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227 Cards in this Set

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Temperature (general)
-may be influenced by internal or external factors
-may indicate complications
-body temp
-heat prod minus heat loss
Core Temperature
-temp of the deep tissues of the body are relatively constant
-surface temp fluctuates depending on the:
amt of bld flow to the skin
amt of heat loss to the external environment
Normal Temp Ranges
36 C to 38 C
98.6 F to 100.4 F
-optimum functioning for cells and tissues
Oral temp msmt
-not for a client that isn't completely alert
-not after hot or cold beverages (wait 30 mins)
Axillary Temp Msmt
less accurate than oral/rectal
Tympanic temp msmt
-quick results
-often not utilized correctly
Rectal temp msmt
often thought of as most accurate method
Other methods/sites of temp msmt?
-esophageal
-pulmonary artery
-urinary bladder
~require continuous invasive devices
~used in critical care settings
Hypothalamus(Cerebral Hemisphere)
-controls body temp as close as possible to constant or set temp
-anterior hypothalamus controls heat loss
-posterior hypothalamus controls heat prod
Mechanisms of Heat Loss
-Sweating
-Vasodilation
-inhibitions of heat prod
-bld is redistributed to the surface to prod heat loss
Radiation (heat loss)
transfer of heat w/o contact
Conduction (heat loss)
transfer of heat by direct contact
Convection (heat loss)
transfer of heat by air mvmt (fan)
Evaporation (heat loss)
turning liquid to gas
Diaphoretic (heat loss)
visual perspiration
When would the use of hot and cold therapy be contraindicated?
-impaired circulation
-bleeding
-wound complications
-inability to tolerate tx
Warm water is defined as...
105 to 115 degrees
A compress is?
a moist gauze dressing applied to a wound. soaked in heated soln
A soak involves?
immersing the affected area
A sitz bath soaks the?
pts perineal area
Aquathermia pads?
aka K-pads. plastic or vinyl pads that circulate water in the interior.
What is considered a fever high enough to use a cooling bath?
above 104 degrees F.
What is rebound phenomenon?
at the time the cold reaches max therapeutic effect, the opposite effect begins.
What is thermoregulation?
process of temperature regulation
What is the BMR?
basal metabolic rate
-the amt of energy required to maintain the body at rest
What is insensible water loss?
water loss that we don't see
Do we want to provide ice baths to a client w/ an elevated temp?
No, bc they will shiver which will raise temp more. Tepid bath is ok.
Alteration in temp control is the result of?
-lesion on the hypothalamus or spinal cord
-trauma to the hypothalamus or spinal cord.
~not always inf
About Heat Production(gen.)
-prod. by metabolism
-food is the fuel source
-functional heat-producing process is present
-metabolic rate increases when activities require more heat
-most influenced by muscle activity
Heat production occurs during?
-rest
-voluntary mvmts
-involuntary mvmts
-involuntary shivering
-nonshivering thermogenesis
What is pyrexia?
-body temp is above the normal range
-2 types:
hyperthermia
fever
How does age affect temp?
-infants lose 30% of body heat thru head
-older adults have difficulty maintaining body heat bc of slower metabolism, decr. vasomotor control, loss of subQ tissue.
How does exercise affect temp?
increases metabolism
How does hormone level affect temp?
-woman's body temp varies w/ menstrual cycle.
-menopause causes hot flashes-
How does circadian rhythm affect temp?
temp lowest in early morning and highest in late afternoon or early evening.
What is Circadian rhythm?
cyclical repetition of certain physiological processes that occur every 24 hrs.
How can emotions and stress affect temp?
stimulate sympathetic nervous system, czing prod of norepinephrine and epinephrine which incrs. metabolic rate
What is Hyperthermia?
body's inability to promote heat loss or reduce heat prod.
Causes of hyperthermia?
dz or trauma to the hypothalamus
What is Malignant Hyperthermia?
a rxn to some anesthetic drugs given to persons w/ hereditary cond of uncontrolled heat prod.
What is heatstroke?
-prolonged exposure to the sun or environmental temps
-heat depresses the hypothalamus function
What are the S/S of heatstroke?
-hot,dry skin(doesn't sweat)
-headache,dizziness,faintness
-delirium,giddiness,confusion
-excessive thirst
-nausea,muscle cramps
-incontinence
-visual disturbances
What is fever?
