Chamberlain College of Nursing :NR 222 Health and wellness latest updated 2022/2023,100% CORRECT

Chamberlain College of Nursing :NR 222 Health and wellness latest updated 2022/2023 Chapter one Nursing as a profession ⟶ Patient centered ⟶ Professionalism o Administer quality care o Be responsible and accountable ⟶ Health care advocacy groups : FWJF / IOM Benner’s stages of nursing proficiency ⟶ Novice (us) ⟶ Advance beginner ⟶ Competent ⟶ Proficient ⟶ Expert Definitions of nursing American nurse Association Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities, and populations. International Council of nursing Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people Six Standards of Practice Assessments Standards of Professional Perform Ethics Quality of Practice Diagnosis Education Communication Outcomes identification Evidence-Based practiced and research Planning Leadership Environmental health Implementation Resources Professional practice evaluation Evaluation Collaboration Code of Ethics ⟶ A code of ethics is the philosophical ideas of right and wrong that define principles used to provide care. Professional Roles ⟶ Provider of care ⟶ Advanced practice registered nurse  ⟶ Nurse educator ⟶ Nurse administrator ⟶ Nurse researcher Clinical Nurse specialist Certified Nurse practitioner Certified Nurse Midwife Certified Registered Nurse Anesthetist Nursing storage ⟶ Less nurses = its important to learn to use patient contact time efficiently and professionally. ⟶ Essential skills include  Time Management Therapeutic communication Patient education Compassionate implementation of bedside skills Histor y Florence Nightingale ⟶ First practicing epidemiologist ⟶ Organized first school of nursing ⟶ Improved sanitation in battlefield hospitals ⟶ Practices remain a basic part of nursing today ⟶ believed that the role of nurses was to help the body recover, and the then remain free, from disease. Civil war – 20th century The Civil War, fought from 1860 to 1865, stimulated the growth of nursing in the United States Clara Barton founder of the American Red Cross Mother Bickerdyke organized ambulance services Harriet Tubma Underground rail road to help free slaves Mary Mahoney as a noted nursing leader she brought forth an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion. Lilian wald opened the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in New York City. Twenty Century ⟶ Movement toward scientific, research-based practice and defined body of knowledge ⟶ Nurses assumed expanded and advanced practice roles ⟶ Changes in curriculum ⟶ Advances in tech and informatics ⟶ New programs and leardership roles. Contemporary influences Importance of nurses’ self-care Changes in society lead to changes in nursing: Affordable Care Act (ACA) Rising health care costs Demographic changes Medically underserved Chapter 2 Health Care ⟶ Uninsured patients ⟶ Reducing health care costs while maintaining high quality-care for patients. Challenges ⟶ Improving access and coverage for more people ⟶ Encouraging healthy behaviors ⟶ Earlier healthy behaviors Earlier hospital discharges result in more patients needing nursing homes or home care National priorities partnerships ⟶ Promote best practices ⟶ Promote prevention, treatment, and intervention. ⟶ Ensure person- and family -centered care ⟶ Make care safer ⟶ Promote communication and care coordination ⟶ Make quality care affordable. Institute of medicine (IOM) Nursing need to be transformed by: ⟶ Practicing to the full extent of their training ⟶ Achieving higher levels of education through an education system that provides seamless progress ⟶ Becoming full partners with physical and other health care providers in redesigning the health care system. Improving data collection and the information infrastructure for effective workforce planning and policy making. Health care regulation and Reform Regulators and competitive approaches ⟶ Professional standards review organizations (PSROs) o Create to review the quality, quantity and cost of hospital care provide through Medicare and Medicaid. ⟶ Utilization Review (UR) committees o Review admissions, diagnostic testing, and treatments ordered by physicians who cared for patients receiving Medicare. Health care Regulation and Reform Patient protection and Affordable care act ⟶ Access to health care for all ⟶ Reducing costs ⟶ Improving quality ⟶ Provisions include o Insurance industry reforms o Increased funding for public programs o Improved coverage for children. Emphasis on population wellness Health services pyramid ⟶ Managing health instead of illness ⟶ Emphasis on wellness ⟶ Injury-prevention programs. Preventive Reduces and controls risk factors Primary ⟶ Focuses on improved health outcomes ⟶ Requires collaboration Secondary Focus: diagnosis and treatment of diseases. ⟶ Disease management is the most common expensive service of the health care delivery system ⟶ Postponement of care by uninsured contributes to high costs. ⟶ Hospital ED, urgent care, etc. o Work redesign, discharge planning. ⟶ Intensive care, psychiatric faculties, rural hospitals. Tertiary Restorative ⟶ Services patients recovering from an acute or chronic illness/ disability. ⟶ Helps individuals regain maximal function and enhance quality of life. Home Health Care ⟶ ⟶ ⟶ Provision of medically related services and equipment to patients and families in their home for health maintenance. Involves coordination of services and focuses on patient/family independence. Usually reimbursed by gov. Rehabilit ation ⟶ ⟶ ⟶ ⟶ Aims to restore a person to the fullest physical, mental social, vocation, economic potential possible. All types of therapy: physical, occupational speech and social services. Beginning on admission- focuses on preventing complications Maximizes