Week 7 - 13 Flashcards
o Network of national, provincial, and territorial social programs designed to protect the most vulnerable members of Canadian society.
o Welfare, subsidized housing, employment insurance, food bank
o Ex.) Medicare – Provincial and territorial health insurance that provides access to medically necessary hospital and physician services to citizens and permanent residents.
o Medicare is Canada’s national health insurance system – uses taxes to finance medically necessary services.
o Free healthcare for all
Social Safety Net (Canadian Health Care Delivery System)
o Administers of Canada Health Act (1984) principles (CHA)
o Ensures provinces comply with Canada Health Act
o Assists in financing of health care services
o Delivers health services for first nations and Inuit people, veterans, federal inmates, and RCMP
o Provides national policy and programming to promote health
The Federal Government
o Develop and administer their own health care insurance plans
o Manage, finance, and plan insurable health care services and delivery, in alignment with CHA’s 5 principles
o Determine amount of money dedicated to health care services
Provincial and Territorial Government
Canada Health Act 1984 (5 Key Principles)
o Public Administration (Emergency)
♣ Operated on a non-profit basis by government
o Comprehensiveness
♣ Cover all medically-necessary hospital and physician services
o Universality
♣ Every permanent resident is entitled
o Portability
♣ Coverage is maintained within and outside of Canada
o Accessibility (Copeman) ♣ Everyone must have reasonable access to services (Additional charges for insured services are not permitted)
o Medicare is sustainable and must be preserved because it represents Canadians’ core values
o Emphasized modernizing the Canada Health Act through appropriate funding and the following changes:
♣ Build information technology infrastructure
♣ Improve access (ex. In remote areas)
♣ Offer catastrophic drug coverage
♣ Strengthen and expand home care
Influential Health Care Reports
THE ROMANOW COMMISSION 2002
o Medicare system is not sustainable and advocated for stronger private sector involvement
♣ Granting more responsibility to regional health authorities for contracting out the delivery of publicly insured health services
♣ Offering a health care guarantee to Canadians (ex. Time limits for wait times, if exceeded, the government pays for care provided elsewhere)
Influential Health Care Reports
THE KIRBY REPORT 2002
DAL - Seniors’ Options (3)
o Home Care (Private home) - Services offered to maintain safety and independence in one’s own home
o Supportive Living (Extendicare Fairmont) - Home like setting with personal and health care support, No RN on-site
o Long-term Care (St. Michael’s Health Centre) - Hospital-like model to meet complex healthcare needs, 24hr RN support
Supportive Living (SL3)
o 24hr personal care support o Stable medical condition o Self or one-person transfer o Mild dementia: No risk of wandering o Ex.) Alberta Rose Lodge, Blue-sky Lodge, Garden View Lodge
Supportive Living (SL4)
o 24hr personal care support by LPN’s and HCA’s
o Complex but stable medical condition
o Mechanical/2-person transfers
o May have dementia, minimal risk for elopement
o Ex.) Fairmont Extendicare, St. Therese Villa
Supportive Living (SL4-Dementia)
o Same as SL4 except for unpredictable behaviours:
♣ Risk for elopement
♣ Risk for self and others
♣ Lack of awareness of personal space of others
o Ex.) Dementia units, Fairmont Extendicare
o Complex health needs
o Complex medication management
o Complex nutritional intake requirements
o Unstable behaviour that places client or others at risk
o 24hr RN support under the direction of a family physician
o Requires unscheduled assessments
o May have any stage of dementia
Long-term Care
o 1._______ = (Complex but stable medical conditions
o 24hr service by LPN and HCA’s
o 24hr RN on-call service)
o
o 2._______ = (Complex, unpredictable medical needs
o 24hr on-site RN services
o Unstable behaviour that places client or others at risk )
- Supportive Living
2. Long-term Care
o Philosophy and model for improving health
o Foundation of Canada’s health care system
o Strong emphasis on the principles of health promotion and disease prevention
o Emphasize the determinants of health
o Sensible approach (cost-effective)
Primary Health Care
Pillars of Primary Health Care (4)
o Teams
♣ Team-based care with full range of services (Physician, RN, dietician, OT, PT, etc.)
♣ Ex.) Copeman healthcare, WISH clinic
o Access
♣ Ex.) Street nursing
♣ Grocery purchase help at Edmonton day-support program for Seniors
o Information
♣ Ex.) 24/7 RN telephone advice that offer alternatives to emergency department visits.
