Week 10/11 Health & Wellness/Stress & Adaptation, Loss & Grief, Dying & Death/legal and ethical and integrative Flashcards
what are the 4 models of health and illness
health belief, health promotion, mallows hierarchy of needs, holistic health
what is the health belief model?
Rosenstoch (1974) and Becker/maiman (1975)
based on relationship between individuals beliefs and behaviors.
examines and aids in understanding factors that influence patient perception/belief/behavior
what is the health promotion model?
proposed by pender 1982
designed to complement health protection, and defines health as a “positive, dynamic state, not merely the absence of disease”
what is maslows hierarchy of needs?
although each person has individual needs, humans all have the same basic needs, and some needs are more basic than others and need to be met first
what is the correct order of maslows needs? (love and belonging, safety/security, self actualization, physiologic needs, self esteem
most basic
physiological= breathing, food/water, shelter, sleep
safety/security= health, employment, property, family, social stability
love and belonging= friendship, family, intimacy, connection
self esteem= confidence, achievement, respect of others
self actualization=
what is true of holistic health models?
consider emotional and spiritual well being as important aspects of physical health and wellness
recognizes natural abilities of the body and incorporates alternative and complementary modes of healing
what internal variables can influence health, health beliefs, and health practices?
development stage, intellectual background, perception of functioning, emotional factors, spiritual factors
what external variablescan influence health, health beliefs, and health practices?
family practices, psychosocial and socioeconomic factors, cultural background
what is primordial prevention?
eliminating risk factors (discouraging development of habits such as smoking or other negative ones)
what are the 4 levels of prevention?
primordial, primary, secondary, tertiary
what is primary prevention?
health promotion.
stop it before it even occurs
education, providing resources, hygiene, immunizations, screenings
what is secondary prevention?
early diagnosis and treatment
Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.
screening, selective exams to cure or prevent disease processes, treatments to prevent complications of diseases
what is tertiary prevention?
restoration and rehabilitation
Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments)
hospital and community facilities, selective placement
what are the 5 stages of behavioral change?
precontemplation, contemplation, preparation, action, maintenance
what is the precontemplation stage
not intending change in the next 6 months
what its he contemplation stage
considering a change in the next 6 months
what is the preparation stage?
making small changes in preparation for change in the next month
what is the action stage?
actively engaged in strategies to change behavior, lasts up to 6 months
what is the maintenance stage?
sustained change over time. begins 6 months after action has started and continues indefinitely.
what are the three developmental theories?
Frued, Erikson, Piaget
what is Freud’s developmental theory?
5 stages of psychosexual development, with each stage characterized by sexual pleasure in parts of the body depending on the age
resolving conflict between sources of pleasure and mandates of reality
what is the Infancy (birth to 18 mos) stage of freud’s development
oral stage
primary source of interaction is through the mouth, with pleasure through actions of the mouth
(feeding)
oral personality in adults is smoking/biting nails
Early Childhood/toddler (18 mos to 3 yrs)
stage of freud’s development
anal
child learns to control and manage elimination. (toilet training)
adults is orderliness and messiness
Preschool (3 to 5 years)
stage of freud’s development
phallic stage
Childs begin to see their mother/father as competition for their spouse (oedipus/Electra complex)
adults is sexual dysfunction
Middle childhood (6 to 12 years) stage of freud's development
latent
libido is there, but not focused into any area.
social and interactional skills
Adolescence (12 to 19 years)
stage of freud’s development
genitals
child focuses on sexual activity and maturing
not really any adult fixation
what is the pnemonic for Freuds stages ?
old age parrots love grapes
oral, anal, parrots, phallic, latent (none), genital
what are the stages for eriksons development?
infancy, early childhood, preschool, middle child, adolescence, young adult, adult, old adult,
what is the infancy stage?
birth to 18 months
trust vs. mistrust = ability to trust others
learning trust by being given attention through parents
what is the early childhood stage?
18mos-3 years
autonomy vs. shame and doubt= self control and independence vs shame because they can’t do their own thing
walking, making choices, etc
what is the preschool stage?
3-5yrs
initiative vs guilt= highly imaginative
feeling they have purpose in decisions vs. developing guilt and feeling as if they are not valued
what its the middle childhood stage?
6-12yo
industry vs. inferiority= engaged in tasks and activity
feeling industrious and confident, or feeling that they do not have competence and inferior
what is the adolescence stage?
