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**** Nursing Fundamentals (Potter/ Perry) Unit 1
Terms in this set (168)
What are the four goals of the Healthy People 2020?
1). Attain high- quality, longer lives free of preventable disease, disability, injury, and premature death
2). Achieve health equity, eliminate disparities, and improve the health of all grps.
3). Create social & physical environments that promote good health for all
4). Promote quality of life, healthy development, and healthy behaviors across all life stages
What are the two overarching goals for Healthy People 2020?
1)To increase quality and years of healthy life.
2) to eliminate health disparities.
What is the WHO's definition of health?
"A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity."
Health Beliefs Model
addresses the relationship between a person's beliefs and behaviors.
3 Components of health beliefs model
1) individual's perception of susceptibility to an illness.
2) Individual's perception of the seriousness of the illness.
3) The likelihood that a person will take preventive action—results from a person's perception of the benefits of and barriers to taking action
Health promotion model
defines health as a positive, dynamic state, not merely the absence of disease
3 focuses of the Health Promotion Model
1) Individual characteristics and experiences, (2) behavior-specific knowledge and affect, and (3) behavioral outcomes
Basic Human Needs
are elements that are necessary for human survival and health (e.g., food, water, safety, and love).
Maslow's hierarchy of needs
1) physiological needs such as air, water, and food.
2) safety and security needs, which involve physical and psychological security.
3) love and belonging needs, including friendship, social relationships, and sexual love.
4) esteem and self-esteem needs, which involve self-confidence, usefulness, achievement, and self-worth.
5) self-actualization, the state of fully achieving potential and having the ability to solve problems and cope realistically with situations of life.
Holistic Health Model
nurses consider patients to be the ultimate experts concerning their own health and respect patients' subjective experience as relevant in maintaining health or assisting in healing.
Internal variables influencing health beliefs & practice
Perception of functioning
(person's thought and behavior patterns change throughout life); nurse considers the patient's level of growth and development when using his or her health beliefs and practices as a basis for planning care
person's beliefs about health are shaped in part by the person's knowledge, lack of knowledge, or incorrect information about body functions and illnesses, educational background, and past experiences
subjective data about the way the patient perceives physical functioning such as level of fatigue, shortness of breath, or pain.
patient's degree of stress, depression, or fear can influence health beliefs and practices.
how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life
External variables influencing health beliefs & practice
the way that patients' families use health care services generally affects their health practices.
Psychosocial variables include the stability of the person's marital or intimate relationship, lifestyle habits, and occupational environment
influences beliefs, values, and customs. It influences the approach to the health care system, personal health practices, and the nurse-patient relationship.
activities such as routine exercise and good nutrition help patients maintain or enhance their present levels of health.
strategies help people achieve new understanding and control of their lives
activities (such as immunization programs) motivate people to avoid declines in health or functional levels
Levels of Preventive care
is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy.
• Immunization, health education programs, physical & nutritional fitness activities
focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions.
• Dx and prompt intervention, thereby reducing the severity and enabling the pt. to return to normal level health as early as poss.
occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration
a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired
Impact of illness on patient & family
Behavioral & emotional changes
family roles (dynamic)
Behavioral & emotional reactions (to illness)
depend on the nature of the illness, the patient's attitude toward it, the reaction of others to it, and the variables of illness behavior
Body image (impact to illness)
depend on the type of changes (e.g., loss of a limb or an organ), their adaptive capacity, the rate at which changes takes place, and the support services available.
Self- concept (impact to illness)
depends in part on body image and roles but also includes other aspects of psychology and spirituality.
Family roles (impact to illness)
role reversal- can lead to stress, conflicting responsibilities for the adult child, or direct conflict over decision making.