-alteration in hypothalmic setpoint.
-abnormal high body temp
Benefits of fever?
-WBC prod incr.
-hormone-like subs are reproduced and defend the body
-enhance the body's defense mechanism
-suppress the growth of bacteria
-fights viral infs by stimulating interferon
-aid in dx
What is interferon?
the body's natural virus-fighting substance
Negative effects of fever?
-metabolism incr
-heart & respiratory rate incr
-demand for O2 incr
-inadequate supply of O2 results in myocardial hypoxia and cerebral hypoxia
-dehydration in older adults and kids
What can cz seizures in kids?
if brain temp gets too high due to fever
Important factors R/T fever?
-severity
-client's response to the elevation(how pt responds to fever)
-client's general health status
-client's age
-duration
-fever patterns
What is intermittent fever?
temp alternates regularly bw periods of fever and periods of normal or below-normal temp
When may intermittent fever be seen?
seen in TB and flu
What is remittent fever?
wide fluctuations in temp(>3.6°F),all above normal, during a 24-hr per.
What constant(sustained) fever?
temp may fluctuate slightly but is always above normal.
What is relapsing fever?
short periods of fever alternating w/ periods of normal temps, each lasting 1-2 days.
When might you see relapsing fever?
Malaria
6 Goals of Fever Therapy?
-reduce heat prod
-incr heat loss
-prevent complications
-provide comfort
-ID underlying cz or contributing factor
-maintain core temp w/in normal range
What is the Initial stage of fever?
period when body temp is rising but has not yet reached new set pt.
S/S of Inital stage of fever?
person usually feels chilly and generally uncomfortable and may shiver.
What is the 2nd phase(course) of fever?
per. when body temp reaches its max set pt and remains fairly constant @ the new higher level.
S/S of 2nd phase of fever?
person feels warm and dry, phase may last from a few days to a few wks
What is the 3rd phase(defervescence or crisis) of fever?
per when the temp returns to normal.
S/S of 3rd phase of fever?
person feels warm & flushed in response to vasodilation.
-diaphoresis occurs.
Nursing Diagnoses R/T Pyrexia?
-risk for imbalanced body temp r/t..
-hyperthermia r/t inf of lung aeb temp elevation of 102.4
-ineffective thermoregulation r/t injury to hypothalamus
Antipyretics include...
-nonsteroidal compounds
acetaminophen,salicylates,indomethacin,ketoralac)
-reduce fever by incr heat loss
-usually RXed for temp control
-some also decr discomfort
Nonpharmacological therapy for Pyrexia?
-Increase heat loss by:
evaporation
conduction
convection
radiation
Interventions for fever?
-focused assessments
-min heat prod
-max heat loss
-meet reqts for incr metabolic rate
-promote comfort
Temp below set pt?
-posterior hypothalamus senses the change
-efforts to conserve heat are initiated
-vasoconstriction(bld flow to extremities & skin is reduced)
-heat prod is stimulated via voluntary muscle contraction and muscle shivering
What is hypothermia?
-prolonged exposure to cold overwhelms the body's ability to prod heat.
-the body's rxn to temp below 95°F
How does the body react to temp below 95°F? (hypothermia)
-uncontrolled shivering
-memory loss
-depression
-poor judgment
Effects of temp 94°F?
-vital signs fall
-skin becomes cyanotic
-cardiac arrhythmias
-loss of consciousness
-unresponsive to stimuli
Interventions for Hypothermia?
-passive rewarming measures
-warm environment
-warmed blankets
-warming blood
-active external rewarming avoided
-can result in metabolic acidosis
Induced Hypothermia?
-central cooling:helps in stroke pts
-cardiac,transplant or neurosurgery
-rewarm bld
-warming blanket
-pharmacological agents
-carefully watch lab values:K,glucose
Thermal Therapy
-application of hot or cold
-requires a docs order
-need to assess area to be txed
-risk of damage is incr if:
impaired circulation
impaired skin integrity
edema
Heat therapy benefits...
