Unit 1: Nursing and Health Promotion (History and Theories)

What is Nursing?
-def’n by ANA
-the protection, promotion, and optimization of health and abilities
-prevention of illness and injury
-alleviation of suffering through the dx and tx of human response
-advocacy in the care of individuals, families, communities, and populations
What is nursing?
-def’n includes roles of nursing
-encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings
-includes promotion of health, prevention of illness, and care of ill, disabled, and dying people
-nursing roles: advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education
Florence Nightingale
-author: “Notes on Nursing: What It Is and What It Is Not”
-viewed nursing as “charge of somebody’s health” based on the knowledge of “how to put the body in such a state to be free from diseases or to recover from disease”
~defined profession and standardized nursing; promoted health and improving health
Florence Nightingale
-contributions
-developed 1st organized training program for nurse (Nightingale Training School for Nurses @ St. Thomas’ Hospital in London)
-Crimean War (1853) volunteer: studied poor sanitation led to high mortality rate
~reduced mortality rate @ Barracks Hospital in Scutari, Turkey from 42.7% to 2.2% in 6 months
Nursing in the 20th Century: Evidence-Based Practice
-the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals
∙ex: catheter in urethra leads to infection→ sterile techniques used to decrease infection with a urethra catheter; now a standard of care
Nursing in the 20th Century: Advanced Practice Nursing (APRN) Roles
-RN that obtain master’s to specialize in nursing
-(1) Clinical Nurse Specialist: expert at dx and treating client’s in their area of specialty-client’s, nurse mgmt, or nurse administration
-(2) Nurse Practitioner: primary care provider; asses, dx, and prescribe rx for client’s
-(3) Certified Nurse Midwife: pregnant or post-partum client’s
-(4) Certified Registered Nurse Anesthetist: administer anesthesia to client’s
Nursing in the 21st Century
-Societal needs: adaptable and flexible to societal needs
-Aging population: more geriatric client’s
-Emerging infections/antibiotic resistance: (ex.) Zika virus, Ebola, untreatable strains of bacteria
-Disaster management: (ex.) mass shootings, flooding in Baton Rouge
-Advances in technology: (ex.) telemedicine→ sky ping online between provider and client to assess client
-Higher acuity of hospitalized clients: Client’s are sicker in hospitals therefore increase preparedness to care for client’s
-Earlier discharges: Insurance covers shorter hospital stays thus have to prepare client’s for earlier discharge and return home
-Nursing shortage: older nurses are retiring and there’s a professor shortage to teach nursing students
-Affordable Care Act: defines where and how care is given
-Increased incidence of chronic and long-term diseases: Increased chronic diseases, but people can live longer
Roles of the Nurse: Advocate
-nurses protect the human and legal rights of their patients and help patients assert those rights when needed
-help individuals receive healthcare, and make healthcare system more responsive to individual and community needs
~representative for client; speaks for client
Roles of the Nurse: Care Manager
-prevents duplication of services, reduces costs, and facilitate communication among involved parties
-as a manager, you will collaborate with others to help your patients meet their established outcomes and will evaluate the manner in which care is administered
~non-direct client care; behind the scenes; utilize resources efficiently
Roles of the Nurse: Consultant
-provides knowledge about health promotion and disease prevention to individuals and groups
-some nurses have specialized areas of expertise or advanced practice standing which equips them to provide information
~provides info and educates by being specialized
Roles of the Nurse: Deliverer of Services
-nurses help their patients regain health and find their maximum level of independent function through the healing process
-healing involves the body, mind, and spirit; foundation of public image of nursing
~hands-on client care tasks; improve current health status
Roles of the Nurse: Educator
-teaching can be formal or informal and will involve the patient, family, significant other, or other support systems
-teaching may range from chance remarks based on perception of client behavior to formal planned teaching
Roles of the Nurse: Healer
-assist individuals to integrate and balance the various parts of their lives
-requires mindful blending of science and subjectively
~strategizes care and gives knowledge to improve health and achieve health goal; holistic
Roles of the Nurse: Researcher
-nurses use research findings as the foundation to clinical practice and decision making
-evidence based practice= conscientious, explicit, and judicious use of current best practice evidence
~problem→ formulates decisions or solutions
Chamberlain Care Model
-correlates with health and wellness and creating health and wellness
Chamberlain Care Model:
Components
-(1) Care for self: increasing emphasis on self=take care of oneself
-(2) Care for peers: communication and civility=teamwork and respect
-(3) Care for clients: promoting self-care
Health
State of physical, mental, and social functioning that realizes the potential of which a person is capable
-our current status, but there’s potential for improvement (physical, mental, emotional, spiritual, social, environmental)
Wellness
State involving progression toward a higher level of functioning, an open-ended and ever-expanding future, with its challenge of fuller potential and the integration of the whole being.
