NR 222 Health and Wellness test 1

UNIT 1 Health Defined Models of health  Wellness- illness continuum o Health as dichotomy o High-level wellness  Sense of well being, life satisfaction, and quality of life o Negative end  Adaptation to disease/ disability Social determinant of health  Factors in a society that have an influence on health and the options available to people to improve or maintain their health Models of Health  Clinical o Health is defined as Absence of signs or symptoms of disease or illness ; prevention not emphasized  Role performance o Health based on whether person can perform societal roles  Adaptive o Abilities to adapt positively to social, mental, and physiological change  Eudaimonistic model o Exuberant well-being: interaction and inter relationships in multiple aspects of life *compare and contrast different type of models High-level wellness  Wellness is positive state with increases in health beyond midpoint of continuum  Dunn (1961) expanded concept of health to include favorability of environment  Progressions toward a higher level of functioning  Emphasizes interrelationship between environment and health on personal and societal level Eudaimonistic model  Aspects predate clinical model  Congruent with integrative modes of therapy  Address more comprehensive health needs  Compatible with complementary and alternative medicine (CAM)  Health is more broadly defined and can encompass more individuals and more diverse life circumstances Key Health Concepts  Functioning- levels reflected in terms of performance/ social expectations; loss indicator of need for nursing intervention  Health- state of physical, mental, spiritual and social functioning within developmental context, both individual and societal responsibility  Disease- failure of adaptive mechanisms, results in functional or structural disturbances  Illness- subjective experience of individual and physical manifestation of diseasepsychological, spiritual and social components What is nursing?  Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; treating medical response to treatment and diagnosis; advocacy in the care of individuals Nursing interventions  Care for patients and follow the nursing process  Any task that a nurse does to or for a patient  Making a plan and setting goals for the patient  Nursing process- the essential core of practice for the registered nurse to deliver holistic, patient- focused care Planning for health  Previous focus was just on disease prevention  We need to promote health  healthy people iniative started in 1979 by US department of Health, Education, and welfare  call to action to set goals for every 10 years  interest waned during the 1980s  healthy people 2020- renewed interest- became landmark document (initiated 1990) Health model- Potter and Perry Healthy People Iniative  healthy people 2000 o goal- increase span of healthy life, reduce health disparities, create access to preventive services for all o set 22 areas of achievement but by 1995, 30% of goals lacked progress  healthy people 2010  healthy people 2020 o health promotion and disease prevention efforts Definition of health and health promotion  health- a state of complete physical, mental, and social well being. Not merely the absence of disease or infirmity; a state of physical and mental being that people define in relation to the their own values, personality, and lifestyle  health promotion- the science and art of helping people change their lifestyle to move toward a state of optimal health; the process of advocating health to enhance the probability that the person support positive health practices will become a societal norm Levels of Prevention  primary o health promotion and specific protection  secondary o early diagnosis o prompt treatment o disability limitation o ex. Screening to treating early stages of disease to limiting disability by averting or delaying the consequences of advanced disease  tertiary o restoration and rehabilitation *diagram page 10- 3 levels of prevention Health Promotion model  incorporates o stages of change o decisional balance o self-efficacy o processes of change o six stages of change:  precontemplative- not considering change  contemplative- aware but not considering change soon  preparation- planning to change  action- has begun to make behavioral change  maintenance- continued commitment to behavior  relapse- reverted to old behavior The nurses role  shifting from acute, hospital based care to preventative community based care  must assume blended roles with a knowledge base using evidence- based practice  greater emphasis on promoting and maximizing health Evidence based practice  using research findings to make decisions  conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals  integrating individual clinical experience in practice  quantitative, qualitivative research, and applied research Improving prospects for health  population effects o increase diversity o changes in age distribution  shifting problems o environment o stress o lifestyle o increase in chronic conditions  moving toward solutions o individual involvement o government involvement Health policy Historical role of women  Florence nightingale- crusaded for nutritious food, cleanliness, and sanitation for soldiers  Lillian wald- founded NYC visiting