-beneficial during subacute or chronic infl
-promotes analgesia
-facilitates soft tissue repair
-relaxes skeletal muscle
Moist Heat Applications
-Wet Compresses
can submerge compress in warm soln, wring out & apply
can apply dry & use a syringe to apply soln
can use a hot water bottle
use a waterproof pad
no heating pads or anything electrical
Moist heat applications(Baths)
-sitz baths incr circulation to anal/perineal areas
very soothing after surgery
-warm whirlpool baths
Dry heat works to about how many cms?
about 2 cm.
-moist heat conducts better.
Dry heat applications(hypothermia blanket)
-large body-sized blanket
-fluid is heated and circulates thru blanket
-rectal probe in place to monitor temp
Dry heat appl.(heat lamps)
-monitor temp constantly
-often used in infants
-monitor for mvmt toward lamp
Dry heat appl(electric heating pads)
-dry heat to small area
-never use more than low setting unless order specifically says to do so
-put on top, never underneath
-make sure linens are dry
Dry heat appl(chemical heat packs)
-2 seperate compartments filled w/ chemicals
-when combined, prod. heat
Cold therapies(Cryotherapies)
Cold...
-contricts vessels(conrols bleeding)
-reduces edema formation
-decr nerve conduction velocity
-incr pain threshold
-decr muscle spasticity
When is cryotherapy most effective?
in acute infl. phase
Cryotherapy Tx of Choice
-immediately following local tissue injury
-during acute infl phase
-usually accompanied by:
compression
elevation
Cryotherapy...
-therapy should be limited to 15 min on distal extremities
-area temp remains lower for 1-2 hrs after removal of cooling modality
What should skin be checked for after removal of cold therapy?
purplish color
Types of Cold Therapy?
-ice pack
-cold pack
-cold compress
-cool sponge bath
What is psychosocial theory?
understanding ppl as a combo of psychological and social events
Pt responses to illness are influenced by the relationship among:
-physical pathology
-psychosocial health
-overall wellness
What is biopsychosocial?
overall well-being
What is self-concept?
one's overall view of oneself.
What forms a person's self-concept?
Forms out of a person's eval of:
-physical appearance
-sexual performance
-intellectual abilities
-success in workplace
-friendship/approval 4m others
-problem-solving & coping abilities
-unique talents, etc.
Factors affecting self-concept?
-gender
-developmental level
-socioeconomic status
-family
-peer relationships
-internal locus of control
Components of Self-Concept?
-Body Image
-Role Performance
-Personal Identity
-Self-esteem
What is the internal locus of control?
the inner "voice" that influences our self-concept
What is an external locus of control?
ppl who attribute control of their situation to external factors,including other ppl, institutions, and God.
What is body image?
mental image of your physical self, including physical appearance & physical functioning.
What is body image influenced by?
-Ideal vs perceived and actual body image
-appearance & function of body
-Gradual vs. sudden body changes
What can make a person's body image more ideal?
the closer the match bw a person's ideal body image and sensory input about his or her body the more pos. the body image
What type of feelings can occur with an abrupt change in appearance or functioning?
-denial
-anger
-self-hatred
-despair
What is role performance?
the actions a person takes and the behaviors demonstrated in fulfilling a role.
What is interrole conflict?
when 2 roles make competing demands on an individual
What is interpersonal role conflict?
a mismatch bw 2 ppls ideas of how to perfom a role
What is role strain?
a mismatch bw role expectations and role performance.
What is personal identity?
your view of yourself as a unique human being, different and seperate 4m all others.
-relatively constant and consistent.
What is self-esteem?
how well a person likes one's self.
-the diff. bw ideal self and actual self.
What categories should a comprehensive psychosocial assessment include?
-biological,psychosocial,& social details
-functional abilities
-Self-efficacy
-family relationships
-relationships w/ the wider social environment
-interpersonal communication
-social resources and networks
-understanding current illness
-usual coping mechanisms
-health priorities
What is self-efficacy?
the belief that you can influence your own behaviors and outcomes
Behaviors to look for during a psychosocial assessment.
-avoidance of eye contact
-hesitant speech
-overly critical
-excessive anger
-frequent crying
-putting self down
-slumped posture
-lack of interest
-passive attitude
-difficulty in making decisions
-unkempt appearance
Why is it important to determine cause and effect in a psychosocial diagnosis?
bc psychosocial and self-concept issues can be a prob, a symptom of a prob, or the etiology of a prob.
11 common psychosocial diagnoses?
