ENTRY INTO PROFESSIONAL NURSING

• HEALTH AND WELLNESS• CARING IN NURSING PRACTICE• CULTURE AND ETHNICITY• ETHICS AND VALUES

HEALTH AND WELLNES

• IS IT THE ABSENSE OF DISEASE?• MULTIDIMENSIONAL CONCEPT– CONCEPTS OF:• WELLNESS• ILLNESS• HEALTH

HEALTH AND WELLNESS

• ILLNESS BEHAVIOR—REACTION TO ILLNESS• HEALTHY PEOPLE 2000 FOCUS ON HEALTH

PROMOTION AND DISEASE PREVENTION• HEALTHY PEOPLE 2010 INCREASE QUALITY

AND YEARSS OF LIFE, ELIMINATE DISPARITIES IN HEALTH

• HOW DO YOU DEFINE HEALTH?

HEALTH AND WELLNESS

• WORLD HEALTH ORGANIZATION DEFINES HEALTH O AS A STATE “OF COMPLETE PHYSICAL, MENTAL, AND SOCIAL WELL BEING”

• VARIABLES DEFINE HEALTH IN RELATION TO VALUES, LIFESTYLE, PERSONALITY, MENTAL, SOCIAL, AND SPIRITUAL WELL BEING

VIEWS OF HEALTH

• VIEWS OF HEALTH DEPENDENT ON:– AGE– GENDER– RACE– CULTURE

CONDITIONS OF LIFE HAVE NEGATIVE OR POSITIVE EFFECTS ON HEALTH

VIEWS OF HEALTH

• PHYSIOLOGICAL• PSYCHOLOGICAL• SOCIOECONOMIC• LIFESTYLE CHOICESHEALTH DEFINED IN TERMS OF INDIVIDUAL

NOT EVERY ILLNESS/DISEASE AFFECTS EVERYONE IN THE SAME WAY—WHY?

HEALTH BELIEF BEHAVIORS

• HEALTH BELIEF BEHAVIORS– ATTITUDES ABOUT HEALTH– FACTS/MYTHS– FALSE EXPECTATIONS/REALITY

POSITIVE/NEGATIVE HEALTH BEHAVIORS

HEALTH MODELS

• HEALTH BELIEF MODEL--PREDICTS PT’S BEHAVIOR IN RELATION TO HEALTH COMPLIANCE WITH HEALTH CARE THERAPIES

• HEALTH PROMOTION MODEL--DEFINES HEALTH AS NOT JUST ABSENSE OF DISEASE BUT AS A POSITIVE DYNAMIC STATE– HEALTH PROMOTING BEHAVIOR– MODIFIED THROUGH NURSING ACTIONS

HEALTH MODELS

• BASIC HUMAN NEEDS MODEL (MASLOW)• HIERARCHY OF NEEDS• INTERRELATIONSHIP OF BASIC HUMAN NEEDS• PEOPLE SHARE BASIC HUMAN NEEDS• EXTENT TO WHICH NEEDS ARE MET

DETERMINES PERSON’S LEVEL OF HEALTH• CAN BE USED FOR ALL PTS IN ALL HEALTH

CARE SETTINGS

MASLOW BASIC NEEDS MODEL

• PHYSIOLOGICAL– OXYGEN– FLUIDS– NUTRITION– BODY TEMP– ELIMINATION– SHELTER– SEX

MASLOW’S BASIC NEED MODEL

• EMERGENT PHYSIOLOGICAL NEED ALWAYS TAKES PRECEDENT OVER A HIGHER LEVEL NEED

• FOCUS ON PT NEEDS INSTEAD OF ADHERING TO HIERARCHY OF NEEDS

• MUST PRIORITIZE—RELATIONSHIP OF DIFFERENT NEEDS AND REASONS DETERMINE PRIORITY

MASLOW’S BASIC NEED MODEL

• SAFETY AND SECURITY—PHYSIOLOGICAL AND PSYCHOLOGICAL

• LOVE AND BELONGING

• SELF ESTEEM

• SELF ACTUALIZATION

VARIABLES

• INTERNAL VARIABLES AFFECTING/INFLUENCING HEALTH AND HEALTH BEHAVIOR– DEVELOPMENTAL STAGE– INTELLECT– PERCEPTION OF FUNCTIONING– EMOTIONAL FACTORS– SPIRITUAL FACTORS

