint Commission
Accrediting body
Legislation
No federal safe patient handling laws
Some state-level
Safe Patient Handling and Mobility
Duke Moves- move often, very early, and safely
Promote consistent use of lifting devices
No federal standard requiring workplace violence protections
Some state level approaches
OSHA voluntary guidelines
Stress prevention
Organizational change program
Counseling
Training in stress management
Factors influencing the effectiveness of approaches designed to promote occupational safety and health among healthcare workers
Greater impact when hazards are designed out and substituted with safer processes instead of putting emphasis on individual’s to change their behavior
Management needs to be committed and employees need to participate
First steps in reducing workplace violence
Management needs to be committed and employees need to participate
Purpose of NIOSH
Conduct and fund research
Make recommendations
Provide training
*not a regulatory body
What is one strategy that would make the largest impact on workplace safety for nurses?
Hazards need to be designed out and substituted with safer processes
How can unconscious bias impact the care given to a patient?
Can result in substandard care
Poor health outcomes
Health disparities
Why has obesity bias increased and its impact on quality of healthcare?
Increasing levels of obese people and obese people needing treatment
Decreases quality of care:
- Feel discriminated against and don’t want to seek care
- Providers don’t understand underlying issue
Contributing factors of obesity including genetics, biology, sociocultural influences, the environment, and individual behavior
- Genetics and biology
- Sociocultural influences
- Environment
- Individual behavior
Genetics and biology on obesity
Genetic component to acquiring excess weight is complex
Genetic susceptibility towards overweight/obesity seems to be fully expressed in environments in which food is tasty, variable, plentiful, cheap and widely promoted, and in which technology has replaced human physical labor
In most cases, obesity is a polygenic disease in which numerous genes interact to facilitate overweight/obesity when the environment is permissive
Sociocultural influences
Types of foods Food preparations practices Eating habits (rushed vs slow) Access to food Socioeconomic status
Environment
What food is available, restaurants, supermarkets, access to food physically and financially
Is physical activity safe and a possibility
Individual behavior
Increased portion sizes, poor food choices, lack of access to healthy foods, decreased psychical activity
How to optimize sensitivity to the needs and concerns of the patient
Don't be judgmental Don't make assumptions Consider all influences and underlying factors Use motivational interviewing Treat with respect and sensitivity
Describe trends in the prevalence of obesity over the past 30 years
Increasing worldwide; 30% of world population is overweight/obese
Increasing in US across all states; 2/3 of Americans are overweight/obese- continued to grow
2.1 billion people are overweight/obese worldwide
Discuss the health consequences of obesity
negatively affects every system of the body
Quality of life consequences of obesity
Diminishes quality of life in some cases due to illness, lack of mobility, missed work, stigma
Income, social status, employment and working conditions, biology and genetics, culture, social support, health services, social environment, personal health practices, child development, living conditions, safe neighborhood
Impact of obesity and targeted interventions on children and adolescents
Concerned with reducing stigma and discrimination, changing the environment in schools, limiting sugar sweetened beverages, monitoring growth charts, limiting added sugars and salts early in life, limiting screen time
Want to encourage breast feeding and healthy diet for whole family
Want them in 5-85% ile
Impact of obesity and targeted interventions on fertility, prenatal, intra-partum, post-partum
Fertility- PCOS (polycystic ovary syndrome), lack of regular menstruation, decreased levels of pregnancy both planned and spontaneous
Prenatal- UTI, high blood pressure, miscarriage, preterm labor
Intra-partum- complications, dysfunctional labor, bleeding, blood clots, wound infections, more C sections, prolonged delivery
Postpartum- increased hospital time, infection/bleeding, breastfeeding difficulty
Want to encourage weight loss prior to pregnancy
Monitor and screen for diabetes
Limit gestational weight gain
Monitor for preclampsia
Impact of obesity and targeted interventions on adults
Follow healthy eating plan, focus on portion sizes, be physically active, reduce screen time, keep track of weight and BMI
Impact of obesity and targeted interventions on older adults
Do not ignore the benefits to older adults!
