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163 Cards in this Set
- Front
- Back
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Primary Health Care System
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Health promotion and illness prevention includes: nutrition programs (WIC), weight control, stress reduction, immunization programs, family planning and prenatal care (focus on prevention)
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Difference between primary care and primary health care
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primary care is normal health care for a single individual or family (PCP or NP)
primary health care improves the outcomes for a population and includes primary care |
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Secondary Health Care
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Diagnosis and treatment including: hospitals and clinics, screening tests, education about early detection, and is the most expensive part of healthcare. (focus on restorative care-gain maximal function and quality of life)
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Tertiary Health care
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Rehabilitation and health restoration includes: long term care, hospitals, rehabilitation(focus on managing chronic problems ie. disability, terminal condition)
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Challenges of Community-based Health care
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socail lifestyles, political policy, and ecomonic initiatives
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Vulnerable population
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immigrants, poor and homeless, abused, substance abusers, mentally ill, older adults
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Risk factors related to Homelessness
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poor physical environment, inadequate rest and privacy, improper nutrition, poor acess to facilities-hygiene, exposure to elements, lack of social support, few personal resources, personal safety, poor compliance
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evidence based practice
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get the basis for nursing care from experts and base practices on procedures/interactions which have been proven to be beneficial (based on evidence from research, theories, clinicians, cleitn history and resources, client preferences and values)
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Steps to evidence based practice
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1.ask clinical questions
2. collect best evidence 3. critique the evidence 4. integrate the evidence 5. evaluate the practice decision or change |
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Evidence based practice-ask PICO questions
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P-identify population
I-Intervention of interest C-comparison of interest O-outcome |
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Evidence based practice-collect best evidence
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best are usually systematic reviews, must carefully read material, want randomized controlled trials (best with double blind)
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Evidence based practice-critique evidence
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the most difficult step and takes a lot of time. What to see if information is addressing proposed interest(proposed change), is the information reliable, and can it be used in practice
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Evidence based practice-Integrate evidence
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talk to directors to get permission to try interest (intervention) within nursing practice
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Evidence based practice-evaluate
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do more research to see if change was better than the old way, decide whether to return to old way, use new way, or look for more options. Must provide enough time to see if change actually works.
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Nurse as an Advocate
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protect your client's human and legal rights and provide assistance ins asserting those rights if the need arises.
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Changes in nursing
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are impacted by changes in society, technology, demographic patters, consumerism, health promotion, womens and human rights movements
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Integrated delivery network
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a set of providers and services organized to deliver a continuum of care to a population of clients at a capitated cost in a particular setting. reduces duplication of services across the levels or settings
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Restorative care
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goal is to help clients regain maximal functional status and to enhance quality of life through promotion of independence and self-care. additional services required to return to previous function after illness or injury
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Primary providers
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Include school health, occupational health, physician offices, nursing centers, block or parish nursing, and community centers
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vulnerable populations
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those clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care. poverty
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Risk factors for immigrant populations
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access to care may be limited because of language barriers and lack of benefits, resouces and trasportation. some have specific health risks like hepatitis B, tuberculosis, intestinal parasites, visual, hearing and dental problems.
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Risk factors for the poor
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more likely to live in hazardous environments, work at high risk jobs, eat less nutritious diets, and have multiple stressors, lack financial resources to access care
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Risk factors for abused clients
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mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships.