-interrupted family processes
-family coping
-parental role conflict
-ineffective individual coping
-post-trauma syndrome
-risk for loneliness
-social isolation
-risk for violence:directed at others
-impaired social interaction
-coping ineffective
-hopelessness
Self-Concept Diagnoses?
chronic low self-esteem
situational low self-esteem
disturbed personal identity
ineffective role performance
disturbed body image
Psychosocial,Self-concept,and Self-Esteem Outcomes
Approx. 30 NOC standardized outcomes to describe:
psychological well-being
psychological adaptation
self-control
social interaction
What domain can you find psychosocial, self-concept, and self-esteem outcomes in?
found in psychosocial health and family health issues.
Psychosocial Illness:Anxiety
-common emotional response to a (usually known) stressor
-results 4m psychological conflicts
-accompanied by physical symp
-can be mild,moderate,severe,disabling
Psychosocial Interventions for Anxiety?
-provide support measures to reduce anxiety
-prevent client isolation
-help estab. simple routines
-encourage self care
-allow client to make decisions regardign tx & routine
-use therapeutic comm skills
-explore use of coping resources
-reinforce client's strengths
-support 4m family & friends
Evaluation for Anxiety Interventions?
-observe clients nonverbal behavior
-verbal cues
statements of self acceptance
acceptance of change in appearance or function
willingness to share opinions and ideas
-observe appearance
What is grieving?
the physical, psychological & spiritual responses to a loss
What does the intensity of the grieving depend on?
the meaning the person attaches to the loss-what the loss represents to the person.
Complicated grief(dysfunctional grief)?
-a person's responses are maladaptive,unusually prolonged or overwhelming.
-severe depression
-drug/alcohol abuse
-suicidal
-several yrs later person may be having same intensity of grief initially experienced
7 kinds of losses?
-loss of loved ones
-physical
-psychological
-loss of role
-maturational loss
-significant relationships
-anticipatory
What is a perceived loss?
internal; identified only by the person experiencing it
What is a physical loss?
Includes:
1.injuries
2.removal of a bodily organ
3.loss of function
What is a psychological loss?
challenge our belief system. Commonly seen in areas of sexuality,control,fairness,meaning,and trust.
What is an external loss?
actual losses of objects that are important to the person bc of their cost or sentimental value.
What is loss of aspects of self?
includes physical losses such as body organs,limbs,body functions,and/or body disfigurement.
What is environmental loss?
involves a change in the familiar,even if change is seen as positive.
According to Worden, what are the 4 tasks of grieving?
-Accepting the reality of the loss
-working thru the pain & grief
-adjusting to the environment in which the deceased is missing
-emotionally relocating the deceased & moving on w/ life
Stages of grieving according to Rando? (6 R's of grieving)
-Recognizing the loss
-Reacting to the separation(feel the loss)
-Recollecting memories of the deceased(remembering,reliving)
-Relinquishing the old attachment (new ways of living w/o the deceased)
-readjusting to the new environment(new coping skills)
-reinvesting self(energy once turned inward on grief begins to be focused outward again)
Stages of grief according to Bowlby?
-Shock and Numbness
-Yearning & Searching
-Disorganization & despair
-Reorganization
3 Phases of grieving according to Rando?
-Avoidance
-Confrontation
-Accomodation
Moving thru Stages of Grief
-ppl don't fit neatly into or match exactly the phases described
-ppl go back & forth bw phases or are in more than 1 at the same time
-important for recognizing what person goes thru,not for categorizing
-most important to find out what an individual is experiencing
Factors Affecting Grief
Significance of the loss
Amt of support for the bereaved
conficts existing @ time of death
circumstances of the loss:guilt or feeling of being responsible may be present
previous losses
developmental stages
spiritual/cultural factors
timeliness
Developmental Considerations conc. Grief (Early Childhood)
-don't understand finality until around 5 yrs
-bw 5-9 understand its permanent but believe it will never happen to them or anyone they know
-magical thinking
-regression
Developmental Considerations conc Grief (Adolescence)
-pushing away:guilt
-may look mature, but lack maturity
Physical Responses to Grief?
-loss of appetite
-fatigue
-headache
-nausea
-stomach pain
-decr libido
-decr energy
-decr immune system response
-weight loss or gain
Emotional responses to Grief?