-a positive state in which incremental increases in health can be made beyond the midpoint. These increases involve improved physical and mental health states.
-achieving our optimal level of health (physical, mental, emotional, spiritual, social, environmental)
Illness
Social construct in which people are in an imbalanced, unsustainable relationship with their environment and are failing in the ability to survive and to create a higher quality of life
-symptom or manifestation
-ex: fever, burning during urination
Disease
Failure of a person’s adaptive mechanisms to adequately counteract stimuli and stresses, resulting in functional or structural disturbances
-the cause or medical dx
-ex: urinary tract infection (UTI)
Wellness-Illness Continuum
Paradigm that is bipolar, interactive portrayal of health and illness in myriad configurations, ranging from high-level wellness (+) to depletion of health (death)(-)
Health Promotion
Science and art of helping people change their lifestyle to move toward a state of optimal health. The process of advocating health to enhance the probability that person (individual, family, and community), private (professional and business), and public (federal, state, and local government) support of positive health practices will become a societal norm
-use of evidence based knowledge and caring to change negative behaviors to reach optimal health→education
Holism
Theory that people have an existence other than the mere sum of their parts and must be perceived or studied as a whole
-providing care to the entire person (spiritual, mental, physical, etc.)
Health Belief Model
Helps understand factors influencing patient’s perceptions, beliefs, and behaviors to plan care that will most effectively assist individuals in maintaining and restoring health and preventing illness
-we gather what the client knows about health, then educate to improve the health of the client
Health Promotion Model
Focuses on 3 areas: (1) individual characteristics and experiences, (2) behavior-specific kowledge and affect, (3) behavioral outcomes.
-these personal characteristics interact with the environment to determine a person’s motivation, attitudes, and actions to engage in health-promoting behaviors
→3 areas will assist in improving health
Basic Human Needs Model:
Maslow's Hierarchy of Needs
Basic Human Needs Model:
Maslow’s Hierarchy of Needs
Shows interrelationships of basic human needs
-higher order needs can only be met when the lower needs have been met satisfactorily (physiological needs→safety and security needs→love and belonging needs→self-esteem needs→self-actualization)
Holistic Health Model
Views health by considering emotional, spiritual, and cultural well-being. Understands the natural healing abilities of the body.
