Exam (elaborations) Nr 222 HW_exam_1_review_Group

Group doc started 11/9/17 NR 222 Exam 1 Review Know the definition of health promotion Definitions vary O’Donnell Definition: “the science and art of helping people change their lifestyle to move toward a state of optimal health” Kreuter & Devore Definition: “the process of advocating health in order to enhance the probability that personal (individual, family, community), private (professional & business), and public (federal, state, local govt.) support of positive health practices will become a societal norm” Know the WHO definition of health and what WHO is Defined as “the state of complete, physical, mental, and social well-being; not merely the absence of disease or infirmity” WHO is an agency of the United Nations that is concerned with international public health Know differences of wellness education vs. health promotion Closely related, overlap to some extent Wellness education: teaches people how to care for themselves in a healthy way; includes topics such as ◆ Physical awareness ◆ Stress management ◆ Self-responsibility Health promotion: promotes activities like routine exercise, good nutrition to help patients maintain/enhance their present levels of health Know the levels of prevention Primary Prevention ◆ True prevention ◆ Precedes disease ◆ Applied to patients considered physically, emotionally healthy ◆ Includes health education programs, immunizations, nutritional programs, physical fitness activities Secondary Prevention ◆ Focuses on individuals who are experiencing health problems/illness and are at risk ◆ Activities directed at diagnosis and prompt intervention ◆ Mostly delivered in homes, hospitals, nursing facilities ◆ Includes screening techniques, treating early stages of disease Tertiary Prevention ◆ Occurs when defect/disability is permanent and irreversible ◆ Involves minimizing effects of long-term disease/disability by interventions directed at prevention complications/deteriorations ◆ Activities directed at rehabilitation Know what Healthy People 2020 is, its major goals, and the nurse’s role in achievement of these goals Healthy People 2020 serves as road-map for improving the health of all people in the US Promotes a society in which all people live long, healthy lives 4 Goals: ◆ Attain high-quality, longer lives free of preventable disease ◆ Achieve health equity, eliminate disparities, improve health of all groups ◆ Create social and physical environments that promote good health for all ◆ Promote quality of life (QoL), healthy development, healthy behaviors across all life stages Nurse’s Roles: ◆ Advocate ● Helps individuals obtain what they’re entitled to receive through the healthcare system ● Try to make system more responsive to individual/community needs ● Help person advocate for themselves ◆ Care manager ● Prevent duplication of services ● Maintain quality and safety ● Reduce costs ◆ Consultant ● May provide knowledge about health promotion and disease prevention ● Some have specialized areas of advanced practice/expertise (gerontology, women’s health, community/public health) ◆ Deliverer of services ● Core role is delivery of direct services ● ex.) health education, flu shots, counseling in health promotion ◆ Educator ● Individuals are unique in their response to efforts to changing behavior ● Teaching may range from chance remark by nurse or structurally planned teaching according to individual needs ● Health promotion/protection heavily rely on individual’s ability to use appropriate knowledge ◆ Healer ● Requires nurse to help individuals integrate and balance the various parts of patient’s life ● Mindful blending of science and subjectivity Know the cost of financing health care and its sources of funding Hospital spending accounts for 31% of national health expenditure ◆ Is expected to continue growing 6.3% per year (as of 2010) Many other countries spend far less per capita, but life expectancy is greater & infant mortality rates are lower US spends more than any other country in healthcare dollars per person Factors driving costs: ◆ General inflation ◆ Healthcare cost inflation ◆ Application of new/more advanced technologies ◆ Growth in proportion of older adults ◆ Government financing of healthcare services ◆ Growth of prescription drug usage/costs ◆ Maldistribution of healthcare providers/services ◆ Expansion of medical technology & specialty medicine ◆ Growing number of uninsured/underinsured people Sources of Funding: ◆ American people pay for all healthcare costs ◆ Money is transferred from consumer → provider by different mechanisms ◆ Major sources: ● Government (federal, state, local monies collected by taxes) ● Third party payment (private insurance) ● Independent plans ● Out of pocket support (totaled $2.6 billion in 2010) ◆ Largest % of nation’s healthcare $$$ came from private health insurances (33%) ◆ 12% were out of pocket payments ◆ Cost of Medicare accounted for 20% of the healthcare $$$ ● Medicaid and SCHIP counted for 15% ◆ 31% of healthcare $$$ spent on hospital care ◆ 20% on physicians and clinics ◆ 10% on prescription drugs ◆ 6% on nursing home facilities ◆ 7% on dental care and administrative costs ◆ 14% on non-acute care Know what Medicare and Medicaid are Medicaid ◆ Essential health insurance program available for certain low-income individuals/families who fit into an eligible group ◆ Is an assistance program (referred to as welfare) ◆ Managed jointly by federal and state govt. ◆ Provides partial or full payment of medical costs for people/families of any age who are too poor to pay for the care ◆ Provides coverage for: ● 29 mil. children ● 15 mil. adults in low-income families ● 15 mil. elderly & persons with disabilities ● More than 1 mil. Medicaid recipients live in skilled nursing facilities ◆ Medicaid pays Medicare premiums, deductibles, and coinsurance for certain low-income Medicare recipients Medicare ◆ Federal health insurance program ◆ Finances care for: ● People older than 65 ● Disabled people who are entitled to social security benefits ● People with end-stage renal disease that require dialysis/kidney transplant ◆ Original intent was to protect older adults against financial debt often incurred in managing chronic illness ◆ 4 Parts of Medicare: ● Part A ○ Financed largely through mandatory tax of 2.9% earnings paid by employees/their employers into Hospital Insurance Trust Fund ○ Covers inpatient care in hospitals, skilled nursing facilities (not custodial or long-term care), home health services, hospice care ○ For individuals who have contributed to/have had a spouse contribute for 10 years of Medicare-covered employment, there’s no monthly premium ● Part B ○ Supplementary voluntary medical insurance ○ Financed through combination of general tax revenue + beneficiary paid premiums ○ Covers physician visits, outpatient services, preventive services, home health visits ● Part C ○ Refers to Medicare Advantage program ○ 25% of beneficiaries (12 mil. older adults) are enrolled in these private plans ○ Account for 21% of benefit spending ● Part D ○ Voluntary, subsidized outpatient prescription drug benefit ○ Additional subsidies are available for low-income beneficiaries ○ Offered through private plans that contract w/ Medicare ○ Has Medicare Advantage prescription plans and stand-alone ones ○ Accounts for 12% of benefit spending (more than 29 mil. people are enrolled in this program) ○ Part D prescription drug coverage gap is known as the donut hole Know the models of health & illness, health beliefs, and variables/risk factors that influence health beliefs and practices Clinical Model ◆ Health is defined by the absence and illness by the conspicuous presence of signs/symptoms of disease ◆ People who use this model may not seek preventive health services or wait until they’re very ill ◆ Conventional model of the discipline of medicine Role Performance Model ◆ Defines health in terms of people’s ability to perform social roles ◆ Role performance includes work, family, social roles ◆ Performance based on societal expectations ◆ Illness would be the failure to perform roles @ the level of others in society ◆ Basis for occupational health evaluations, school physicals, physician-excused absences Adaptive Model ◆ People’s ability to adjust positively to social, mental, physiological change is measure of their health ◆ Illness occurs when person fails to adapt/becomes maladaptive to these changes Eudaimonistic Model ◆ Emphasizes interactions between physical, social, psychological, spiritual aspects of life and environment ◆ Illness is reflected by lack of involvement with life ◆ Aspects of this model predate clinical model of health Health Belief Model ◆ Addresses relationship b/t person’s beliefs + behaviors ◆ First component involves individuals perception of susceptibility