-anger
-sadness
-shock
-numbness
-loneliness
-guilt
-fear
-relief
-anxiety
-powerlessness
-helplessness
Cognitive responses to Grief?
-decr concentration
-forgetfulness
-impaired judgment
-preoccupation
-confusion
-feel "in a fog"
-questioning of spiritual beliefs
-searching for understanding
-searching for purpose & meaning
-obsessive thoughts of the deceased or lost object
-thoughts of dying
Behaviors r/t to Grief?
-forgetfulness
-withdrawal
-insomnia
-too much sleep
-dreaming of the deceased
-verbalizing the loss
-crying
-loss of productivity at work or school
How can grieving affect health?
bc it takes a lot of energy
How is grief different for each person?
-everyone has their own timeline
-ppl grieve differently
-some losses a person never "gets over," they adjust to a new life that doesn't include the lost person/pbject
-cultural expectations unrealistic
-2nd yr may be worse than the 1st
Mourning means:
-releasing,allowing to flow
-pouring whatever wells up 4m the soul
Mourning allows grief to flow:
-without criticizing its contents
-w/o limiting its time
-w/o fear:trusting in its healing mystery
Mourning can only be encouraged & suppported:
-in a time & place found safe
-in a way fitting the mourning person
-thru invitation to speak
-thru receptive response of those who hear
To be safe, Mourning needs:
-a time & place for pouring out
-a receptacle to receive the out-pouring
-a response that honors the outpouring
Listening from the heart is:
the authentic response to grief poured out.
Listening from the heart does not:
-critique the thoughts or feelings poured out
-interrupt the flow of the outpouring
-give directions or advice
Listening from the heart does:
-offer pure & non-anxious presence
-create space for receiving whatever the other chooses to pour out
-convey reverence for the person and the contents poured out
Listening from the heart:
-looks like doing nothing
-comforts like warm oil
-relieves the soul & fills the heart
What is palliative care?
-"comfort care"
-tx of symptoms
-cure no longer the goal
What is hospice philosophy?
-provide comfort
-help individuals & families make the most of the time they have
-maintain dignity & choice
-ease pain & tx symptoms
4 hospice settings?
-homes
-LTC facilities
-hospice beds in hospitals
-inpatient units
Hospice Care:
-criteria for admission:6 mo or less life expectancy
-interdisciplinary approach
-24 hr on call nurses & social workers
-respite care
-crisis care
-volunteers
-bereavement counseling
-inpt units for symptom control
-specialists available
-no home bound requirement
-durable med eqpt
Hospice Interdisciplinary Team?
-home health aides
-nurses
-chaplains
-counselors/social workers
-physicians
Most common areas for dx r/t dying/hospice?
-pain
-nausea
-anxiety
-constipation
-self care deficits,hygiene,oral care
-altered urinary elimination
-risk for impaired skin integrity
-knowledge deficit(caring for pt,meds,active dying phase)
-ineffective breathing patterns
-sensory perceptual alteration
-fear
-powerlessness
Major goals conc Hospice Care?
-to maintain physical,psychological,& spiritual comfort
-to achieve a dignified & peaceful death
Ex of Desired Outcomes for client w/ Grief
The client:
ID's areas of personal control
reminisces & rvws personal life pos.
participates in self care activities as able
accepts limitations & seeks help as needed
expresses control over present situation
Common Concerns of the Family for Hospice
-pain & other symptoms
-fluid & nutrition
-mobility
-providing personal care for dying fam member
-planning for the death-How long? Making arrangements,Calling in Family, What will it be like?
Interventions for Hospice Care?
-energy conservation
-skin integrity
-eye care
-mouth care
-hydration
-elimination
-respiratory secretions
-pain control
-mgmt of nausea
-environmental mgmt
-safety
-communication
Family Support conc Hospice
-encourage involvement in care
-acknowledge feelings & grief
-encourage self care
-teach them what to expect
-find out if they want to be present at the time of death
-keep them informed
Post Mortem Care
-note time of death
-notify doc & fam
-handle body w/ dignity
-care for the body
-support the family
-observe cultural,religious & family preferences
-ID the body
-notify funeral home
-transport to morgue
Advance Directives
-instructions stating a person's health care wishes if incapacitated or unable to make decisions
-all HC providers who receive Medicare funds must educate pts & provide pts w/ opportunity to complete advance directives
Living will
-document prepared by competent person giving instructions regarding medical care if unable to make decisions.
