Exam 4: NSG 3009/ NSG3009 (2026/2027 Updated Edition) Principles of Assessment | Verified Q&A | 100% Accurate Solutions | – South University

1 Exam 4: NSG 3009/ NSG3009 (2026/2027 Updated Edition) Principles of Assessment | Verified Q&A | 100% Accurate Solutions | – South University Q. What is self concept ANSWER A person's view of themselves Q. Components of self concept ANSWER identity, body image, role performance, self-esteem Q. What are identity stressors ANSWER occurs during developmental changes or role transitions Q. What are types of body image stressors ANSWER involve changes in appearance or function Q. What are role performance stressors ANSWER conflict between role expectations (Job loss, illness, caregiver strain) Q. What are self-esteem stressors ANSWER failure in personal or professional life 2 Q. What is self esteem? ANSWER how one feels about themself (overall sense of self-worth or value) Q. What is the family influence on self-concept ANSWER helping to form, higher support = higher self-esteem, positive communication fosters well-being Q. Remaining aware of personal biases or attitudes, approach with genuine acceptance and empathy, promote trust and open communication, nonverbal behaviors ANSWER The nurse's role in self-concept Q. Which D condition course fluctuates and is usually worse at night? ANSWER Delerium Q. What is the difference between Delirium and dementia ANSWER Delirium lasts hours to weeks while dementia is months to years Q. Which 2 D conditions are usually reversible ANSWER Delirium or Depression Q. Identity, orientation, behavior and intimacy, intergral to physical, emotional, social, and spiritual health, involve developmental stages and life experiences ANSWER Sexuality 3 Q. What stage does gender identity develop where a person is curious about their body? ANSWER Infancy/early childhood Q. In what stage does a person have a strong identification with same-gender parent and gain awareness of norms ANSWER school age Q. In what stage does puberty and explanation of sexual identity and orientation take place? ANSWER adolescence Q. In what stage of life do intimate relationships, decision making around conception, and STIs occur in? ANSWER Young Adulthood Q. In what stage do hormonal changes, concerns about attractiveness, menopause and erectile dysfunction take place? ANSWER Middle Adulthood Q. In what stage does sexual activity potentially decline despite interest remaining, while inamacy is valued ANSWER older adulthood Q. What is sexual identity defined as ANSWER How one perceives themself 4 Q. What is gender identity ANSWER inner sense of being male, female, both, or neither Q. What is sexual orientation ANSWER attraction to same, opposite, or multiple genders Q. Reproductive health concerns, body image changes, LGBTQ+ stigma or discrimination, sexual dysfunction, STIs, sexual assault or abuse ANSWER sexuality stressors Q. What is a nursing consideration for infertility? ANSWER emotional distress of the patient Q. Which of the following statements accurately depicts the nurse's role regarding abuse ANSWER Nurses are mandatory reporters and must report suspected child and elder abuse to proper authorities Q. What is the most critical development period affecting self-concept and self-esteem ANSWER adolescents and teenagers Q. Learned and shared beliefs, values, norms, and traditions of a particular group which guides our thinking, decisions, and actions ANSWER culture 5 Q. Bias we are unaware of and that happens outside of our control which is influenced by our own personal background, cultural enviornment, and personal expiriences ANSWER unconscious bias Q. The need to provide care based on an individuals cultural beliefs, practices, and values ANSWER culturally congruent care Q. Culturally sensitive, appropriate, and competent care to meet the multifaceted health care needs of each person, family, and community ANSWER cultural competence Q. A set of assumptions that are developed in childhood and guides how we think, see, and interact with others - how we interpret the world - evolves over the lifetime through different expiriences ANSWER world view Q. An assumed belief about a specific group of people ANSWER stereotyping Q. Health disparities are exacerbated by ANSWER bias, stereotyping, prejudice Q. Social, economic, and or environmental disadvantages ANSWER health disparities 6 Q. Age, access to healthcare, access to nutritious foods, education ANSWER social determinants of health Q. The process by which an individual or group transitions from one culture and develops traits of another culture, adaptation ANSWER acculturation Q. The process by which an individual adapts to the host cultural values and no longer prefers the traits of their original culture ANSWER assimilation Q. Disease ANSWER the malfunctioning of biological or physiological processess Q. Ilness ANSWER the way in which individual and families react to disease Q. What are the different aspects of the Camphinha-Bacote model of cultural competence ANSWER cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire Q. A self-examination of one's own biases toward other cultures and an indepth exploration of one's own cultural and professional background ANSWER cultural awareness 7 What is the L in the LEARN model Listening What is the E in the LEARN model? Explaining What is the A in the learn model Acknowledging What is the R in the LEARN model? Recommending What is the N in negotiating negotiating True or False Nurses are legally responsible for providing education to all clients True What are the domains of learning cognitive, affective, psycomotor A client who has been newly diagnosed with diabetes needs to