-incorporates traditional and nontraditional medicine to maintain wellness and achieve health and healing
Variables Influencing Health, Health Beliefs, and Health Behaviors:
Internal Variables
∙defines how we think
-Development stage: how we do things during different ages
-Intellectual background: higher education=↑ health
-Perception of functioning: how things are and how they should be
-Emotional factors: stress/anxiety impact how we think
-Spiritual factors: religion
Variables Influencing Health, Health Beliefs, and Health Behaviors:
External Variables
∙result of the internal variables
-Family practices: family
-Psychosocial and socioeconomic factors: economics (↑/↓)
-Cultural background: culture
~all impact what we think and how our health is affected
Levels of Prevention:
Primary Prevention
∙Person is healthy→want to keep them healthy and prevent disease
-prior to disease or dysfunction
∙Interventions maintain health
-health promotion (education)
-specific protection (immunization, reduce exposure to carcinogens and occupational hazards)
Levels of Prevention:
Secondary Prevention
∙Person is in the early stages of a disease or at risk to develop a disease
∙Interventions for people with disease
-early diagnosis
-prompt treatment
-limiting progression of disability
Levels of Prevention:
Tertiary Prevention
∙Person already has a defect or disability that’s permanent or irreversible
-minimize effect to prevent complications or deterioration
∙Maximize remaining abilities
-restoration
-rehabilitation
Cost of Health and Illness:
Financing Healthcare
∙(1) Expected to continue to increase due to:
-inflation
-new, more advanced technologies
-aging population
-government financing of healthcare services
-growth of prescription drug usage and costs
-misdistribution of healthcare providers and services
-growing number of uninsured and underinsured people
Cost of Health and Illness:
Financing Healthcare (2)
∙Less time in system for health promotion
→no time for health promotion leads to more time spent with clients to improve health
-changes in hospital care and use of hospitalists
-increased utilization of outpatient services
-shorter inpatient stays
-increased time caring for chronic illness as opposed to acute illness
→→focused on mgmt of issue rather than getting well
-nursing shortage
→→increased use of nonprofessional caregivers
→→inadequate resources (staff)
→→lower reimbursement
Healthy People 2020
∙national guidelines to promote health by health promotion and disease prevention efforts
-government program; national initiatives
-increase health status of everyone in the country; large group of people educated
-began in 1979 as “Healthy People”
-reviewed every 10 years to increase health
Four Goals of Healthy 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
-receive same levels of healthcare
∙create social and physical environments that promote good health for all
∙promote quality of life, healthy development, and healthy behaviors across all life stages
-improve health of all ages
Healthy People 2020-Leading Health Indicators:
Access to Health Services
-Persons with medical insurance
-Persons with a usual primary care provider
Healthy People 2020-Leading Health Indicators:
Clinical Preventative Services
-Adults who receive a colorectal cancer screening based on the most recent guidelines
-Adults with hypertension whose blood pressure is under control
-Persons with diagnosed diabetes whose A1c value is >9%
-Children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and PCV vaccines
Healthy People 2020-Leading Health Indicators:
Environmental Quality
-Air Quality Index (AQI) exceeding 100
-Children exposed to secondhand smoke
Healthy People 2020-Leading Health Indicators:
Injury and Violence
-Fatal injuries
-Homicides
Healthy People 2020-Leading Health Indicators:
Maternal, Infant, and Child Health
-All infant deaths
-Total preterm live births
Healthy People 2020-Leading Health Indicators:
Mental Health
-Suicides
-Adolescents who experience major depressive episodes
Healthy People 2020-Leading Health Indicators:
Nutrition, Physical Activity, and Obesity
-Adults who meet current federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity
-Adults who are obese
-Obesity among children and adolescents
-Total vegetable intake for persons aged 2 years and older
Healthy People 2020-Leading Health Indicators:
Oral Health
-Children, adolescents, and adults who visited the dentist in the past year
Healthy People 2020-Leading Health Indicators:
Reproductive and Sexual Health
-Sexually active females aged 15 to 44 years who received reproductive health services in the past 12 months
-Knowledge of serostatus among HIV-positive persons
Healthy People 2020-Leading Health Indicators:
Social Determinants
-Students who graduate with a regular diploma 4 years after starting 9th grade
Healthy People 2020-Leading Health Indicators:
Substance Abuse
-Adolescents using alcohol or any illicit drugs during the past 30 days
-Adults engaging in binge drinking during the past 30 days
Healthy People 2020-Leading Health Indicators:
Tobacco
-Adults who are current cigarette smokers
-Adolescents who smoked cigarettes in the past 30 days
Who’s Responsible for Implementing Healthy People 2020?
∙Individuals
-lifestyle and behavioral modifications
∙Healthcare providers
-offer preventative services/monitoring behaviors
∙Community partnerships (work sites/faith communities)
-to promote health
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