-includes kinds of HC the person would wish to have or not have
Durable Power of Attorney
a competent person names another individual to make decisions regarding HC when he is unable to do so.
Sexual development in Infancy/early childhhod
-gender identity
-role ID(male or female)
Sexual Development in School-Age years
-parents,teachers,peers are role models
-may ask questions
Sexual Development in Puberty/Adolescence
-physical/emotional changes
-exploration
Sexual Development in Young Adulthood
-Intimacy & Sexuality
Sexual Development in Middle Adulthood
-physical/emotional changes
-perimenopause,dyspareunia
Sexual Development in Older Adults
changes
Gender
-biological sex,being male or female
-Gender Roles
societal norms for behavior
What is gender identity?
the image we have about ourselves as a man or woman. An internal experience: whether we feel like a woman or man.
What is transgendered?
used to describe ppl whose gender ID differs in some way 4m their apparent biological gender.
What is transsexual?
someone who feels trapped in the body of the opposite gender.
What is intersexed?
ppl born w/ ambiguous sexual organs. Older term is hermaphrodite.
What is a cross-dresser?
AKA transvestite. person who occasionally or frequently wears the clothes of the opposite sex.
Factors affecting sexuality?
-culture
-religion
-lifestyle
-knowledge about sex
-health status
-meds
Assessment(Sexual Health History)
-determine if client has sexual concerns
-routine/matter of fact manner
-It is not unusual for ppl w/ your cond to experience sexual changes. Do you have any concerns?
-opens the door for discussion/education
-Gives pt permission to discuss sexual concerns
Obtaining a Sexual History
-examine your own beliefs & values
-be aware of your nonverbal communication
use relaxed approach
maintain eye contact
provide privacy
watch for cues to client discomfort/concerns
How many men are affected by ED(erectile dysfunction)?
30 million men in US
Risk factors for sexual dysfunction(ED)
-diabetes
-hyperlipidemia
-hypertension
-hypothyroidism
-chronic renal failure
-smoking
-obesity
-alcohol abuse
-lack of exercise
Meds that can cz sexual dysfunction?
antihypertensive,antipsychotic,antidepressants,anxiolytics,anticonvulsants
Addt'l nursing dx r/t alterations in sexual function
-activity intolerance & fatigue
-impaired physical mobility
-fear
-chronic pain
-chronic low self esteem
Sexual Health Promotion
-Education(STD,contraception,abuse,etc)
-Women:Kegel exercises
-Men:testicular self-exam
-counseling for sex probs
About Kegel exercises
-strengthens pubic muscles
-decr urinary incontinence
-can enhance sexual enjoyment
Sexual Health Evaluation
-follow up discussion to determine if goals were met
-positive self esteem
-dealing w/ inappropriate sexual behavior
What is religion?
-A "map" that outlines essential beliefs,values,& codes of conduct into a manner of living
-many of the world's religions hold common beliefs
What is spirituality?
-A "journey" that takes place over time & involves the accumulation of life experiences & understanding
-an attempt to find meaning,value,& purpose in life
Spirituality
-Religion provides a framework for beliefs & rituals.
religious care is helping clients maintain their faithfulness to their belief system.
Spirituality is the...
umbrella under which religion is a part.
Spiritual care is seen as helping ppl maintain personal relationships & a relationship to a higher being or life force to ID meaning & purpose in life.
Core issues of Spirituality
-Faith
-Hope
-Love
Concepts in spiritual health(spiritual well-being)
sense of harmonious interconnectedness bw self,others/nature..
Concepts in spiritual health(faith)
relationship w/ a divinity,higher power,authority or spirit...
Concepts in spiritual health(religion)
system of organized beliefs & worship that a person practices
Concepts in spiritual health(hope)
provides comfort while enduring life threats & personal challenges
Spiritual beliefs & health
-research suggests religion has a pos influence over physcial & mental health
-research doesn't answer how or why religion affects health
What every nurse should know conc Spiritual health
-Gain self knowledge
be open
welcome challenges
take time to reflect
spiritual care demands nonjudgmental attitudes & open thinking
Barriers to Spiritual Care
-lack of awareness of spirituality in general
-lack of awareness of your own spiritual belief system
-diff. in spirituality bw nurse & client
-fear that your knowledge base is insufficient
-fear of where spiritual discussions may lead
What is the JAREL spiritual well-being scale?