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Community assessment
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includes structure (name of community, boundaries, emergency services, water and sanitation, economic status and transportation, Population includes ages, gender distrb, growth trends, density, educational level, ethnic group and religion. Social system includes education sys., governments, communication, welfare, volunteer programs and health system
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nursing research process
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identify problem, design study, conduct study, analyze data, use findings
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Models of Health and illness
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Health belief model, health promotion model, basic human needs model, holistic health model (models are theoretical ways of understanding a concept or attitude)
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Health Belief Model
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focus on relationship between beliefs and behaviors in order to anticipate how people will respond to health therapies
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Health promotion model (nora pender)
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Increase the client sense of well being incorporating psychology and nursing with factors that influence health
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Basic human needs model
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Focus on maslows heirarchy of need. 1. need for survival: air, water, food, shelter, sleep and sex. 2. safety 3. love and belonging 4. self esteem 5. self actualization (person must have basic needs first and then move up)
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Holistic health model (mandel)
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create a condition that promotes optimal health, use nursing process but consider patient as ultimate experts regarding their own health and wellness. focus on person as a whole, addresses mind, body and spirit, includes alternative therapies (touch, imagery, music, relaxation, aromatherapy, calming, distraction)
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Internal variables influence health
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developmental stage, intellectual background, perception of functioning (pt perception), emotional factors, and spiritual factor
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internal variable-development
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thought and behavior change throughout life. nurse must adapt planning to fit expectations for the stage of development and client abilities to allow client participation in care
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internal variable-intellectual background
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a person's knowledge, lack of knowledge or incorrect information about body function and illness, educational background will influence ability to understand and apply knowledge
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internal variable-perception
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how patient views health will impact the practices and responses of client
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internal variable-emotion
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degree of stress, depression, fear etc., can influence how person views health, and will help determine how person will react to situation
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Internal variables-spirtual factors
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spirituality will impact persons values, and beliefs which will impact pt ability and way of coping and finding hope
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External variables
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family practices, socioeconomic factors, and cultural background
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external variables-family practices
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what is done within the family will influence what health practices are practiced (immunizations, well exams)
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external variable-socioeconomic
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may increase risks as clients may wait to seek care
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external variable-cultural background
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may impact client belief about illness and its source, and remedies that are expected
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Levels of prevention
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primary-true prevention, secondary- focus on how have and those at risk, Tertiary-occur when defect is permanent
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Risk factors
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age, genetic and physiological factors, environment, and lifestyle
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Stages of health behavior change
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precontemplation, contemplation, preparation, action, maintanance
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Health promotion- advisement
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nurse advises of activities which would help maintain and enhance present level of health
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wellness education-
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nurse teaches patient how to care for themselves in a healthy way
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Changes in nursing
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are impacted by changes in society, technology, demographic patters, consumerism, health promotion, womens and human rights movements
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Integrated delivery network
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a set of providers adn services organized to deliver a continuum of care to a population of clients at a capitated cost in a particular setting. reduces duplication of services accross the the levels or settings
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Restorative care
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goal is to help clients regain maximal functional status and to enhance quality of life through promotion of independence and self-care. additional services required to return to previous function after illness or injury
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Primary providers
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Include school health, occupational health, physician offices, nursing centers, block or parish nursing, and community centers
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vulnerable populations
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those clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care. poverty
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Risk factors for immigrant populations
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access to care may be limited because of language barriers and lack of benefits, resouces and trasportation. some have specific health risks like hepatitis B, tuberculosis, intestinal parasites, visual, hearing and dental problems.
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Risk factors for the poor
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more likely to live in hazardous environments, work at high risk jobs, eat less nutritious diets, and have multiple stressors, lack financial resources to access care
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Risk factors for abused clients
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mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships.
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Community assessment
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includes structure (name of community, boundaries, emergency services, water and sanitation, economic statis and transportation, Population cinludes ages, gender distrb, growth trends, denisty, educational level, ethnic group and religion. Social system includes education sys., governments, comunication, welfare, volunteer programs and health system
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nursing research process
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identify problem, design study, conduct study, analyze data, use findings
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illness prevention
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activities such as immunizations
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illness behavior
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how people monitor their bodies, define and interpret their symptoms
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illness behavior-internal variable
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perception of illness and the nature of illness
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illness behavior-external variables
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visibility of symptoms, social group, cultural background, economics, and accessibility to health care.