learn how to use a glucometer. Use of a glucometer constitutes psychomotor learning During a teaching session, the client with a recent neck injury that damages the nerve is comparable to a water hose that has pinched off. During this teaching session, the nurse is using analogy What is the difference between spirituality and religion? Spirituality is connectedness to a higher being or nature, religion is state of doing or practices When caring for patients the nurse must understand the difference between religion and spirituality. Religious care helps individuals maintain beliefs and worship practices To assess, evaluate, and support a client's spirituality, the best action a nurse can take is to Determine the client's perspective and belief system 8 A loss that can be recognized with others (Death, amputation, loss of job, loss of function) Actual loss A normal part of life, often predictable, often associated with growth (Child leaving home, age related changes) Necessary loss Occurs as a person moves through life transitions (A child going away to college, retirement) maturational loss A sudden unpredictable external event (drama, job loss, severe illness) Situational loss Defined by the person experiencing it, may not be obvious to others (Loss of independence, security, or confidence) Perceived loss Common reactions (sadness, anger, guilt, sleep changes, physical symptoms) moves towards acceptance over time Normal (uncomplicated) grief Occurs before the actual loss, common with terminal disease or progressive illness anticipatory grief loss that is not acknowledged or supported (miscarriages, ex-partner deaths, stigma related losses) disenfranchised grief loss without closure (missing person, demenia) ambiguous griefs grief that is prolonged, intense, or interferes with functioning complicated grief The stages of grief/dying Kubler Ross model denial, anger, bargaining, depression, acceptance What is the attachment theory by Bowlby grief intensifies when attachments are strong Grief Task Model (Worden) 9 accept the reality of the loss, work through the pain, and adjust to a world without the loved one, finding an enduring connection Rando's R Process Model Recognizing the loss, reacting to the separation, recollecting, relinquishing old attachments, readjustments, reinvesting in life human development, personal relationship, nature of the loss, coping strategies, socioeconomic status, culture factors influencing loss and grief You are caring for an adolescent patient who underwent a gastric banding procudure 6 months ago. She tells you, "There is still a fat person inside of me". This type of statement illustrates which type of stressor? Body image stressor You are assigned to care for a patient who retired months ago. While providing care, you identify that this patient is struggling emotionally with change. This situation is most likely associated with which self-concept component? Role performance stressor Two 50-year-old men are discussing their saturday activities. The first man described how he tutors children as a volunteer at a community center. The other man says that he would never work with children and that he prefers to work out at a gym to meet young women to date. Which developmental stage is the second man exhibiting? Self-absorption Which of the following populations have the highest incidence of STI? Select all that apply Hispanic women ages 15-24, African American men ages 15-24 A nurse in an outpatient setting is performing an admission assessment on a 77-year-old woman who was suddenly widowed 3 weeks ago. During the health history the patient tells the nurse that at times she "feels lost and isolated" and says she "does not feel like participating in previous social or hobby activities." She says she "just doesn't feel like her usual self." The nurse needs to understand that which of the following most directly influences the patient's current self-concept? adjustment to role change, loss of loved ones, and physical energy A 16 year old female tells the school nurse that she doesn't need the HPV vaccine since her partner always uses condoms. What is the nurse's best response The HPV vaccine is recommended even if you use condoms because it targets the specific virus that causes cancer and genital warts A nurse is completing a health history with the daughter of a newly admitted patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer disease 1 year ago but became 10 extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a stranger. On the basis of this history, the nurse suspects that the patient is experiencing: Delirium Your patient has a sudden onset of confusion with altered incoherent speech. The nurse notices cloudy urine and the patient has a fever. What issue is most likely in this case? Delirium related to UTI A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: Depression Upon admission what should the nurse do when gathering a patient's sexual history include questions related to sexual function You are assigned to care for a patient who has just undergone a mastectomy for a malignant tumor. How would you most appropriately classify this self-concept stressor? Body image stressor What is one of the most common sexual problems affecting women of all ages? Hypoactive sexual desire dysfunction A patient with newly diagnosed diabetes needs to learn how to use a glucometer. Use of a glucometer constitutes learning in which domain? psychomotor You conduct an assessment of your patient, who is a 65-year-old male with hypertension. Which risk factors will you address with the patient that could affect hypertension patient's activity level and high sodium diet