Obesity contributes toward negative health consequences and functional decline (more challenges with physical activity/safety):
Because of weight and body habitus and age, anticipate difficulty getting up, getting down, and encourage all types of ambulatory activity
Use machines that are both safe and structural secure (i.e., frames/seats)
If OA/joint pain, alternate lower-impact activities
Recommendation: Improve availability of fruits, veggies and whole grains at convenience stores (areas without supermarkets)
Pregnancy and Obesity
Comprehensive approach across care
Encouraging weight loss prior to attempting to conceive
Restricted gestational weight gain
Modifications to routine prenatal care, examples:
First trimester screening for diabetes
Close monitoring of blood pressure and baseline labs for preeclampsia
Early ultrasound
Anesthesia consultation
Ensure provision of resources for delivery
Obesity alone is not an indicator of early delivery
Losing muscle and gaining weight
Non-exercising adults lose over 5 pounds of muscle and add about 15 pounds of fat each decade, bringing about an increase in body fat that may be 50% greater than the increase in bodyweight
Older adults
Losing weight in older adults
Studies suggest that intentional, structured weight loss is beneficial
Focus on weight-loss risks that may be exacerbate the normal aging process
Nutrient absorption – post-menopause estrogen reduction can affect calcium absorption (i.e., calcium and other nutritional supplements)
Bone density loss – provide nutritional supplements (i.e., Vitamin D supplements)
Lean muscle mass loss – muscle strengthening exercises, adequate protein intake
Tips for working with obese
Describe priorities of nursing workforce caring for patients who are obese
create inclusive environment
Have necessary equipment to accommodate obese people (chairs, bp cuffs, lifts, tables,etc.)
Recognize there is more to obesity than food and inactivity
Focus on underlying causes
Recognize that weight loss is difficult and they probably have tried many times before
Use motivational interviewing
Understand that people respond more favorably to positive themes than stigmatizing ones
How do we diagnose obesity
BMI
25-29.9 - overweight
30-34.9 - obesity 1
35-39.9 - obesity 2
40 < or greater is obesity 3
Frequent comorbid conditions associated with obesity
Cardiovascular disease, stroke, high bp, diabetes, cancer, osteoarthritis, pancreatitis, fatty liver disease, PCOS, impaired kidney function, depression, and many others
Strategies to improve weight-related bias and discrimination
- Treat patients with same care and courtesy you treat all
- Look at physical environment of the healthcare setting
- Identify personal attitudes
- Understand complexity of obesity
- Don’t make assumptions
- Consider previous negative interactions with providers
- Understand they may have tried to lose weight previously and were unsuccessful
- Recognize that small weight loss can have large impacts
- Acknowledge the difficulty of weight loss
Latinos and substance abuse treatment
Latinos have the lowest rates, even though they are also more like to go to jail than White (not more than Blacks) because of substance abuse issues.
Latinos have traditionally the lowest access to substance abuse and mental health treatment (also medical treatment in general).
African American and substance abuse treatment
The higher rates of substance abuse treatment among Blacks are largely due to court mandated treatment which is dictated by criminal justice responses. Since Blacks are more likely to go to jail for substance abuse than Whites, they are more likely to seek treatment (they have to), despite the multiple barriers they would encounter if they would seek voluntary substance abuse treatment.
Highest rate of substance abuse?
African American’s have a higher rate of treatment in substance use than Non-Latino Whites and Latinos and/or minorities have higher rates of treatment
First step in reducing workplace violence
The first step is assessment (as in the nursing process). You first need to find out what is the incidence and prevalence of work place violence and what types are being experienced. For example, is the violence perpetrated by patient vs employees vs an intimate partner? The type of violence would help inform what type of programs and policies to implement.