nurses association to provide health services for indigents in tenements  Through the decades, nurses developed unique roles as agents for health Historical industrial influences  Adequate food supply prolonged life span  Industrial advances prevented diseases o Toilet, sewer systems o Decrease in typhoid, paratyphoid, gastroenteritis Historical scientific influences  Prior to 20th century, infectious disease was major cause of death Historical socioeconomic influences  Elizabethan poor laws  New law 1834  Protestant work ethic Public Health influences  Edwin chadwick- father of public health Political and economic influences  Roosevelt’s new deal had a effect on health car o Passage of social security act in 1935 o This then developed into Medicaid and medicare Preventative vs Curative Medicine Nursing in the 21st century  Societal needs  Aging population  Emerging infections  Disaster management  Advnaves in technology  Higher acuity of hospitalized clients  Earlier discharges  Nursing shortage  Affordable care act  Increased incidence of chronic and long term diseases The patient protection and affordable care act  New health care federal reform law signed in 2010  Largest change in financing since medicare and Medicaid (1965)  Focus on vulnerable populations  Designed to reduce the number of uninsured persons via expanding Medicaid and establish subsidies  US supreme Court upheld the ACA in June 2012  Likely will change secondary to trump presidency Measuring the Nation’s Health  Informs [policymakers of trends in nations health  Healthy People 2020 o Goal to increase quality and years of healthy life, and eliminate health disparities  CIA statistics  Morbidity data  Compares United States with other countries US health trends  Successes in infections  Obesity  Chronic illnesses  Health disparities persistent  Vulnerable populations  Rise in suicides Healthcare Legislations and Agencies Global Health  World Health Organization (WHO) o All people to attain highest possible health o Budget issues limit achievement of goals Financing health care  Costs  Sources Mechanisms for Financing  Salaried providers  Hourly compensation  Capitation- flat fee regardless of services used Organization of Delivery System  Public and private components  Public sector- nonprofit agencies, govt agencies, organized at local, state, and national levels  Private sector – for profit services, physician practices, primary healthcare networks  PPOs- “brokers” between insurers and health care providers  HMOs- independent repayment plans  POS plans- combine features of HMOs with person choice characteristics of PPOs Public sector- current/ future policy Official health care agencies  Local  State  Federal Cost Containment Managed Care  An experienced health care professional helps determine the nursing care that is necessary, monitors that care, and arranges for individuals to receive care in the most cost-effective and most appropriate setting Medicaid  Low income individuals  State-determined eligibility Medicare  People over 65  Disabled  Hospice  Part A- financed largely through a mandatory tax of 2,9% of earnings paid by employees and their employers  Part B- supplementary voluntary medical insurance financed through a combination of general tax revenues  Part D- voluntary, subsidized outpatient prescription drug benefit with additional subsidies available for low income beneficiaries The uninsured  Groups most at risk o Persons of Mexican origin o Young adults o Working uninsured o Illegal aliens HIPAA- Health insurance portability and accountability act Unauthorized immigrants  Fear to seek medical help because of legal action  Not eligible for medicare or Medicaid Nurses role in health policy  Advocate  Participating in policy decision- making Notes 7/11 Unit 2 Health Promotion and the Individual screening health evaluation The nursing process (ADPIE)  Assess  Diagnosis  Outcome criteria  Planning/ interventions  Implementation  Evaluation Maslow’s Hierarchy of Basic Needs 11 Functional Areas Gordon’s framework 11 Function Health Patterns  Health perception/health management  Nutritional- metabolic  Elimination  Activity- exercise  Sleep-rest  Cognitive- perceptual  Self- perception  Roles- relationships  Sexual- reproductive  Coping (stress tolerance)  Values- beliefs Health perception- an individuals perceived health and well being Health management pattern- affect lifestyle and ability to function. Provides clues to improve or maintain optimal quality of life Stages of Change Types of data  Subjective data- what the patient tells you  Objective data- what the nurse measures NANDA- nursing diagnosis  North American Nursing Diagnosis Association  Founded in 1982 for the purpose of standardizing the nursing technology Screening  The secondary prevention (primary objective)  Detection of disease in early stages  Treat disease and prevent progression  Reduce cost of disease management Advantages of screening  Simple screening tests are cost effective  Community screening fairs  Some screenings are mandated by law  Screening process can be applied to both individuals and larger populations Disadvantages of screening  Possibility of errors  False positive- anxiety, unnecessary interventions  False negative- disease is overlooked, missed opportunity for early interventio