Risk factors (health hazards)
any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, spiritual condition, or other variable that increases the vulnerability of an individual or group to an illness or accident
Types of Risk Factors
Genetic & Physiological
Genetic & Physiological (risk factors)
pregnancy, obesity, diabetes, cancer, heart disease, or mental illness
Age (risk factors)
premature infants; heart disease & cancer w/ increased age
Environment (risk factors)
industrial workers are exposed to certain chemicals or when people live near toxic waste disposal sites (cancer)
Lifestyle (risk factors)
habits are risk factors (sunbathing, smoking, poor diet, obesity, stress)
The goal of risk factor identification
is to help patients visualize the areas in their life that can be modified, controlled, or even eliminated to promote wellness and prevent illness
5 stages of Health Behavior change
not intending to make changes w/in the next 6 mths
considering a change w/in the next 6 mths
making small changes in preparation for a change in the next mth.
actively engaged in strategies to change behavior; lasts up to 6 mths
sustained change over time; begins 6 mths after action
Nurses role in health and illness
Nurses emphasize health promotion activities, wellness-enhancing strategies, and illness prevention activities as important forms of health care because they assist patients in maintaining and improving health.
how people monitor their bodies, define, and interpret their symptoms, take remedial actions, and use the resources in the health system.
Illness behavior-- internal variables
pt perception of symptoms and the nature of the illness, influence pt behavior. (Patient experiencing chest pain in the middle of the night seeks assistance)
Illness behavior -- External variables
visibility of symptoms, social grp, cultural background, economic variables, accessibility of the health care system, and social support.
Development of professional nursing
* continuing education
* It has a theoretical body of knowledge
* It provides a specific service.
* Autonomy and accountable
* Code of ethics
* Teaching, leadership, career development, working in different areas (caregiver, manager, educator, advocate, etc.)
Professional nursing organizations
Nat'l League for Nursing (NLN)
Am. Nurses Assoc. (ANA), Nat'l Student Nurse Assoc. (NSNA),
Internat'l Council of Nursing (ICN)
Economic changes on nursing practice
NP instead of physicians; greater influx in patients; preventive care; nurses are no longer limited to just the hospital setting
Social influences on nursing practice
medication cost, demographic population (65yrs and older), medically underinsured; threat of bioterrorism; rising health care cost
Political influences on nursing practice
health care reform, raising health care costs, medically underinsured, nursing shortage
Standards of Practice (ANA)
collecting comprehensive data about the client's health
analyze the assessment data to determine the dx or issues.
develop a plan that prescribes strategies and alternatives to attain expected outcomes
implements the identified plan
The objective of the ANA
is to promote national associations of nurses, improve standards of nursing practice, seek a higher status for nurses, and provide an international power base for nurses
Primary/ Preventive Health care
focuses on improved health outcomes for an entire population. It includes primary care and health education, proper nutrition, maternal/child health care, family planning, (preventive care) immunizations, and control of diseases
Primary/ Preventive Health care facilities:
school health, occupational health, physicians' offices, nurse-managed clinics, block & parish nursing, community health centers
Secondary & Tertiary care
the diagnosis and treatment of illnesses are traditionally the most common services.
Secondary & Tertiary care facilities
Hospital ER, Urgent care, Critical care units (ICU), and Inpatient medical & surgical units
is to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care
Restorative care facilities
Home health, Rehab facilities, & Extended care facilities
are for people who are disabled, who were never functionally independent, or who suffer a terminal disease
Continuing care facilities
Nursing homes, Assisted living, Respite care (patient sitting service), Adult day care
Public health nursing
focus requires understanding the needs of a population (high-risk infants, older adults, or a cultural group) or a collection of individuals who have one or more personal or environmental charac. in common
Public Health nursing involves
Nursing roles (epidemiologist, collaborator, change agent)
Community health nursing
the primary focus on health care of individuals, families, and groups in the community; goal is to preserve, protect, promote, or maintain health
Community Health Nursing involves
Individuals in the community
Direct patient care where patients live, work, and play (different locations)
Nursing roles (educator, advocate, change agent, epidemiologist, caregiver, collaborator, counselor, case manager, must be competent, expert on needs of population & resources, critical thinker)
patients who are limited in access to health care services, or who depend on others for care.