You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes which of the following? Biocultural history A patient is admitted to a rehab facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech therapy. Which level of preventative care is the patient receiving? Tertiary prevention 11 A 26-year-old patient visits a medical clinic and asks a nurse to provide instruction on how to perform a breast self-examination. "My mom had cancer so I want to learn how." Which domains are required to learn this skill? Select all that apply. cognitive and psychomotor A nurse is teaching a culturally diverse patient with a learning disability about nutritional needs. What must the nurse do first before starting the teaching session? during a teaching session, the nurse tells a patient with a recent neck injury that damage to the nerves is comparable to a water hose that has been pinched off. During this teaching session, the nurse is using what teaching process? analogy Which area should the nurse assess to determine the effects of external variables on a patient's illness? patient's socioeconomic status A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? role-playing Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. What can exacerbate these disparities? all of the above 3 multiple choice options A nurse is using Maslow's hierarchy to prioritize care for an anxious patient that is not eating and will not see family members. Which area should the nurse address first not eating A nurse is teaching a patient with a risk for hypertension how to take a blood pressure. Which action by the nurse is the priority? focus on a patient's learning needs and objectives L.D. is a 55-year-old Bosnian immigrant. She is overweight and is concerned about her health. She has come for her yearly physical. Ashley is a 23-year-old nursing student assigned to care for L.D.. During their first visit, the patient states, "I am interested in getting some information to help me become healthier and lose some weight." The patient is likely in which stage of health behavior change? contemplation What term is used to describe a counseling and educational technique that focuses on a patient's perceived goals and helps people resolve insecurities and ambivalent feelings to find the internal motivation needed to 12 change their behavior motivational interviewing Over the last couple of weeks, a nurse on your unit has been chronically absent and performing poorly. The nurse does not seem to display empathy for patients and makes poor judgments. Based on these symptoms, what is the nurse most likely experiencing compassion fatigue A nurse is preparing to teach a kinesthetic learner about exercise. Which technique will the nurse use? Let the patient touch and use the exercise equipment Which client would be considered to belong to a marginalized group A black man with a high school degree Upon completing a past medical history, the nurse finds that a client has risk factors for lung disease. How should the nurse interpret this finding The chances of getting the disease are increased A nurse is assessing internal variables that are affecting the patient's health status. Which area should the nurse assess perception of functioning A nurse who works in an outpatient chemotherapy infusion center is assigned to the care of a 56-year-old male patient who is receiving chemotherapy for colon cancer. This is the patient's first clinic visit. The nurse reviews the patient's medical record and sees a note about the patient receiving instruction on how chemotherapy treats cancer; the note does not summarize the patient's response. The nurse's assessment reveals that the patient is motivated to learn more about his chemotherapy and is alert and currently feeling well. The nurse has prepared the first infusion, regulated it, and now takes time to begin instruction. Which teaching approaches are best suited for this situation? Provide verbal one-on-one instruction, with the patient participating in selection of content. A nurse is following the goals of the Healthy People Initiative to provide care. Which action should the nurse take? Create social and physical environments that promote good health. A patient suddenly experienced a severe headache with numbness and decreased movement in the left arm. An emergency brain scan confirmed a cerebral vessel clot. With a stroke confirmed, the emergency room physician consults with a neurosurgeon to schedule an emergent angiogram to remove the clot. Which teaching approach is most appropriate for explaining to the patient what to expect from the procedure? telling approach You are caring for a patient who is depressed because the only child has gone away to college. What type of 13 depression is the patient experiencing? maturational loss As a first-year nursing student, you are assigned to care for a dying patient. To best prepare you for this assignment, what will you want to do develop a personal understanding of your own feelings about grief and death A nurse is caring for a patient who has just had a near-death experience following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE? allowing the patient to discuss the expirience A patient diagnosed with terminal cancer asks the nurse what the criteria are for hospice care. Which information should the nurse share with the patient? It is for those expected to live less than 6 months What is the best action a nurse can take to assess, evaluate, and support a patient's spirituality determine the patient's perceptions and belief system Your patient is having a significantly difficult time moving forward after the unexpected loss of her partner. After a year, she is still having trouble accepting the death