VARIABLES

• EXTERNAL VARIABLES AFFECTING/INFLUENCING HEALTH AND HEALTH BEHAVIORS– FAMILY PRACTICES– SOCIOECONOMIC– CULTURE

LEVELS OF PREVENTATIVE CARE

• PRIMARY PREVENTION– AIMED AT PREVENTING DISEASE– PRECEDES DISEASE– HEALTH PROMOTION• IMMUNIZATIONS• PERSONAL HYGIENE• ALLERGENS• NUTRITION• STRESS

LEVELS OF PREVENTATIVE CARE

• SECONDARY PREVENTION– FOCUS ON PT WHO IS EXPERIENCING DISEASE OR

AT RISK OF DISEASE• DIAGNOSIS—PROMPT INTERVENTION• REDUCE SEVERITY• DELAY CONSEQUENCES OF ADVANCING DISEASE• SCREENING, TREATING EARLY DISEASE EVALUATE

OUTCOMES

LEVELS OF PREVENTATIVE CARE

• TERTIARY– DISEASE IS PERMANENT/IRREVERSIBLE– MINIMIZE EFFECTS OF LONG TERM DISEASE,

DETERIORATION• REHABILITATION• PREVENT FURTHER DISABILITY• ACHIEVE AS HIGH A LEVEL OF FUNCTIONING AS

POSSIBLE

RISK FACTORS ASSOCIATED WITH ILLNESS

• RISK FACTOR—HABITS, CONDITIONS, SITUATIONS THAT PREDISPOSE A PERSON TO ILLNESS/ACCIDENT

• PRESENCE OF RISK FACTORS DOES NOT MEAN PERSON WILL GET DISEASE

RISK FACTORS

• GENETIC AND PHYSIOLOGICAL FACTORS• AGE• ENVIRONMENT• LIFESTYLE

IDENTIFY, MODIFY, AND CHANGE RISK FACTORSDO THEY WANT TO CHANGE BEHAVIORS?

CHANGING BEHAVIORS

• MANY FIND CHANGE DIFFICULT• MUST MOVE THROUGH DIFFERENT STAGES

TO ACCOMPLISH CHANGE• NURSE ASSISTS PT WITH CHANGE– ASSESSEMENT– INTERVENTION– EVALUATION (OUTCOMES)