Vulnerable populations include
Poverty & homelessness
access to health care is limited because of language barriers and lack of benefits, resources, and transportation
Poverty & homelessness
live in hazardous environments, work at high-risk jobs, eat less nutritious diets, have multiple stressors in their lives, and be at risk for homelessness
socioeconomic problems result from the financial strain of the cost of drugs, criminal convictions from illegal activities used to obtain drugs, communicable disease from sharing drug paraphernalia, and family breakdown
many patients homeless or live in poverty; others lack the ability to remain employed or even to care for themselves on a daily basis
suffering from chronic diseases, sensory loss, and a greater demand for health care services
mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships
is a conceptualization of some aspect of nursing that describes, explains, predicts, or prescribes nursing care; theory helps to identify the focus, means, and goals of practice.
contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon
4 concepts common in all nursing theories
Person (key element)
Types of Nursing Theories
Middle- range theories
structural framework for broad, abstract ideas about nursing
Middle- range theories
address specific phenomena and reflect practice
first level of theory development; describe phenomena, speculate on why they occur, and describe their consequences.
are action oriented and test the validity and predictability of nursing interventions
explains the systematic view of a phenomenon specific to the discipline of inquiry
data/ info that comes from the patients assessment
end product of a system
reflected patient responses to the outcome of a nurse intervention
is the product and information obtained from the system.
describe and predict behavior and development at various phases of the life continuum; as in the phase of older adulthood
Theoretical models to explain and/or predict patient responses exist in each of these domains (physiological, psychological, sociocultural, developmental, and spiritual needs of patients)
includes and "reflects on the basic values, guiding principles, elements, and phases of a conception of nursing
The goals of theoretical knowledge
stimulate thinking and create a broad understanding of the "science" and practices of the nursing discipline
The environment was the focus of nursing care
Nurse- patient relationship
14 basic needs
Transcultural care theory
Stress reduction is the goal of the system theory
Benner & Wrubel
focuses on patient needs (Caring)
is a problem- solving approach that integrates best current evidence w/ clinical practice
Benefits of evidence-based practice
* Lead to changes in practice
* New fields of research
5 steps of evidence-based practice
* Ask a clinical question
* Collect the best evidence
* Critically appraise the evidence
* Integrate the evidence
* Evaluate the practice decision or change
* Share the outcomes w/ others
Evidence is integrated in a variety of ways through
teaching tools, clinical practice guidelines, policies and procedures, and new assessment or documentation tools
Developing a PICOT Question
P = Patient population of interest
I = Intervention
C = Comparison
O = Outcome
T = Time
I, C, T are not used in every situation.
Searchable Scientific Literature Databases and Sources
1). AHRQ- clinical guidelines & evidence summaries
2). CINAHL- Include studies in nursing, allied health, and biomedicine
3). MEDLINE- Include studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health
4). EMBASE- Biomedical and pharmaceutical studies
5). PubMed- Offers free access to journal articles
Quantitative nursing research
study of phenomena that offers precise measurement and quantification (describes data in a numerical form)
Qualitative nursing research
study of phenomena that are difficult to quantify or categorize such as patient's perception to illness. (data in the form of written transcripts from a series of interviews);
Offers answers when trying to understand patient's experiences w/ health problems and the context in which the experiences occur
means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity
guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team
is the most reliable evidence when reviewing literature.
improvement of any healthcare related processes
Quality improvement (QI) Model
Plan: review available data
Do: select an intervention
Study: evaluate the results
Act: act on the practices
foundation of all research
is a universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another
what matters to a person; care helps protect, develop, nurture, and provide survival to people.