and tells you she feels "emotionally numb." Which type of grief is this patient likely experiencing? complicated grief The nurse is planning spiritual care interventions for an 8-year-old patient. Based on the patient's age, the nurse must consider which growth and development factor when planning the spiritual care? This age-group has a clear concept of a higher spiritual being and is interested in learning about spirituality. When caring for patients, the nurse must understand the difference between religion and spirituality. The nurse providing religious care is helping patients do what? maintain their belief systems and worship practices A patient has just learned she has been diagnosed with a malignant brain tumor. She is alone; her family will not be arriving from out of town for an hour. The nurse has been caring for her for only 2 hours but has a good relationship with her. What is the most appropriate intervention for support of her spiritual well-being at this time? Sit down and talk with the patient; have her discuss her feelings and listen attentively what is one of the most important influences on a child's development parents a child's positive self esteem and school achievements are fostered by parents who respond in a firm, consistent and warm manner 14 a child's negative self esteem is fostered by parents who respond in a harsh, inconsistent, and low-self esteem parents self concept how an individual THINKS of themself; subjective involving a mix of thoughts, attitudes, and perceptions -directly affects self-esteem self esteem how an individual FEELS about themselves; overall feeling of self worth; represents overall judgement of personal worth development of self concept is a life long process self concept is based on -sense of competency -perceived reactions of others to one's body -ongoing perceptions and interpretations of the thoughts and feelings of others -personal/professional relationships -academic/ employment related identity -personality characteristics that affect self-expectations -perceptions of events that have impact on self -mastery of prior/new experiences -cultural identity factors influencing self concept -real/perceived change that threatens ID, body image, or role performance -changes that occur in physical, spiritual, emotional, sexual, familial, and sociocultural health -other crises Erikson's Psychosocial Theory each stage builds on tasks of the previous stage, successful mastery leads to sense of self Infancy (Erikson stage) trust vs mistrust early childhood (Erikson stage) autonomy vs shame and doubt preschool (Erikson stage) 15 Initiative vs. guilt; Show independence...line leader! school age (Erikson stage) industry vs inferiority adolescence (Erikson stage) identity vs role confusion young adulthood (Erikson stage) intimacy vs isolation middle adulthood (Erikson stage) generativity vs stagnation maturity (Erikson stage) ego integrity vs despair Nurse's Effect on Patient's Self-Concept -remain aware of own feelings, ideas, values, expectations, and judgments -use pos. and matter of fact approach -build trusting relationship -be aware of facial/body expression components of self concept -identity -body image -role performance identity confusion occurs when there is an inability to adapt to identity stressors role performance stressors -role conflict -role ambiguity -role strain -role overload identity internal sense of individuality, wholeness, and consistency of a person over time 16 body image involves attitudes related to physical appearance, structure, or function role performance role conflict, role ambiguity, role strain, role overload nursing process with self concept (assessment) patient-centered care, direct questioning, observe non-verbal behavior (content of convo), use your own knowledge of developmental stages, through patient's eyes, coping behaviors (previous coping strategies as well), significant others (have insights into pt's way of dealing with stressors) nursing process with self concept (implementation) -Healthy lifestyle behaviors: nutrition, exercise, sleep/rest -Acute care: address stressors -Restorative care: acts to solve problems and cope with stressors; allow patient to explore thoughts/feelings; help patient identify problems and identify coping mechanisms nursing process with self concept (evaluation) positive self-concept, verbalizing statements of self-acceptance Identify the nurse's role in maintaining or enhancing a patient's sexual health. -therapeutic communication skills/ be knowledgeable about sexual functioning, issues, and assessment -sound sci. knowledge base regarding sexuality to provide with necessary info to help pt achieve sexual health -have a basic understanding of sexual development, sexual orientation, contraception, abortion, and STIs sexuality is influenced by interaction among biological, sociological, psychological, spiritual, economic, political, religious, and cultural factors sexual health a state of physical, emotional, mental, and social well-being in relation to sexuality; it is NOT absence of disease, dysfunction, or infirmity how many people in the US are diagnosed with STIs each year 20 million people, half being 15-24 years old, black and hispanic populations being dx more frequently curable STIs syphilis gonorrhea chlamydia, trichomoniasis 17 chlamydia causes... infertility, PID, and neonatal complications chlamydia is spread by contact with fluids from infected site viral STIs HPV Herpes HIV AIDS HIV most common viral STI, spread through warts and semen HIV is spread through needles, intercourse, oral sex, blood transfusions (body fluids) symptoms of STIs - sores/blisters - unusual discharge - painful urination - itching, burning, redness - rashes - warts, bumps - pain during sex nursing process with sexuality questions (assessment) -open ended -focused -contrast -ethnohistory -sexual orientation/ gender ID -social organization -socioeconomic -bicultural ecology and health risks -language and communication -caring belief and practices nursing process with sexuality (implementation) -health promotion: educate, have regular screenings -Acute care: can create situational stressors -Continuing care: provide info on how illness limits sexual activity 18 nursing process with sexuality (evaluation) ask about risk factors, sexual concerns, level of satisfaction; when outcomes are not met, ask questions to determine appropriate changes in interventions religion associated with a specific group with specific beliefs (typically church) with special rituals (more external) - ex. going to church regularly spirituality more internal, personal belief in a higher power, awareness of meaning, purpose in life, as well as life values - ex. relationship with God/higher being constructs of spirituality Self-transcendence Connectedness Faith Hope health belief model (Rosenstoch and Becker and Maiman's) addresses the relationship between person's beliefs and behaviors components of the health belief model 1. perceived susceptibility to a disease 2. perceived seriousness of a disease 3. likelihood the person will take preventive action health promotion model defines health as a positive, dynamic state not just the absence of disease health promotion model focuses on 1. individual characteristics/ experiences 2. behavior-specific knowledge and effect 3. behavioral outcomes where the pt commits to/changes behavior health promotion is directed at increasing a patient's level of well being health promoting behaviors result in improved health, enhanced functional ability, and better quality of life 19 health promotion examples routine exercise and good nutrition illness prevention example immunizations Healthy People Initiative aims to prevent disease and improve Americans' quality of life healthy people 2020 goals -Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. -Achieve health equity, eliminate disparities, and improve the health of all groups. -Create social and physical environments that promote good health for all. -Promote quality of life, healthy development, and healthy behaviors across all life stages. negative health behaviors Include practices actually or potentially harmful to health (smoking, drug/alc abuse, poor diet, refusal to take necessary meds) primary prevention True prevention that lowers the chances that a disease will develop primary prevention examples -health edu programs -immunizations -nutritional programs -phys. fitness activities secondary prevention -focuses on early identification of illness and prevent worsening health status secondary prevention examples -communicable disease screening -early detection and tx of diabetes -performed in homes, hospitals, or skilled nursing facilities tertiary prevention occurs when a defect/disability is permanent/irreversible; preventive care; helps pt achieve highest level of functioning possible 20 tertiary prevention examples support groups/rehab nurse practice act in relation to client education patient teaching is within the scope of practice for nurses. The Joint Commission sets standards for pt and family education; it is the nurse's responsibility to educate successful accomplishment of standards requires collaboration among health care professionals teaching clients is part of independent nursing practice what is the basic purpose of providing client education -to provide info that will empower clients/families to perform self-care and make informed decisions about health care options -Promotes wellness, prevents illness, restores health, adapt to changes in body, and facilitate coping strategies health beliefs are a person's ideas, convictions, and attitudes about health and illness Maslow's Hierarchy of Needs is used to understand the interrelationships of basic human needs; certain human needs are more basic than others and need to be met 1st Hollistic health model attempts to create conditions that promote optimal health; includes mind, body and spirit internal variables of health beliefs -intellectual background -developmental stage -perception of functioning -emotional factors -spiritual factors external variables of health beliefs -family practices 21 -socioeconomic factors -cultural background internal variables of illness behavior perception of illness and nature of illness external variables of illness behavior -Visibility of symptoms -social group -cultural background -economics -accessibility to health care risk factors that inc. the vulnerability of an individual/group to an illness -genetic/physio factors -age -env. -lifestyle Changing health behavior stages pre contemplation contemplation preparation action maintenance stage You are caring for an adolescent patient who underwent a gastric banding procedure 6 months previously. This adolescent tells you, "There is still a fat person inside of me." This type of statement illustrates a flaw in the self-concept of: body image You are assigned to care for a patient who retired 6 months ago. While providing care, you identify that this patient is struggling emotionally with change. This situation is most likely associated with the self-concept component of: role performance stressor the LGBTQ community have an increased risk for -depression -anxiety -substance use disorders -4x more likely to attempt suicide that requires med attention which group of people is more likely to postpone medical care due to lack