12-19 years
identity vs. role confusion= sexual maturity, who am I?
learning identity and place through peers, or confusion when they dont find a place
what is the young adult stage?
intimacy vs isolation= affiliation vs. love
exploring relationships and commitment, or avoiding it to create isolation/loneliness
what is the adult stage?
generativeity vs. stagnation/self absorption
establish career and feeling as if they are part of a bigger picture, vs feeling as if they are stuck and not adding to the world
what is the old adult stage?
integrity vs. despair
feeling as if your life was productive and accomplished, or feeling as if they didn’t do enough and then are dissatisfied
what is Piagets theory?
moving from one stage to another specifically by creating frameworks (schemas) to create cognitive equilibrium
what are the stages of Piaget?
sensorimotor, pre operational, concrete operational, formal operational
what is sensorimotor stage
birth to 18mos
reflex activity to repetitive actions
what is preoperational stage
18mos to about 5years
thinking using symbols, egocentric
what is concrete operational stage
6-12 years
logical thinking, conservation, reversibility
what is formal operation stage
12-19 years
abstract thinking, hypothetical, etc
what is stress?
physiologically, it is a flight or fight response. high BP, high CO, high RR, ETC
what is selye general adapt syndrome (GAS)
alarm, resistance, exhaustion stages
what is the alarm stage
stress is introduced, fight or flight initial response
what is resistance stage of stress?
stress over time, trying to return to normal
what is exhaustion stage of stress
body can’t take it anymore
what are the two assessments to determine stress
primary and secondary appraisal
what is primary GAS appraisal
evaluate event and what the meaning is to you or someone
what is secondary GAS appraisal
focuses on possible coping strategies
what are coping approaches
alter stressor, avoid stressor, adapt to stressor
what is adaptive coping
directly reduce negative effects
i.e. change lifestyle, solve course of stress
what is maladaptive coping
unhealthy style, temp fix
i.e. over eating or drinking
ability to adapt depends on ___?
intensity of stressor, effectiveness of coping, personal factors
what are ego defense mechanisms?
how you defensively react to a stressor
i.e. denial, regression (progress but then new comes and you regress)
what are some resiliency skills? (healthy ways to cope)
relaxation ,eating well, fitness, social support, etc
what factors influence stress and coping?
situational (job change, illness, caregiver stress), maturational (vary with life stages) , sociocultural (environmental, social, cultural) perceived by patient
what is chronic stress
occurs in stable conditions resulting from stressful roles
what is acute stress
time limited events that threaten a person for brief period of time
what is developmental crises?
occur as a person moves through life stages (kids, adults, being old, etc)
what is a situational crises?
external sources such as job change, accident, death, severe illness.
what is adventitious crises?
natural or man made disaster (i.e. shooting or hurricane)
what are some nursing diagnoses for stress?
anxiety, ineffective coping, fear, multiple diagnoses
what is loss?
produced by an event perceived to be negative by those involved and results in changes to ones social, relationship, or cognition
what is bereavement?
state of being without or In absence of something valued
what is grief?
the response to loss
what is grieving and suffering
grieving is working through losses
suffering is measure of gap between reality and what is desired
what is mourning?
outward expression of loss
what is normal/uncomplicated grief
includes, physical, psychological/emotional, cognitive, social, spiritual reactions
what are some normal physical grief reactions?
heart palpitation, breathlessness, headache, fatigue, nausea, tightness in throat, sleep disturbances
what are some normal psychological/emotional grief reactions?
irritability/anger, restlessness, sadness/depression, numbness/shock, helplessness, hopelessness
what are some normal cognitive grief reactions?
difficulty concentrating, difficulty expressing, forgetful, disorientation, hyperactivity, difficulty organizing tasks
what are some normal social/familial grief reactions?
closed communication, changed power structure, social stigma
what are some normal spiritual grief reactions?
questioning meaning of life, comfort in faith, doubt in or loss of faith, anger at God
what is complicated grief ?
can include normal grief, but reactions are intensified and prolonged
what are the types of complicated grief
chronic, masked, delayed
what is chronic grief
reactions that do not subside, but continue for long time
what is masked grief?
survivor is unaware that behaviors are interfering with normal functioning as result of a loss
what is delayed grief?
reactions are suppressed or postponed
survivor consciously or unconsciously avoids the pain of the loss
what is disenfranchised grief?
when loss cannot be openly acknowledged
what is anticipatory grief?