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impact of illness on client and family
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illness impacts entire family as everyone deals with consequences of being ill. Behavior and emotional changes, impact on body image,self-concept,family roles, and family dynamics
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Clients perspective on caring
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expect a reassuring presence, recognizing an individual as unique, and keeping a close and attentive eye on the situation
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Madeleine Leiningers transcultural perspective on nursing care
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care is essential to human need, helps individual or group improve a human condition, helps protect, develop, nurture, and sustain people
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Jean watson-Theory of Transpersonal care
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promotes healing and wellness, rejects disease orientation to health care., places care before cure, and emphasizes the nurse-client relationship, 10 carritive factors
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10 carative factors-Watson
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forming a human-altruistic value system, instilling faith-hope, cultivating a sensitivity to one's self and to others, develping a helping trusting, human caring relationship; promoting and expressing positive and negative feelings; using a creative problem-solving careing processes; promoting transpersonal teaching learning; providing for a supportive, protective and/or corrective mentla, physical, societal, and sprititual environment; meeting human needs; allow for existential phenomienological spiritual forces
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Swansons theory of caring
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defines caring as a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility
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Swansons theory of caring
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knowing, being with, doing for, enabling, maintaining belief
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caring in nursing practice
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behaviors in include being with, providing caring touch, and listening.
A product of culture, values, experiences, and relationships with others |
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Providing presence
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Includes; being with, making eye contact, body language, tone of voice, listening, and positive and encouraging attitude.
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Touch
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provides comfort and creates a connection: contact touch, non contact touch (eye contact), protective touch, and task oriented touch
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listening
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creates trust, opens lines of communication, creates a mutual relationship
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knowing client
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develops over time, core process of clinical decision making, include: responses to therapy, routines, and habits; coping resources; physical capacities
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Cultural preparation
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nurse should become familiar with main cultural groups in area of practice, learn the practices, rituals, customs
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culturally congruent care
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fits the person's valued life patterns and set of meanings (must have knowlege in order to provide)
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Ethnocentrism
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our way is the best way, is based on bias and prejudice
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Characteristics of culture
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culture is learned, taught, social, adaptive, satisfying, difficult to articulate, and exists at different levels
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Culture impacts
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family patterns, gender roles, values, extended family, and naming, communication style (verbal and nonverbal), space orientation, time orientation, nutritional patterns
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Changes in Healthcare
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Many things have contributed to the ever-changing industry, patient needs and expectations, awareness of society, technology, focus(from illness treatment to prevention), ethics (cause no harm), client centered
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why are nursing theories important?
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they are designed to explain a phenomenon. a nursing theory is is a conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, and/or predicting nursing care. They provide nurses with a perspective view to client situations, a way to organize data, and a method to analyze and interpret information. theory's can guide a nurse through interventions.
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Relationship of theory to nursing practice
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theories generate nursing knowledge for use in practice, and integration of theories is the basis for professional nursing,directs the nurse through the nursing process.
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Nursing paradigm
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includes four linkages-the person, health, environment, and the discipline
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Nightingale's Theory
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the environment was the focus of nursing care
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Components of Theory
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Include a set of concepts, definitions, and assumptions/propositions regarding a phenomenon
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Theory-Phenomenon
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an aspect of reality that people consciously sense or experience: in nursing theory focus on phenomenon of nursing and nursing care
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Theory-Concepts
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Interrelated ideas and mental images which help to label or describe phenomenon
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Theory-Definitions
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communicate the general meaning of the concepts. Describe the activity necessary to measure the concepts, relationships, or variables within a theory.