of insurance encounters with 22 discrimination from others trans individuals cultural competency the enabling of health care providers to deliver services that are respectful of/ responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients linguistic competence the ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences teach back closed-loop communication technique that assesses patient retention of the information imparted during a teaching session Cues that raise a question of possible sexual abuse include extreme jealousy and refusal to leave a woman's presence. To assess, evaluate, and support a patient's spirituality, the best action a nurse can take is to: determine the patient's perceptions and belief system TJC's Speak Up Tips -Speak up if you have questions or concerns. -Pay attention to the care you get. -Educate yourself about your illness. -Ask a trusted family member or friend to be your advocate. -Know which medicines you take and why. -Use a health care organization that has been carefully evaluated. -Participate in all decisions about your treatment. Cognitive Domain of Learning includes storing and recalling info in the brain affective domain of learning deals with expression of feelings and acceptance of attitudes, opinions, or values Psychomotor Domain of Learning involves acquiring skills that require integration of mental and muscular activity ability to learn depends on physical and cognitive abilities, developmental level, physical wellness, thought processes 23 readiness to learn the demonstration of behaviors or cues that show the learner is motivated and able to learn at a specific time family durability System of support and structure within a family that extends beyond the walls of the household family resiliency ability to cope with expected and unexpected stressors family diversity Uniqueness of each family goal of family centered nursing care is -to address the comprehensive health care needs of the family as a unit. -to advocate, promote, support, and provide for well being and health of pt and fam members current trends with family -marrying later -delaying childbirth -fewer children/none -stabilizing single parent families -adolescent preg is inc. concern -America is aging -remarriage causes blended families -more living alone -gay couples -grandparents raising grandchildren factors influencing family forms -changing econ status/poverty -homelessness -domestic violence -family caregivers (burden of care) structure of family is based on ongoing membership of the family and pattern of relationships family function involves processes used by family to achieve its goals (the way a family reproduces, raises children, cooperates to meet econ needs, relates to larger society) 24 family nursing is based on the assumption that all people, regardless of age, are members of some kind of family family as context primary focus is on health and development of individual members (assess how much the family provides the individual's basic/psych needs) family as patient primary focus is on the family processes and relationships family as system focuses on the individual members and family as a whole at the same time/ both context and as patient (not mutually exclusive) nuclear family Mother, father and children living as a unit extended family includes relatives (aunts/uncles, grandparents and cousins) along with nuclear family single parent family formed when one parent leaves the nuclear family because of death, divorce, or desertion or when a single person decides to have or adopt a child blended family formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation alternative family Include multi-adult households, skip generation families and communal groups with children, nonfamilies (adults living alone), cohabiting partners, and gay partners. A patient comes from a close-knit family. The patient's family functions as context. You will need to evaluate: attainment of pt needs family health system a holistic model used to assess and care for families, includes 5 processes of family life -interactive -developmental 25 -coping -integrity -health factors affecting family with health -acute/chronic illness -end of life care -genetic factors nursing process with family (assessment) -cultural aspects -discharge planning -family focused care (include interactive, developmental, coping, integrity, and health processes of the family) nursing process with family (Dx) -conflicting caregiver attitude -impaired fam coping -risk for caregiver stress -impaired fam process -risk for parent child attachment -fam able to participate in care planning -fam knowledge of disease Calgary Family Assessment Model (CFAM) used to ask the family questions about themselves in order to gain understanding of the structure, development, and function at a point in time nursing process with family (implementation) family caregiving (find resources, provide personal care, monitor for complications, providing IADLs and ongoing emotional support) restorative and continuing care (family) -clear communication -maintain pt functional abilities in context of fam -make sure env will accommodate pt strengths/limitations -show how to perform phys care -stressful for fam members as caregivers -est caregiving schedule -connect caregivers with comm. resources When completing the nursing data on a client, to complete the admission and develop a plan of care, the nurse will need to: identify family unit form and attitudes 26 actual losses -occur when a person can no longer feel, hear, see, or know a person/object (Necessary losses, Maturational losses, Situational losses) maturational loss necessary loss that includes all normally expected