o Healthy Living
♣ Ex.) Nurse-led heart health clinic in Quebec that focuses on prevention and early treatment for women
Levels of Healthcare (5)
o Level 1: Health Promotion
o Enabling people to increase control over or improve their health
o Ex.) Anti-smoking education in schools, addressing public policies
o Level 2: Disease and Injury Prevention
o Prevention services/strategies
o Reduce risk factors for illness and injury
o 3 Levels of Prevention
o Level 3: Diagnosis and Treatment
o Recognizing and managing symptoms
o Primary care (first contact with health care system)
o Secondary care (provision of specialized medical service)
o Tertiary care (high technical care)
o Level 4: Rehabilitation
o Required after physical/mental illness, injury, or addiction
o Services include: physiotherapy, occupational and speech therapy
o Restoration of health to previous level of function
o Level 5: Supportive Care
o Clients with chronic illness, progressive illness, or disability
o Long-term care and assisted-living facilities, adult day care centers, home care
3 Levels of Prevention
♣ Primary
• Activities that protect against a disease before signs and symptoms occur
• Ex.) hand hygiene, immunization, reducing air pollutants, reduction of trans-fatty acid in diet
♣ Secondary
• Activities that promote early detection (screening) of disease, so that prompt treatment can be initiated
• Ex.) If you are diabetic – have your eyes checked regularly.
♣ Tertiary
• Activities that minimize residual disability from disease and help the client live productively
• Ex.) Loss eyesight, now preventing kidneys from failing.
o KEY (Keep Educating Yourself) o Training you to be a generalist, not specialist
Life-Long Learning
o “The process in which individuals take on the responsibility for their own learning process by diagnosing their personal learning needs, setting goals, identifying resources, implementing strategies, and evaluating the outcomes.”
o Take initiative to find resources and solutions.
Self-Directed Learning
Adults learn differently from children by…
o Children have more concrete thoughts – if they complete the task then you get a candy.
o Adults have more life experiences to help guide them.
o Adults would like to be respected.
Define Andragogy and Pedagogy
o Andragogy = is the art and science of helping adults learn, focuses on the learner and their needs.
o Pedagogy = is the art and science of teaching children, has the teacher in the central power role.
Adults learners are… (6)
o Adults are internally motivated and self-directed
o Bring life experiences and knowledge to learning experiences
o Are goal orientated
o Are relevancy oriented
o Adult learners like to be respected
o Favor a problem-focused approach to learning rather than content driven.
Adult Learning Principles (Knowles) (6)
o 6 core principles to Knowles’ Andragogy framework
o 1.) Learner’s Need to know (why, what, how)
o 2.) Self-Concept of the Learner
o 3.) Prior Experience
o 4.) Readiness to Learn
o 5.) Orientation to Learning
o 6.) Motivation to Learn
Determine learning styles to…. (2)
o To know one’s personal learning style
o To know other’s learning style
Nursing Roles in Health teaching (2)
o Health education: Focuses on wellness, health promotion, and disease prevention.
o Nurses assume different roles depending on the setting
♣ A guide, information provider, resource support
o Influenced by many factors: learning environment/style/needs
Ways to assess learning style: observation, interviews, learning style instruments
Learning Process
VAK Learning Style Inventory stands for?
Visual, Auditory, Kinesthetic
Learning Style Principles (6)
o 1.) Style by which the nurse prefers to teach and the style by which the learner prefers to learn can be identified.
♣ ID your own style, and observe for the learners.
o 2.) Nurses need to avoid relying on teaching methods and tools that match their own preferred learning styles.
♣ Expand outside of comfort zone, think about patient’s POV
o 3.) Nurses are most helpful when they assist learners in identifying and learning through their own style preferences
♣ Take time to understand them and offer assistance in the best way you can to benefit the patient.
o 4.) Learners should have the opportunity to learn through their preferred style.
♣ Give them the right of way
o 5.) Learners should be encouraged to diversify their style preferences.
♣ Just to give a variety
o 6.) Nurses can develop specific learning activities that reinforce each style
♣ Challenge, be more creative
o Knowledge
o Recall or recognition of specific facts and concepts that serve to develop intellectual abilities and skills.
Cognitive Domain
Blooms Taxonomy
♣ Remember – remembering information/facts
♣ Understand – interpret, explain
♣ Apply – use information in a new way
♣ Analyze – consider each part and how they relate to each other
♣ Evaluate – make judgements, critique, prioritize
♣ Create – create something new, create new patterns
RUAAEC
o Attitudes or “heart”
o Feelings, values, appreciation, enthusiasm, motivations, and attitudes.
Ex.) Therapeutic communication, answering questions/discussions, reflection
Affective Domain
o Skills or “hands”
o Ex.) Bed making,
o Use the 3A’s
♣ Accept – set aside preconceptions
♣ Apply – practices makes perfect, learn what works well for you and what does not.
♣ Adapt – experiment with ways to use and not forget the basic principles
o SUMMARY
Psychomotor Domain
o _____ = manual or physical skills (skills)
o _____ = feelings or emotional areas (attitude)
o _____ = mental skills (knowledge)
o Cognitive = mental skills (knowledge)
o Affective = feelings or emotional areas (attitude)
o Psychomotor = manual or physical skills (skills)
o Recognizing that an issue exists, analyzing information, evaluating information, and making conclusions.
Critical Thinking
Requirements for Critical Thinking.. (4)
o More than just cognitive skills ♣ Ability to ask questions ♣ Be well informed ♣ Be honest in facing personal biases ♣ Be willing to reconsider and think clearly about issues
Critical Thinking RULE
o “One size doesn’t fit all”
o Critical thinking and clinical reasoning are contextual – they change with circumstances.