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Theory-Assumptions
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the "taken for granted" statements that explain the nature of concepts, definitions, purpose, relationships, and structure of a theory
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Peplau's theory of interpersonal relations
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focus on the nurse-client relationship
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Hendersons Theory
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help client perform 14 basic needs; assisting the client to perform the activities which will lead to health, recovery, or death that the client would do on their own if they could
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Roger's theory
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The "unitary human being", looks at individual as an energy field in universe, is a unified whole (4 dimensional energy fields which are identified as a whole not by their individual parts)
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Orems' Theory
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focus on client's self-care needs, identify what client can/cannot do, help with things that they cannot do, focus on increasing client independence
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Leininger's theory
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transcultural, states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. and should vary among cultures
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Roy's theory
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the goal is to help client adapt to changes in physiological needs, self-concepts, role function, and interdependent relations during health and illness
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Watson's Theory
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philosophy of transpersonal caring- nursing actions purpose is to understand the interrelationship between health, illness, and human behavior
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Benner and Wrubel's theory
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personal concern is an inherent feature of nursing practice-caring is central
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Application of nursing theory
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provide critical thinking structure to guide clinical reasoning and problem solving
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Alternative therapy
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includes: touch, massage, music, imagery, distraction, positioning, breathing, meditation, aromatherapy
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Nursing Research
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a way to identify new knowledge, improve professional education and practice, and use resources effectively
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outcomes of management research
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designed to assess and document the effectiveness of health care services and interventions, a response of the health care industry to demands from policy makers, insurers, and public; must be specific, nurse sensitive,observable, and measurable
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Current trends and New Family Forms
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families are smaller, women are delaying childbirth, couples are having no children, divorce rates have tripled since 1950s, remarriage results in blended families, single parent families are prevalent, homosexual couples are family units, America is aging
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Current Trends affecting families
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changing economic status, homelessness, family violence, and acute/chronic illness. All of these events take a toll on the entire family
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Family Health System
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a holistic model used to assess and care for families/includes 5 realms or processes of family life: interactive, development, coping, integrity and health.
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Family stages (McGoldrick and Carter)
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Unattached young adult, Joining of families through marriage: newly married couple, Family with young children, Family with adolescents, Launching children and moving on, Family in later life
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Family Life Cycle-Unattached young adult
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accepting parent-offspring separation
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Family Life Cycle-Joining of families through marriage: new married couple
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commitment to new system
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Family Life Cycle-Family with young children
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Accepting new generation members into system
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Family Life Cycle- Family with adolescents
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Increasing flexibility of family boundaries to include children's independence
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Family Life Cycle-Launching children and moving on
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accepting multitude of exits from and entries into family system
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Family Life Cycle-Family in later life
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accepting shifting of generational roles
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Family as Context
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the primary focus is on the health and development of an individual member existing within a family
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Family as Client
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family processes and relationships are the primary focus of nursing care. focus assessment on family patterns instead of individual characteristics.
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Family as System
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providing care for both family as context and family as client.
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Nursing process for the family
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family assessment is priority, determine family form and membership, assess family functions, recognize cultural backgrounds, includes 5 realms of assessment: interactive processes, developmental processes, coping processes, health processes
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Growth and development
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growth encompasses the physical changes across a person's lifespan and developmental processes include biological (nutrition, exercise, stress), cognitive (intelligence, language, thinking, attitudes, beliefs and behaviors), and socioemotional factors (personality, emotions, relationships)
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Biophysical Developmental theory
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examine how bodies grow and change which allows providers to quantify and compare changes. describes the bodies process of biological maturation