Patients continue to value nurses'
effectiveness in performing tasks; affective dimension of nursing care
The Challenge of Caring
Nurses are torn between the human caring model and the task-oriented bio-medical model and institutional demands that consume their practice (technology, etc..)
is a person-to-person encounter conveying a closeness and sense of caring
Types of Touch
when performing a task or procedure. The skillful and gentle performance of a nursing procedure conveys security and a sense of competence
is a form of nonverbal communication, which successfully influences a patient's comfort and security, enhances self-esteem, increases confidence of the caregivers, and improves mental well-being
is a form of touch that protects the nurse and/or patient; can be viewed either positively or negatively
includes "taking in" what a pt. says and interpreting & understanding what the pt. is saying and then giving back that understanding to the pt
leads to truly knowing and responding to what really matters to the patient and family.
active listening you begin to truly know your patients and what is important to them
By observing the expressions and body language of the patient, you find cues to help the patient explore ways to achieve greater peace.
Knowing the patient comprises
both the nurse's understanding of a specific patient and his or her subsequent selection of interventions
Two elements that facilitate knowing
continuity of care and clinical expertise
Knowing the patient
is at the core of the clinical decision-making process
Clinical decision making
involves various aspects of knowing the patient: responses to therapies, routines and habits, coping resources, physical capacities and endurance, and body typology and characteristics.
improved patient outcomes result
Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
limited to biological attributes
To become absorbed into another culture and adopt its characteristics
adapting to and adopting a new culture
socialization into one's own culture
a tendency to hold one's own way of life as superior to others
Nurses and other health care providers who have cultural ignorance or cultural blindness about differences generally resort to use their own values and lifestyles as the absolute guide in dealing with patients and interpreting their behaviors
when health care providers disregard values and cultural beliefs
(the gaining of knowledge) is the process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care
Culturally congruent care
integrating the knowledge gained from cultural competence to give meaningful and beneficial care that fits people's valued life patterns
5 interlocking components to cultural competence
is a systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities
The goal of cultural assessment
is to gather significant information from the patient that enables the nurse to implement culturally congruent and safe patient care
Major components of cultural assessment
• Asking Open- ended Questions
• Census Data (Socioeconomic status)
• Estab. Relationship
According to the Office of Minority Health and Health Disparities, national standards regarding language services include
1). Providing language assistance services free of charge to all patients with limited English at all points of contact.
2). Notifying patients, both verbally and in writing, of their rights to receive language-assistance services.
3). Using interpreters for patients with limited English proficiency (unless the patient requests that family or friends interpret for them)
Selected components of cultural assessment
* Ethnic Heritage & Ethno history
* Bicultural Effects on Health
* Social Organization
* Religious & Spiritual Beliefs
* Communication Patterns
Ethnic Heritage & Ethno history
Knowledge of a patient's country of origin and its history and ecological contexts are significant to health care
Bicultural Effects on Health
• Some distinct health risks are the result of the ecological context of the culture
• Certain genetic disorders are also linked with specific ethnic groups
• Cultural groups consist of units of organization defined by kinship, status, and appropriate roles for their members
• Although different configurations of a family exist, the most common is the nuclear household made up of parents and their young children
• Collectivistic groups often regard members of their ethnic group as closest kin (made up of distant blood relatives across three generations and fictive or nonblood kin) and want to consult them; social hierarchy and roles are further defined by the culture.
Religious & Spiritual Beliefs
• Religious and spiritual beliefs frequently influence the patient's worldview about health and illness, pain and suffering, and life and death.
• Cultural groups have distinct linguistic and communication patterns
attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Healing emphasizes use of naturalistic modalities, including herbs, chemicals, heat, cold, massage, and surgery
believe that an external agent, which can be human (i.e., sorcerer) or nonhuman (e.g., ghosts, evil, or deity), causes health and illness
Cultural & Life Transitions
Rites of passage
Grief & Loss
Barriers to knowing the patient are often related to the
organizational structure of the organization and economic constraints.
Rites of passage:
Ceremonies that mark important transitional periods in a person's life, such as birth, puberty, marriage, having children, and death.
Grief & Loss:
bring traditions that are meaningful to groups of people for most of their lives. When traditional medical measures fail, cultural beliefs and practices that are religious and spiritual become the focus
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