grieving before a loss or fear of a potential loss
experienced by patients, family, and professionals
what is the kubler ross model of grief?
aligned w continuing bonds
includes denial, anger, depression, bargaining and then acceptance
what is the wordens model of grief?
aligned with breaking ties model
tasks of grief (TEAR)
to accept reality of loss, experience pain of loss, adjust to new environment, reinvest in new reality
nursing has been voted the most ___ profession in 17 of the last 18 years
ethical
what is the standard of care
minimum acceptable level of care
what makes sources for standard of care?
boards of nursing, specialty organizations, certifying body, federal statue, research, experts, facilities, accrediting organizations.
what is standards of practice?
same as standard of care, it is the level of competence
what is standards of nursing practice
competent level of nursing care, specific to nursing and nursing processes
what is standards of professional performance
professional behavior as a nurse
what is scope of practice
what someone in profession is legally allowed to do
what is the code of ethics
social contract w society
formal statement of a groups morals, ideals and values
set of ethical principles
what are the divisions of statutory law
civil and criminal
what is the flow for malpractice (unintentional)
law>statutory>civil>tort law>unintentional>negligence>malpractice
what is administrative and regulatory law?
group appointed to pass rules, regulations, and render opinions.
what groups are part of administrative and regulatory law?
FDA and state nursing boards
possible outcomes for BON investigation
dismissed charge, formal or informal letter of warning, license probation with stipulations, license suspension with stipulations, license revocation, diversion program for drug or alcohol related charged
what is license probation with stipulations
you have to do some form of remediation but are still able to practice.
what is tort law
legal wrongs committed against one person or a persons property
what is intentional tort law breach
civil and criminal,
i.e. invasion of privacy, defamation, assault, battery
what is quasi intentional tort
some parts were intentional, but not the consequences of intentional acts
what is unintentional tort?
negligence (Example: dont change grandmas brief and she gets breakdown because you forgot)
What is malpractice?
professional negligence. (ex. nurse forgetting to change briefs and now grandma has pressure ulcer)
malpractice is the most ___ unintentional tort brought against nurses
common
what are the four elements of liability that must be present for someone to be liable
duty, a breach in duty, causation, and damages incurred.
what are ethics
rules or principles that determine what human actions are right or wrong
what is an ethical dilemma
having to chose between two or more equally undesirable alternatives
what are the 6 moral and ethical principles?
autonomy, beneficence, non maleficence, fidelity, justice, veracity
what is autonomy in morals/ethics?
patients right to self determination
what is beneficence in morals/ethics?
duty to actively do good for patients
what is non-maleficence in morals/ethics?
duty to prevent or avoid doing harm
what is fidelity in morals/ethics?
duty to be faithful to commitments
what is justice in morals/ethics?
duty to treat all patients fairly
what is veracity in morals/ethics?
duty to tell the truth
what moral principles are the most important
autonomy and maleficence seen as the frontrunner because it emphasizes respect and harm reduction
what is a deontological ethical framework
right or wrong based on duty
doesn’t look at consequences of action, individual has clear direction in how to act
what is a teleological ethical framework
humanistic origins, outcome focused
what is a principalism ethical framework
based on principles
what is a utilitarianism ethical framework
what is best for the most people
what is a feminist ethics/ethics of care ethical framework
what is right for one group is not necessarily for another
what is a situational ethical framework
each situation creates its own rules and principles.
emphasizes uniqueness.
what is a casuistry ethical framework
case based reasoning, not focused on rules or theories but practical decision making.
can compare to previous cases.
what is a whistleblower
person who identifies an incompetent unethical or illegal situation
what should be part of documentation ?
factual and objective, accurate, what and why you did something, care plans are pertinent and updated
simple documentation rules
date and time all entries, timely documentation, entries are legible/grammatically correct/spelled correct
who performed it, enable reader to know what occurred, authenticated, quotes/descriptions,
Principle 1 of integrative nursing
human beings are whole systems inseparable from their environment
Principle 2 of integrative nursing
human beings have innate capacity for health and wellbeing
Principle 3 of integrative nursing
nature has healing and restorative properties that contribute to wellbeing (outdoors, plants, sunshine, nature)
Principle 4 of integrative nursing
it is person centered and relationship based
Principle 5 of integrative nursing
informed by evidence and uses the full range of therapeutic modalities to support and augment healing process. moving from least to more invasive
Principle 6 of integrative nursing
integrative nursing focuses on health and wellbeing of caregivers as well as those they serve