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Gesells Theory of development
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based on children's physical growth, genes determine sequence, environment influences timing. Four behavioral categories: motor, language, adaptive, and personal-social
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Freud's Psychoanalytic Theory of development
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includes 5 stages of development: Oral stage, Anal stage, phallic stage, latent stage, genital stage
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Freud-Oral Stage
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Birth to 12-18 months- discover pleasure is achieved through sucking (bottle/breastfeeding) and child experiences conflict if parent figure not available
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Freud-Anal Stage
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12-18 month to 3 years-discover pleasure with elimination (toilet training occurs) and experience conflict if experience is painful
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Freud-Phalic/Oedipal Stage
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3-6 years. Child identifies with the same-sex parent in order to gain acceptance (start to develop curiosity about opposite sex)
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Freud-Latency Stage
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6-12 years. Child represses sexuality and is busy accomplishing other things in this phase
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Freud-Genital Stage
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Puberty to adulthood. Reach sexual maturity, resolve conflicts (develop a balance between pleasure and social norms), Id-instincts (devil on shoulder), Ego-mediator (brain), Superego-conscience (angel on shoulder)
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Eriksons Psychosocial Theory
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Emphasized development throughout life and must go through stages in order. Outlines 8 stages of development; stage1-Trust versus mistrust (birth-1year) Stage 2-Autonomy versus shame and doubt (1-3). Stage 3-Initiative versus guilt (3-6), Stage 4-Industry versus(6-11) inferiority, Stage 5-Identity versus role confusion(puberty), Stage 6-intimacy versus isolation (young adult), Stage 7-Generativity versus self-absorption and stagnation (middle age), Stage 8-Integrity versus despair
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Temperament
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is like personality, established early in life within the first year, is the way a person responds to the world, influences how others respond to us
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Gould Stage-Crisis theory
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found a set of developmental themes within the stages of adult development. Theme1-in late 20s challened to move away from home and get established as adults, Theme 2-early 30s challenged with decisions on how to reach independence, Theme 3-Mid to late 30s, challenged with own family issues and those of aging parents. Ask if they have done the right thing in their life, Theme 4-40s, face regret for past mistakes and blame parents for lack of choices, 50s-look at concept of mortality, 50-60s being to look at retirement and life issues
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Jean Piagets Four Stages of Cognitive development
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Sensorimotor, pre-operational, concrete operations, formal operations, post-formal though
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Sensorimotor
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Birth to 2 yrs.-develop patterns of behavior (schema) based on what brings pleasure or reward
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Pre-operational
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2-7 years.-symbols egocentrism (its mine), play learning, language development
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Concrete operations
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7-11 years.-thinking about actions, able to recognize multiple perspectives, cooperation
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Formal operations
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11-adult.- abstract and theoretical thought, reasoning about possibilities, organizing thoughts (cause and effect)
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Post-formal thought (this stage added later)
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after age 20.- accept contradiction and that more than one answer may be correct
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Albert Banduras Social Cognitive Theory
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observation, modeling (imitation), interactions among behavior, environment, and thought, incorporates self-understanding, self-confidence and self-efficacy
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Moral development
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refers to changes in a person's thoughts, emotions, and behaviors that influence the perception of right or wrong
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Piagets Moral development theory
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Heteronomous Morality-age 4-7, rules are unchangeable, and imminent justice expected if rules are broken
Autonomous Morality-After age 7, rules can be changed, intentions matter, needs peer interactions where negotiation occurs |
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Kohlbergs Theory of Moral Development
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Consists of 3 levels with 2 stages in each level. Level 1:Pre-conventional, Level 2: Conventional, Level 3-Post-Conventional
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Level 1-Pre-conventional
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Stage 1:obedience and punishment driven (what is right is determined by what is punished, moral action to avoid punishment)
Stage2: Self-interest driven (determined by what brings rewards and people want, others needs are only important if brings reciprocal action) |
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Level 2: Conventional
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Stage 1: Interpersonal accord and conformity driven (what most this is right is right, want to look good to others)
Stage 2: Authority and social order obedience driven (good is ones duty, show respect for authority, and laws are unquestioned, accepted, and obeyed) |
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Level 3: Post-conventional
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Stage5- Social Contract driven (laws are looked at as social contract, not dictations, individual rights supersede lauw, indv have different ideas and values)
Stage6- Universal ethical principles driven (moral action determined internally not by what others think, or laws in place, based on abstract thinking) |
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Toddler (12-36 months)
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many physical changes (walk, eat, toilet, scribble, draw) Cognitive changes (learning words and putting words together about 200 words by age 2) Psychosocial changes (sense of autonomy, separation anxiety, parallel play.