patient function/ independence. Extended care ⟶ Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities. Intermediate care/skilled nursing facility o Provides care for patients until they can return to their community or residential care location. ⟶ Continuing Care For people who are disabled, functionally independent, or suffering a terminal disease. ⟶ Available within institutional settings or in the home o Nursing centers or facilities, assisted living, Respite care, adult day care centers, hospice. Nursing centers or facilities ⟶ Provide 24 intermediate and custodial care o Nursing rehabilitation, diet, social, recreational and religious services. o Residents of any age with chronic or debilitating illness. Assisted living ⟶ ⟶ ⟶ ⟶ Long term care setting Home environment Greater resident autonomy No fee caps. Respite care Can provide short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. ⟶ Setting include home, day care, or health care institution with overnight care. ⟶ Trained volunteers enable family caregivers to leave the home for errands or social time. Adult day care ⟶ ⟶ Provide a variety of health and social services to specific patient populations who live alone or with family in the community. May be associated with a hospital or nursing home or may operate independently. Hospice ⟶ ⟶ ⟶ Family centered care that allow patients to live with comfort independence and dignity while easing the pains of terminal illness. Focuses on palliative (not curative) care Many hospice programs provide respite care, which is important in maintain the health of the primary caregiver and family. Care coordination Care Coordination Accountable care ⟶ Developed to coordinate medical care Health care reform has organizations (ACOs) ⟶ Nurses act as leaders and care coordinators stimulated the development of two models focused on coordinating medical care for patients and families Patient-centered medical home (PCMH) ⟶ Coordinates care, gathers clinical data, monitors patient outcomes. ⟶ Primary care providers function as the hib of the PCMH. Issues in Health care Delivery ⟶ Nursing shortage ⟶ Competency ⟶ Quality and safety in health care  ⟶ Nursing recognition program  ⟶ Nursing informatics and technological advancements  ⟶ Globalization of health care o Pay for performance o Patient satisfaction o Nursing sensitive outcomes Technological advancements influence where and how nurses provide care to patients and can help nurses improve direct care processes, patient outcomes, and work environments. Technology makes your work easier, but it does not replace nursing judgment. Vulnerable populations ( children, women, older adults) most threatened by urbaniszation. Quality and Performance Improvement Quality data Quality data are the outcome of both QI and PI initiatives. Quality improvement (QI) QI is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy. QI data inform you about how processes work within an organization and thus offer information about how to make evidence-based practice (EBP) changes. Performance improvement (PI) Analyzes what an institution does and how well it does it. an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions. Models and Quality improvement Programs Patient Self-Determination Act (PSDA) Six Sigma or Lean Rapid-cycle improvement or rapid-improvement event (RIE) Future of health care Change opens up opportunities for improvement. Health care delivery systems need to address the needs of the uninsured and the underserved. Health care organizations are striving to become better prepared to deal with these and other challenges in health care. The solutions necessary to improve the quality of health care depend largely on the active participation of nurses. Chapter 6 Healthy People Documents The U.S. government set national health care goals back in 1979, with the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease. The report outlined priority objectives for preventive services, health protection, and health promotion that addressed improvements in health status, risk reduction, public and professional awareness of prevention, health services and protective measures, surveillance, and evaluation. Healthy People 2000 National health Promotion and Diseases prevention objectives. Healthy People 2010 served as a road map for improving the health of all people in the United States. This edition emphasized the link between individual and community health and the premise that the health of communities determines the overall health status of the Health people 2020 ⟶ 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, healthy development, and healthy behaviors across of life stages Definition of Health A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity (WHO 1947) ⟶ A state of being that people define in relation to their own values, personality and lifestyle. ⟶ Nurses need to consider the total person and the environment in which the person lives to individualize nursing care and enhance meaningfulness of the patient’s future health status. Models of health and Illnesses A model Models represent different ways of approaching complex issues. Because health and illness are complex concepts, models are used to understand the relationships between these concepts and the patient’s attitudes toward health and health behaviors. Health beliefs are a person’s ideas, convictions, and attitudes about health and illness. They may be based on factual information or misinformation, common sense or myths, or reality or false expectations. Because health beliefs usually influence health behavior, they can positively or negatively affect a patient’s level of health. Health behaviors Positive behaviors behaviors are activities related to maintaining, attaining, or regaining good