Assesses 3 key dimensions:
1.faith/belief
2.life/self-responsibility
3.life-satisfaction/self-actualization
What is the SPIRIT model?
involves an interview conc w/ 6 key areas designated by acronym SPIRIT:spiritual/religious belief system,integration w/ a spiritual community,ritualized practices & restrictions,implications for med care,terminal events planning.
Spiritual Health Assessment Tools
-JAREL spiritual well being scale
-SPIRIT model
-levels of spiritual assessment
Sources of Info about spirituality
-client & fam interviews
-client environment
-client questions
-nonverbal communication
Causes of Spiritual Distress
-Illness:acute/chronic
-Loss/grief
-major life change
Spiritual Distress Response
-doubt
-loss of faith
-feeling of being alone/abandoned
-questioning of life's purpose
Diagnoses r/t Spiritual Health
-spiritual distress
-risk for spiritual distress
-readiness for enhanced spiritual well-being
-anxiety
-chronic sorrow
-hopelessness
-powerlessness
Nursing Care r/t spiritual health
-Self awareness
-Estab caring relationship
estab presence
encourage expression of feelings
-learn about & value other belief systems
-sensitivity & compassion
silence
listen
-use available resources
pastoral care
support systems
supporting rituals
meditation/prayer
Culture is ___ & ____.
Culture is Universal & Dynamic
Culture according to Leininger?
learned,shared,& transmitted values,beliefs,norms & life practices of a particular group that guide thinking,decisions, & actions in patterned ways.
Culture according to Zimbler?
learned,shared, & symbolically transmitted design for living
Culture according to Purnell & Paulanka?
totality of socially transmitted knowledge of values,beliefs,norms & lifeways of a particular group that guides their thoughts & behaviors.
What is bicultural?
a person who identifies w/ 2 cultures & maintains some of the values & lifestyles of each.
What is multicultural?
refers to many cultures & is used to describe groups rather than individuals
What is ethnocentrism?
the tendency to think that your own group is superior to others & to view behaviors & beliefs that differ greatly from your own as somehow wrong,strange,or unenlightened.
What is the dominant culture?
the group that has the most authority or power to control values & reward or punish behaviors.
What is subculture?
groups w/in a larger culture or social system that have some char. that are diff from those of the dominant culture
What is a minority group?
share race, religion, or ethnic heritage but smaller than majority group
What is a vulnerable population?
those groups who are more likely to develop health probs & experience poorer outcomes bc of limited access to care,high-risk behaviors,and/or multiple & cumulative stressors.
Ex of vulnerable pop as subcultures?
-homeless
-poor
-mentally ill
-ppl w/ physical disabilities
-young
-elderly
-some ethnic & minority groups
Components of Culture
-religious beliefs
-rituals or ceremonies
-health practices
-language
-family interactions
-time orientation
-space rqts
-use of nonverbal comm
-nutrition & food preferences
-methods of child rearing
-value systems
Cultural Values:
a desirable or preferred way of acting or knowing something that over time is reinforced & sustained by the culture & ultimately governs one's actions or decisions.
Culture is:
-learned
-taught
-shared by its members
-dynamic & adaptive
-complex
-diverse
-exists on many levels
-has common beliefs & practices
-is all encompassing
-provides identity
What is indigenous health care system?
consists of folk med & traditional healing methods,also includes OTC and self-tx remedies
Professional health care system?
run by a set of prof HC providers who have been formally educated & trained for their appropriate roles & responsibilities
Biomedical health care system?
combines Western biomedical beliefs w/ traditional North American values of self-reliance,individualism, & aggresive action
Alternative health care?
diet therapy,mind-body control methods,therapeutic touch, acupressure, etc.
Culturally competent individuals:
-value diversity & respect individual differences
-regardless of one's race, religious beliefs, or ethno cultural background.
Cultural competence & sensitivity in nursing care
Is a complex combo of:
-knowledge
-attitudes
-skilss
Questions for a Cultural Assessment?
-Where were you born?
-Who lives with you?
-What czed your current prob?
-What language do you speak at home?
-What is your religious preference?
-What do you do to keep your self well?