life changes across life (child going to college) maturational losses associated with normal life transitions help people develop coping skills to use when they experience situational loss situational loss sudden, unpredictable external events perceived loss uniquely defined by the person experiencing the loss and is less obvious to other people normal (uncomplicated) grief common reaction includes complex emotional, cognitive, social, physical, behavioral and spiritual responses to loss/death anticipatory grief grief experienced prior to a loss; predicted loss (ALS/cancer) disenfranchised grief occurs when relationship to the deceased includes emotion surrounding a loss that others do not support, share, or understand (societally not okay) ambiguous loss a type of disenfranchised grief, occurs when the lost person is physically present but not psychologically available (dementia/ severe brain injury) complicated grief prolonged or significantly difficult time moving forward after a loss chronic grief person experiences normal grief response but it lasts for a longer period of time 27 exaggerated grief person exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders (risk for suicide) masked grief person behaves in ways that interfere with normal functioning but is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution End of Life Nursing Consortium (ELNEC) provides basic and advanced curriculum for loss, grief, death, and bereavement. American Nurses Association (ANA) with grief/loss developed scope and standards for hospice and palliative care American Society of Pain Management Nurses and American Association of Critical Care Nurses offer EBP guidelines for managing clinical/ethical issues at end of life factors influencing loss/grief -Human Development, -Personal Relationships -Nature of Loss -Coping strategies -Socioeconomic status -Culture and ethnicity -Spiritual and religious beliefs -Hope Dying Person's Bill of Rights affirms the dying person's right to dignity, privacy, informed participation, and competent care nursing process with loss (assessment) -be present -use active listening, silence and therapeutic touch -use open honest communication -ask open ended questions -grief variables/reactions nursing process with loss (implementation) -Health promotion: focus on coping/ optimizing health -Palliative care -Hospice care -organ/tissue donation (call org. when pt passes- ONLY report) -autopsy -postmortem care (invite family) 28 palliative care life prolonging measures are still taken (best quality of life) hospice care occurs when there's 6mo. till the end of life; not life prolonging; centered on comfort; adheres to pt wishes health promotion with grief/loss -therapeutic communication -psych care -manage symptoms -promote dignity and self esteem -maintain comfortable env -spiritual care/hope -protect against abandonment/isolation -support grieving fam autonomy commitment to include patients in decisions beneficence Doing good; taking pos. actions to help others Nonmalificence avoidance of harm or hurt fidelity agreement to keep promises code of ethics (ANA) statement about expectations and standards of behavior -advocacy -responsibility -accountability -confidentiality deontology defines actions as right or wrong Utiliarianism the value of something is determined by its usefulness 29 feminist ethics focuses on the inequality between people ethics of care importance of understanding relationships casuistry case-based reasoning statutory law types criminal or civil law criminal laws meant to prevent harm to soc. and provide punishment for these crimes (felonies/ misdemeanors) Regulatory law (administrative law) defines your duty to report incompetent/ unethical nursing conduct to the Board of Nursing common law from judicial decisions concerning individual cases (negligence/ malpractice) standards of care legal requirements (from ANA) that outline the scope, function, and role of nurse in practice TJC (legal) requires accredited hospitals to have written nursing policies/procedures Patient Protection and Affordable Care Act -Consumer rights and protections -Affordable health care coverage -Increased access to care -Stronger Medicare to improve care for those most vulnerable in our society Americans with Disabilities Act protects rights of people with physical/ mental disabilities emergency medical treatment and active labor act When a patient presents to an emergency department, they must be treated 30 Mental Health Parity Act Strengthens mental health services (under PPACA) Uniform Anatomical Gift Act A state statute allowing people 18 years of age to donate an organ (provide signature) health information technology act nurses must ensure the patient's health info is not on social media Uniform Determination of Death Act provides a definition of brain death (cardiopulmonary or whole brain def) Death with Dignity Act A law in Oregon that allows for the practice of physician-assisted suicide seeing that very specific circumstances are met intentional tort -assault -battery -false imprisonment assault pt feels threatened; when the harm could be done (doesn't have to include contact) battery touching without consent; may be harmful/unharmful to pt quasi-intentional torts -invasion of privacy -defamation of character (slander, libel) libel written defamation unintentional torts negligence and malpractice negligence conduct that falls below a standard of care that a reasonably prudent nurse would provide 31 malpractice Failure by a health professional to meet accepted standards (doesn't carry out duty) community health accreditation program require agencies to have guidelines for determining staffing ratios