to illness ◆ Second component is individual’s perception of the severity of the illness Is influenced + modified by demographic and sociopsychological variables, perceived threats of illness, cues to action ◆ Third component is the likelihood that person will take preventive action Results from person’s perception of benefits + barriers to taking action Can include lifestyle changes, increased adherence to medical therapies, search for medical advice/treatment Health Promotion Model ◆ Complementary counterpart to models of health protection ◆ Health is defined as positive, dynamic state ◆ Directed at increasing patient’s lvl. of well being ◆ Focuses on the following 3 areas: 1) individual characteristics and experiences 2) behavior specific knowledge and affect 3) behavioral outcomes in which patient commits to/changes a behavior Maslow’s Hierarchy of Needs ◆ Certain human needs are more basic than others ◆ Self-actualization is highest expression of one’s individual potential ● Allows for continual self-discovery ● Fulfill bottom needs before fulfilling top needs (in most circumstances) Holistic Health Models ◆ Attempts to create conditions that promote a patient’s optimal level of health ◆ Emphasis on the idea that patient is the ultimate expert concerning their own health self-actualization self-esteem Love and belonging needs Physical safety Psychological Safety Oxygen Fluids Sex Shelter Elimination Body Temp. Nutr. ◆ Respects patient’s subjective experience as relevant in maintaining health/assisting in healing ◆ Nurses using HHM should recognize natural healing abilities of the body ● Incorporate complementary/alternative interventions ○ Meditation ○ Music therapy ○ Reminiscence ○ Relaxation therapy ○ Therapeutic touch ○ Guided imagery ◆ Can use alone or in conjunction with conventional medicine Internal Variables ◆ Developmental stage ◆ Intellectual background ◆ Perception of functioning ◆ Emotional/spiritual factors External Variables ◆ Family practices ◆ Psychosocial/Economic factors ◆ Cultural background Risk Factors ◆ Any situation/habit, or other variable that increases individual’s/group’s vulnerability to illness or accident ◆ Categories: ● Genetic/physiological ● Age ● Physical environment ● Lifestyle Know the definitions of illness, disease, and wellness Illness ◆ State in which person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished/impaired ◆ Illness is NOT synonymous with disease ◆ Can be composed of the subjective experience of the individual & physical manifestation of disease ◆ ex.) someone feels ill because of stress, but doesn’t have an actual disease Disease ◆ May be defined as the failure of a person’s adaptive mechanisms to counteract stimuli/stresses adequately ◆ Results in functional or structural disturbances ◆ Definition is an ecological concept; uses multiple factors to determine cause of disease rather than a single one Wellness ◆ Positive state in which incremental increases in health can be made beyond the midpoint ◆ Increases involve improved physical + mental health states ◆ Wellness-Illness Continuum: ● Dichotomous depiction of relationship b/t concepts of health and illness Know who the nursing leaders of the 19th century were Clara Barton ◆ Founder of American Red Cross ◆ Tended to soldiers on the battlefields during the Civil War, cleansed their wounds, met their basic needs, comforted them in death Mother Bickerdyke ◆ Organized ambulance services ◆ Walked around abandoned battlefields at night to look for wounded soldiers Harriet Tubman ◆ Spearheaded Underground Railroad movement ◆ Led over 300 slaves to freedom Mary Mahoney ◆ First professionally trained Black-American nurse ◆ Concerned with how culture affected healthcare ◆ Brought forth awareness of cultural diversity and respect for individual, regardless of background, race, color, religion Lillian Wald & Mary Brewster ◆ Helped significantly increase nursing in the community ◆ Opened Henry Street Settlement in 1893 ● Focused on health needs of poor people/tenants in NYC Florence Nightingale ◆ First practicing nurse epidemiologist ◆ Developed first organized program for training nurses (Nightingale Training School for Nurses) in London ◆ Tasked with organizing and improving quality of sanitation facilities during Crimean War (1853) ◆ Role of nursing defined as “having charge of somebody’s health” based on the knowledge of “how to put the body