Dispositions of CT (7)
Truth-seeking
♣ Learning what is actually happening in a situation
Open-mindedness
♣ Tolerant of others ideas
Analyticity
♣ Analyzing information and ability to come up with conclusions
Systematicity
♣ Organized and focused in data collection
Self-confidence
♣ Trusting own reasoning process, and asking for confirmation from experts
Inquisitiveness
♣ Actively seeking new knowledge
Maturity
♣ Accepting that multiple solutions are possible
o Critical thinking characteristics
o Technical Skills
o Intellectual Skills - theory and exponential
o Interpersonal Skills – people will avoid you or you’ll lose your ability if too nice
4 Circle Critical Thinking Model
Levels of Critical Thinking (3)
o Basic – experts have right answer, thinking is based on rules, comfortable following a step by step procedure, answers are right or wrong
o Complex – separate your thinking from authorities, apply your knowledge, way the benefits and risks of an action.
o Commitment – independent on making decisions (no experts), assume accountability for your actions
CBC
Name two competencies
o General Competencies (not unique to nursing)
♣ Scientific Method (address research questions)
♣ Problem solving
♣ Decision making
o Specific Competencies (Clinical situations)
♣ Diagnostic reasoning and inference
♣ Clinical decision-making
♣ Nursing process as a competency
Developing Skills: Reflection (2)
o Reflective journal writing
♣ A tool used to develop critical thought and reflection through clarifying concepts
o Concept Mapping
A visual representation of client problems and interventions that illustrates an relationship
Evidence sources (4)
o Scientific evidence in journals
o Non-research evidence such as clinical expertise, data gathered from practice
o Individual patient data and patient’s values, beliefs, and experience
o Research Evidence
Evidence needed for… (5)
o Nursing care should be relevant and current
o Problem-solving approach to practice
o Safety net for to make accurate, timely, and appropriate clinical decisions.
o Intervention will actually be effective
o Want experts to back up your opinion
History of EBN (Have an idea)
o Started with Florence Nightingale in the 1850s during the Crimean War
o Originated as evidence-based medicine
o Evolved into evidence-based nursing
o Florence realized increase in sanitation will improve patient’s health.
4 Components of EBN
o Clinical expertise – judgement from the professional nurse. C-div is the bacteria (spores) that cannot be killed with hand rub, therefore must wash hands.
o Resources – must be present but can be expensive
o Research evidence – evidence shows antiseptic hand rub is as effective as hand washing
o Patients’ preferences – whether patients are comfortable with products/procedures
Causes of Conflict (5)
o Lack of communication o Poor communication o Value differences o Personality clashes o Stress
Nurses care about resolving conflict because…. ( 5)
o Unresolved conflicts impede quality of client care
o Conflict makes for a negative working environment
o Undermines therapeutic relationship
o Energy used on conflict rather than on a more positive purpose
o – Job requirement
Conflict Management Styles
AVOIDANCE
♣ Common response to conflict by nurses is to distance themselves from their client or to provide them less support
♣ Sometimes, avoidance is appropriate when the cost of addressing the conflict is higher than the benefit of resolution – “Pick your battles”
♣ Disadvantage: use of avoidance postpones the conflict, leads to future problems, and damages your relationship with your client, making it a lose-lose situation
Conflict Management Styles
ACCOMODATION
♣ Surrendering one’s own needs in a desire to smooth over the conflict – cooperative but non-assertive
♣ Involves a quick compromise or giving false reassurance
♣ Appropriate when the issue is more important to the other person
♣ Disadvantage: Issue is likely to resurface in the future, make it a lose-win situation
Conflict Management Styles
COMPETITION
♣ Response style characterized by domination
♣ One party exercises power at the expense of the other person
♣ Characterized by aggression and lack of compromise
♣ Leads to increased stress – an effective style when a quick decision is needed
♣ Disadvantage: Leads to problems in the long term, making it a lose-lose situation
Conflict Management Styles
COLLABORATION
♣ Solution-oriented response in which we work together cooperatively to problem solve
♣ In this style, both parties are committed to resolve the conflict and finding a mutually satisfying solution
♣ MOST EFFECTIVE STYLE to resolve conflict: win-win situation
Strategies for Conflict Resolution
o Manage your own anxiety
♣ Recognizing and controlling your own emotional responses
o Prepare for the encounter
♣ Purpose is clear, what you will bring up (content), info shared is complete (word choice)
o Organize information
♣ Avoid bringing up the past, don’t lose focus
o Put the situation into perspective
♣ Will the issue be significant in the future? Worth time and energy?
o Use therapeutic communication skills
♣ Active listening, understand his/her POV, clear purpose (don’t beat around the bush)
o Be assertive
♣ ‘I’ statements. Ex.) I feel uncomfortable sharing confidential client information in public places because it breaks the trust with the clients.
Lateral Violence/Conflict Resolution
What can I… (2)
Control or influence