health and preventing illness Negative behaviors health behaviors include practices that are actually or potentially harmful to health. Health Belief Model Addresses the relationship between a person’s beliefs and behaviors. The health belief model helps you understand factors influencing patients’ perceptions, beliefs, and behavior to plan care that will most effectively help patients maintain or restore health and prevent illness. This model has three components: an individual’s perception of susceptibility to an illness, an individual’s perception of the seriousness of the illness, and the likelihood that a person will take preventive action. Health Promotion Model (HPM) Maslow’s Hierarchy of Needs ⟶ A model that nurses use to understand Holistic health model: Attempts to create conditions that promote optimal health. Health care has begun to take a more holistic view of health by considering emotional and spiritual well- being and other dimensions of an individual to be important aspects of physical wellness. Nurses use holistic therapies either alone or in conjunction with conventional medicine like music therapy, or meditation, relaxation therapy, therapeutic touch, guided imagery. Morality, Creativity, spontaneity, problem solving, lack of prejudice. Acceptance of facts Self-esteem, confidence, achievement, respect of others, respect by others. Friendship, family, sexual intimacy Security of body, of employment, of recourses, of morality, of family, of health, of property Breathing, food, water, sex, sleep, hemostasis, excretion, shelter. Variables influencing health and health belief and practices ⟶ Variables influnce how a person thinks and acts. ⟶ Health beliefs can negatively or postivity influence health behavoir or health practices. ⟶ Understanding the effects of these variables allows you to plan and deliver individualized nursing care Internal Variables The nurse considers the patient’s level of growth and development when using health beliefs and practices as a basis for planning care. A person’s thought and behavior patterns change throughout life. Developmental stage Intellectual background Perception of funciton Emtional factors Spiritual factors Subjective data S of ubjective data is about the way the patient perceives physical functioning such as level fatigue, shortness of breath, or pain Objective data O and i bjective data is about actual functioning such as blood pressure, height measurements, lung sound assessment. This information allows you to more successfully plan and mplement individualized care. External Variables External variables influencing a person’s health beliefs and practices include.  Family practices The way that patients’ families use health care services generally affects their health practices. Socialeconomic factors Social and psychosocial factors increase the risk for illness and influence the way that a person defines and reacts to illness Culture background. Cultural background influences beliefs, values, and customs Health Promotion, wellness and illness prevention Health promotion activities help maintain or enhance health. The goal of a total health program is to improve a patient’s level of well-being in all dimension Immunization program (Illness Prevention) Routine exersie, good Nutrition (Health Promotion) Physical awareness, stress managament, self responsibulity. (Wellness) Levels of Prevention Primary goal Primary focus Examples. Primary Prevention Stop disease from occurring ⟶ ⟶ Preventative care Resources to live a healthy life style ⟶ ⟶ ⟶ ⟶ Access to vaccines Avilability to food like fruits nad vegetables Health education, like sex education in for highschool strudents Annual health physicals Secondary Prevention Early discovery of existing disease aimed to begin early treatment. ⟶ Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions ⟶ ⟶ ⟶ Annual diease screening Test to detect diseases early Self exams for disease detection ⟶ ⟶ ⟶ ⟶ Access to emergency contraception Testicular self exam Timing for emergency response mammograms Screening teens for sexually transmitted infections (STI) Tertiary Prevention Deacrease effect of disease on the ADLs of patient life. Increase life expectany. ⟶ Occurs when a defect or disability is permanent or irreversible. ⟶ Access to: o Education about disease o Medication o Medical services o Plan of care o Holistic and supportive care. ⟶ ⟶ ⟶ ⟶ Radiation or chemotherpy Medications for pain management Support groups (AA, NA, etc.) Monitoring teens with know STI Risk factors Variables that increase the vulnerability of an individual or a group to an illness or accident. Risk factors include  ⟶ is any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident. ⟶ Genetic and physiological factors ⟶ Age ⟶ Environment ⟶ Lifestyle Risk factors modification and chnaging health behavoirs – Transtheoretical model of change (TTM) Understanding the process of changing behaviors will help you support difficult health behavior changes in patients. It is believed that change involves movement through a series of stages.  ⟶ These stages range from no intention to change (precontemplation), considering a change within the next 6 months (contemplation), making small changes (preparation), and actively engaging in strategies to change behavior (action) to maintaining a changed behavior (maintenance stage). Precontemplation Contemplation Preparation Action Maintenance Stage Patient Teaching: lifestyle chnages Objective Patient will reduce health risks related to poor lifestyle habits through behavior change. Teching strategies Provide active listneing, ask a about perceived barriers, assist the paitent in establishing goals, and reinforce the process of change. Evaluation Have the patient track adherence, and provide posative reinforcement. Illness A State in which a person’s physical, emotional, intrllectual, social, developmental, or spiritual fuctioning is diminised. Acute illness Short duration and severe Chronic illness Persists longer than 6 months. Illness Behavoir Involves how people monitor their bodies and define and interpret their symptoms. People who are ill generally act in a way that medical sociologists call illness behavior. It involves how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system. ⟶ Variables influencing illness and illness behavior: Internal variables Perception of illness and nature of illness. External Variables Visibility of symptoms, social group, cultural background, economics, and accessibility to health care. Impact of illness: On the patient and family Illness is never an isolated life event. The patient and family deal with changes resulting from illness and treatment. Each patient responds uniquely to illness, requiring you to individualize nursing interventions. The patient and family commonly experience behavioral and emotional changes and changes in roles, body image and self-concept, and family dynamics. Chapter 16 : Nursing Assessment Five – Step Nursing Process First step: Assessment, the gathering and analysis of information about the patient’s health status. ⟶ You then make clinical judgments from the assessment to identify the patient’s response to health problems in the form of nursing diagnoses.  Once you define appropriate nursing diagnoses, you create a plan of care. Planning includes setting goals and expected outcomes for your care and selecting interventions (nursing and collaborative) individualized to each of the patient’s nursing diagnoses The next step, implementation, involves performing the planned interventions.  ⟶ After performing interventions, you evaluate the patient’s response and determine whether the interventions were effective. Assessment Assessment involves collecting information from the patient and from secondary sources (e.g., family members), along with interpreting and validating the information to form a complete database. Two stages  Collection and verificatio n of data First, to collect and verify data from the patient (primary source) and from family, health care providers, and medical records (secondary sources) Analysis of data The data will be used to develop the nursing diagnosis, identify collaborative problems, and develop an individualized plan of care. Critical thinking component Critical thinking is a vital part of assessment. While gathering data about a patient, you synthesize relevant knowledge, recall prior clinical experiences, apply critical thinking standards and attitudes, and use professional standards of practice to direct your assessment in a meaningful and purposeful way. Experience, knowledge, standards, and attitudes all influence critical thinking in assessment. Sources of data ⟶ Patient (Interview, Observation, physical examination)- The best source of information. ⟶ Family and significant others (Obtain patients agreement first) ⟶ Health care team ⟶ Medical records ⟶ Scientific literature Can be done by: ⟶ Establishing a nurse-patient therapeutic relationship allows you to know the patient as a person. ⟶ Connecting with a patient by showing interest in patient problems and conerns. ⟶ Database Types of Assessments The patient- centered interview during a nursing health history. A physical examination. A periodic assessment you can make during rounding or administering care You learn to differentiate important data from the total data you collect. A cue is information that you obtain through use of the senses. An inference is your judgment or interpretation of these cues. Types of Data Subjectiv e Data often reflect physiological changes, which you further explore through objective review of body systems. ⟶ Patients verbal descriptions of their health problem. Objective Data is measured on the basis of an accepted standard such as the Fahrenheit or Celsius measure on a thermometer, inches or centimeters on a measuring tape, or a rating scale. ⟶ Observations or measurements of patient health status. The Patient- Centered Interview ⟶ Motivational interview ⟶ Effective communication ⟶ Interview preparation ⟶ Phases of interview  Orientation and setting an agenda Introduce yourself, your position, explaining the purpose of the interview Working phase Ask open-ended questions. Use attentive listening and other therapeutic communication techniques that encourage a patient to tell his or her story Termination Summarize your discussion with a patient and check for accuracy of the information collected Interview techniques Observation Observe a patient’s nonverbal communication such as use of eye contact, body language, or tone of voice, and determine whether the data you obtained are consistent with what the patient states verbally. ⟶ An important aspect of observation includes a patient’s level of function: the physical, developmental, psychological, and social aspects of everyday living. Open-ended Questions An open-ended question gives a patient discretion about the extent of his or her answer, and does not presuppose a specific answer. They prompt patients to describe a situation in more than one or two words. Leading questions Leading questions are the most risky because of possibly limiting the information provided to what a patient thinks you want to know. Back channeling Back channeling includes active listening prompts such as “all right,” “go on,” or “uh- huh.” These indicate that you have heard what a patient says, are interested in hearing the full story, and are encouraging the patient to give more details. Direct closed-ended Questions Closed-ended questions limit answers to one or two words such as “yes” or “no” or a number or frequency of a symptom. They require short answers and clarify previous information or provide additional information, and do not encourage the patient to volunteer more information than you request. Cultural Considerations To conduct an accurate and complete assessment, you need to consider a patient’s cultural background. ⟶ Respect unfamiliar and be sensitive to a patients uniqueness. (Avoid stereotypes) Components of nursing Health History Diagnostic and laboratory data Results provide further explanation of alterations or problems identified during the health history and physical examination Interpreting and validating assessment data Ensures collection of complete databases Leads to second step of nursing process • Use PQRST: provokes, quality, radiate, severity, time. • Review of systems (ROS): A systematic approach for collecting subjective information from patients about the presence or absence of health-related issues in each body system. During the ROS ask the patient about the normal functioning of each body system and any noted changes. Ethical Terms Term Definition Example Autonomy Patients right to self-determination, independence, and self-direction, respect of patient wishes. ⟶ Commitment to include patients’ decisions Discuss advance directives and durable power of attorney Beneficence Patient Advocate ⟶ Taking positive actions to help others. Best interest of the patient. Patient does not understand what the health care provider discussed about the procedure, but feels uncomfortable about asking questions. The nurse would…. Non-Maleficence Competence in their field. Reporting any suspected abuse. Avoid injury to the patient by following scope of practice. ⟶ Avoidance of harm or hurt. An Incompetent, or chemically impaired nurse or health care provide is providing care for a patient, the nurse would report the incompetence or abuse. Justice Treated fairly and equally. ⟶ Being fair Free plastic surgery for clef palette is given to 5 children in low income area. How do you choose who deserves the survey. Fidelity Being loyal, truthful, fair and advocate ⟶ Agreement to keep promises Your patient has received bad news but does not want you to disclose to partner. Paternalism What is best for your patient when considering diagnosis If a patient discloses to the physician, if he/she get a diagnosis of Alzheimer’s diseases. She will kill herself. Principle of totality and integrity Taking an entire person needs into consideration before plan of care is established. Patient on chemotherapy. Does the benefits outweigh the side effects? Professional Nursing a Code of Ethics ⟶ A set of guiding principles that all members of a profession accept ⟶ Helps professional groups settle questions about practice or behavior ⟶ Includes advocacy, responsibility, accountability, and confidentiality ⟶ The American Nurses Association (ANA) code of ethics provides a foundation for professional nursing. ⟶ Basic principles of responsibility, accountability, advocacy, and confidentiality Values A Value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Values clarification: ⟶ Ethical dilemmas almost always occur in the presence of conflicting values. ⟶ To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Ethics and Philosophy Theories on ethics, provide a foundation for developing strategies to use when an ethical dilemma occurs Term Definition Deontology ⟶ Deontology defines actions as right or wrong based on their “right-making characteristics,” such as fidelity to promises, truthfulness, and justice. Deontology depends on a mutual understanding of justice, autonomy, and goodness. Defines actions as right or wrong Utilitarianism A utilitarian system of ethics proposes that the value of something is determined by its usefulness. Feminist Ethics Focuses on the inequality between people. Ethics of care Emphasis the importance of understanding relationships, especially as they are revealed in personal narratives. Casuistry Case-based evidence. ` Processing an Ethical Dilemma A process for resolving ethical dilemmas that respects differences of opinion and all participants Step 1: Ask if this an ethical dilemma. Step 2: Gather all relevant information Step 3: Clarify values. Step 4: Verbalize the problem Step 5: Identify possible courses of action Step 6: Negotiate the outcome Step 7: Evaluate the action Institutional Resources Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. ⟶ Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee A process for resolving ethical dilemmas that respects differences of opinion and all participants equally helps health care providers resolve conflict about right actions Issues in Health care Ethics Quality of life Central discussion about end of life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR) Disabilities Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges. Care at end of life Interventions unlikely to produce benefit for patient. Health Care Reform Facilitated acess to care for millions of uninsured Americans. Nursing Provisions Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population. Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Provision 4 The Nurse has authority, accountability and responsibility for nursing practice; makes decision; takes actions consistent with the obligation to provide optimal patient care. Provision 5 The nurse owns the same duties to self as others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue professional growth. Provision 6 The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. Provision 7 The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Provision 8 The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities Provision 9 The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.