in such a state to be free of disease or how to recover from disease” Know which organizations establish nursing guidelines American Nursing Association (ANA) establishes standards of practice, performance, and code of ethics for nurses ◆ Include many types of certifications to enhance careers ◆ ex.) med-surg certification, geriatric nursing certification ◆ ANA is most broad State/provincial Nurse Practice Acts (NPAs) establish specific legal regulations for practice ◆ Regulate scope of nursing practice, protect public health, safety, welfare ◆ Shields public from unqualified/unsafe nurses ◆ Most states have similar NPAs ◆ NPAs are more specific Professional organizations establish standards of practice as criteria for nursing care ◆ Variety of specialty organizations exist ◆ Some specify in certain areas: critical care, advanced practice, maternal-child nursing, nursing research ◆ ex.) National Student Nurses Association (NSNA) cooperates in programs with professional orgs. ◆ Pro-orgs are the most specific Know what the Nursing Process is Also known as the ANA Standards of Nursing Practice Assessment ◆ Nurse collects comprehensive data pertinent to patient’s health and/or situation Diagnosis ◆ Nurse analyzes assessment data to determine diagnosis or issues Identification (Outcomes) ◆ Nurse identifies expected outcomes for a plan individualized to the patient/situation Planning ◆ Nurse develops plan that prescribes strategies and alternatives to attain expected outcomes Implementation ◆ Nurse implements identified plan ● a) Coordination of care: nurse coordinates care delivery ● b) Consultation: graduate lvl-prepared specialty nurse/advanced practice registered nurse provides consultation to influence identified plan, enhance others’ abilities, and effect change ● c) Prescriptive Authority and Treatment: advanced practice RN uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance w/ state and federal laws and regulations Evaluation ◆ Nurse evaluates progress towards attainment of outcomes Remember AD(I)PIE ◆ Assessment, Diagnosis, (Identification), Planning, Implementation, Evaluation Know what the different nurse’s roles are Autonomy and Accountability ◆ Nurse needs to develop commitment to personal professional accountability ◆ Involves the initiation of independent nursing interventions w/o medical orders ◆ Nurse is responsible professionally and legally for the type and quality of care provided Caregiver ◆ Help patients maintain and regain health, manage disease and symptoms, attain a maximal level of function/independence through the healing process ◆ Nurse provides healing through psychomotor and interpersonal skills Advocate ◆ Nurse must protect patient’s human and legal rights ◆ Provide assistance in asserting these rights of the need arises Educator ◆ Explain concepts and facts about health, describe reason for routine care activities, demonstrate procedures (self-care activities), reinforce learning, evaluate learning progress ◆ Some patient teaching is unplanned and informal Communicator ◆ Allows nurse to know their patients; including their strengths, weaknesses, and needs ◆ Essential for all nursing roles and activities Manager ◆ Establish environment for collaborative patient-centered care ◆ Provides safe, quality care with positive patient outcomes Advanced Practice RNs (APRN) ◆ Most independently functioning nurse ◆ Has advanced education in pathophysiology, pharmacology, physical assessment, certification/expertise in a specialized area of practice ◆ 4 Core Roles: ● Clinical nurse specialist (CNS) ○ Expert clinician in specialized area of practice ○ Specialty may be ID’d by population, setting, disease speciality, type of care, type of problem ● Certified nurse practitioner (CNP) ○ Provides healthcare to a group of patients (usually outpatient, ambulatory, or community-based setting) ○ Provide care for patients with complex problems, more holistic approach than physicians ● Certified nurse midwife (CNM) ○ Certified by American College of Nurse-Midwives ○ Provides independent care for women during normal pregnancy, labor, delivery, and care for newborn ○ Includes some gynecological services (pap smears, family planning, minor vaginal infection treatment) ● Certified RN anesthetist (CRNA) ○ Has advanced education from nurse anesthesia-accredited program ○ Must have at least 1 year of critical care/emergency experience prior to applying