STAGES OF HEALTH BEHAVIOR CHANGE

• PRECONTEMPLATION• CONTEMPLATION• PREPARATION• ACTION• MAINTENANCE STAGE

ACUTE/CHRONIC ILLNESS

• ACUTE ILLNESS—SEVERE, USUALLY SHORT DURATION

• CHRONIC—USUALLY LONGER THAN SIX MONTH– COPING USUALLY MORE COMPLEX– NURSES HELP PT TO MANAGE ILLNESS

ACUTE/CHRONIC ILLNESS

• INTERNAL VARIABLES– PERCEPTION OF ILLNESS• SEEK HEALTH CARE IF SYMPTOMS DISRUPT/AFFECT

DAILY ROUTINE• THOSE WITH CHRONIC PAIN MAY NOT SEEK

TREATMENT AFTER NO SUCCESS IN PREVIOUS TREATMENTS

– TYPES OF SYMPTOMS• SHARP, SUDDEN, INTENSE VS ACHE

ACUTE/CHRONIC ILLNESS

• EXTERNAL VARIABLES– CULTURE– FAMILY DYNAMICS– SOCIAL GROUP– DIETARY PRACTICES– ECONOMICS

IMPACT OF ILLNESS ON PT/FAMILY

• BEHAVIOR/EMOTIONAL CHANGES• BODY IMAGE/ SELF CONCEPT• FAMILY ROLE CHANGES– ROLE STRAIN– ROLE CONFUSION– ROLE REVERSAL

CARING IN NURSING

• NURSING AND CARING• RECENT GALLUP POLLS• CARING (BENNER, 2000)—”MEANS THAT

PERSONS, EVENTS, PROJECTS, AND THINGS MATTER TO PEOPLE”– ESSENTIAL HUMAN NEED, ESSENTIAL TO POSITIVE PT

OUTCOMES– ALLOWS NURSE TO DETERMINE WHICH

INTERVENTIONS SUCCESSFUL– ABILITY TO KNOW CLIENT

CARING IN NURSING

• TAKES EXPERIENCE• EXPRESSION OF CARING WILL DIFFER WITH

EACH PT• DOES EVERYONE WHO ENTERS A NURSING

PROGRAM HAVE THE CARING COMPONENT?• MANY THEORIES ON NURSING—MUTUAL

GIVE AND TAKE WILL NOT HAPPEN IF NURSE IS NOT CARING

CARING IN NURSING• DIFFICULT TO SHOW CARING IF YOU DON’T

UNDERSTAND WHO THE PT IS AND THEIR PERCEPTIONS OF ILLNESS

• PRESENCE– BEING THERE, EYE CONTACT, BODY LANGUAGE

• TOUCH– TASK ORIENTED, CARING, PROTECTIVE

• KNOWING THE CLIENT– AVOID ASSUMPTIONS

• INCLUDING THE FAMILY– ILLNESS AFFECTS THE FAMILY AS WELL AS THE PT

CARING IN NURSING

• LISTENING– SILENCE– DON’T INTERRUPT– DON’T FINISH SENTENCES

SPIRITUALITY—VERY IMPORTANT, INTERGRAL PART OF WELLNESS TO SOME PTS

CULTURE

• CULTURE—GUIDES BEHAVIOR AND THOUGHTS THROUGH:– KNOWLEDGE OF VALUES– BELIEFS– NORMS– LIFEWAYS– DEALING WITH SIMILAR SURVIVAL ISSUES WITHIN

THEIR ENVIRONMENT

CULTURE

• SUBCULTURES

• ETHNICITY• EMIC WORLDVIEW• ETIC WORLDVIEW

• ENCULTURATION

CULTURE

• ACCULTURATION• ASSIMILATION

• CULTURALLY CONGRUENT CARE

• CULTURALLY COMPETENT CARE

• ETHOCENTRICISM

CULTURE

• CULTURAL IMPOSITION• CULTURAL HEALING COMPARATIVE

CULTURAL CONTENTS OF HEALTH AND ILLNESS TABLE IN POTTER & PERRY

• CULTURAL PAIN• CULTURAL GRIEF AND LOSS

CULTURE

• CULTURAL ASSESSMENT GUIDE– ESTABLISH RELATIONSHIP– ASKING QUESTIONS– KNOWING ETHNIC HERITAGE AND HISTORY– BIOCULTURAL HISTORY– SOCIAL– COMMUNICATION– TIME ORIENTATION– CARING PRACTICES

ETHICS AND VALUES

• AUTONOMY

• BENEFICIENCE

• NONMALEFICIENCE

• JUSTICE

ETHICS AND VALUES

• FIDELITY

• ACCOUNTABILITY, RESPONSIBILITY

• CONFIDENTIALITY

• VERACITY

ETHICS AND VALUES

• VALUE—PERSONAL BELIEF– GIVEN ATTITUDE, IDEA– CUSTOM– OBJECT

REFLECTS CULTURE, RELATIONSHIPS, PERSONAL NEEDS, SOCIAL INFLUENCES

ETHICS AND VALUES

• VALUE FORMATION—HOW DID YOU FORM VALUES IN YOR LIFE?

• VALUES CLARIFICATION

• CULTURAL VALUES

• BIOETHICS

ETHICS AND VALUES

• CULTURAL VALUES EXERCISE• ETHICAL DILEMMAS– STEP 1—IS THIS AN ETHICAL DILEMMS?– STEP 2—GATHER INFO– STEP 3—EXAMINE YOUR OWN VALUES– STEP 4—VERBALIZE PROBLEM– STEP 5—CONSIDER COURSE OF ACTION– STEP 6—NEGOTIATE OUTCOME– STEP 7—EVALUATE THE ACTION