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Preschooler (3-5 yrs old)
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physical changes slow down from toddlerhood, Cognitive-brain development increases (frontal lobe area), language develops 16000 words, Psychosocial-interact with others own age, fear bodily harm, dark, living beings (animals), thunderstorms, medical personnel. Morally beginning to understand right and wrong
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school age (6-12)
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Have firm foundation for adulthood, social interaction increases to include school, home, community and church, more coordinated (begin sports), Posture and body change, have growth spirts, can think logically and being to problem solve. Learn how to put language together. Morally they take on social code, less predictable behavior, peers become important, learn to handle stress, and start to develop social identity
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adolescence (13-20) Physical
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Physical changes, reach sexual maturity, bones, muscles, organs are growing, sex specific changes occur, changes in how fat and muscle are distributed
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adolescence (13-20) Cognitive
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Think rationally, determine possible solutions and events and are able to rank them, solve problems and think rationally to make decisions, realize their actions impact others, use communication to express thoughts, feeling and abstract ideas.
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adolescence (13-20) Psychosocial
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search for identity, develop own ethical system, start to think about future career, what they want, future education, lifestyle, struggle with group interactions, family, moral and health identity.
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Adolescent risk factors
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accidents, homicide, suicide, substance abuse, eating disorders, sex orientation, disease, pregnancy, depression
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Young Adult (18-20 through middle to late 30s)
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most growth is completed by age 20, changes occur reproductive, changing potential, reaching goals, Cognitive changes-critical thinking skills and habits increase.
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Young Adult Psychosocial changes
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lifestyle, career, sexuality, childbearing cycle, types of families, parenthood, alternative family structures and parenting, single-hood, and emotional health (20-30 try to master our world,30-40 examine life-often result midlife crisis)
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Young adult health risks
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risk factors, family history, personal hygiene habits, violent death and injury, substance abuse, unplanned pregnancy, STD, environmental/occupational stress
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Acute Care
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Treatment for accidents, substance abuse, exposure to environment, stress-related illnesses, respiratory infections, influenza, UTI, and conditions requiring minor surgery-education is important
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Middle adult (mid 30-late 60s)
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physical changes impact body image and self-concept (visible thickening of waist, decreased hearing/vision, erectile dysfunction, menopause, gray hair, thinning skin) Cognitive changes-rare, unless illness or trauma occurs
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Psychosocial changes middle adulthood
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expected events-children grow and move away, loss of family,friends,sandwich generation, career transition, family psychosocial events-marital changes, transitions, have to adjust to changes
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Health concerns middle adult
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stress and stress reduction, levels of wellness, obesity, positive health habits, anxiety, depression, aging not a disease, abnormals are still abnormal regardless of age,
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Variability among older adults
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physiological, cognitive, and psychosocial health, levels of functional ability, dependence vs independence, strengths and abilities
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Geriatrics
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focus on the diagnosis and treatment of diseases
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gerontology
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study of all aspects of the aging process and its consequences
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gerontological nursing
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most common nursing term for care of the older adult, includes complete nursing process
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Gerontic nursing
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emphasize the art of nursing, nurturing, caring, and comforting more than treatment of disease
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Biological theories of aging
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stochastic-aging is due to random cellular damage as it accumulates it results in the changes that we see. Non-stochastic-aging is a controlled process
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Psychosocial theories of aging
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disengagement -withdraw from roles and become introspective
Activity-continuing active as a necessary part of successful aging Continuity-personality remains the same and behavior again become more predictable |
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Assessing needs of older adults
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relationship between physical and psychosocial aspect of aging, effect of disease and disability on functional status, decreased efficiency of homeostatic mechanisms, lack of standards for defining health/illness norms, altered presentation and response to disease, need to know what are the normal age-related changes expected
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Functional changes of older adults
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usually linked to illness or disease and degree of chronicity, performance of ADL sensitive indicator of health or illness
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Cognitive changes-older adults
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delirium-acute confusional state, usually reversible
dementia-generalized impairment of intellectual function, gradual and may be permanent Depression-mood disturbance characterized by feeling of sadness or despair |
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Health concerns for older adults
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3 common causes of death: heart disease, cancer, cerebrovascular disease(strokes), lung disease, accidents, diabetes, kidney and liver disease. Every one has preventive measures
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Acute Care setting risks for older adults
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delirium, dehydration, malnutrition, health care-acquired infections, urinary incontinence, falls
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