389 Final Exam Study Guide PDF

389- 12/2 Final Blueprint: 75 total questions (5 NGN) - 115 minutes Tobacco, Nicotine, ETOH, Marijuana Differentiate between the commonly used substances that can lead to negative health outcomes in the United States- Would you be able to identify how a nurse c...

389- 12/2 Final Blueprint: 75 total questions (5 NGN) - 115 minutes Tobacco, Nicotine, ETOH, Marijuana Differentiate between the commonly used substances that can lead to negative health outcomes in the United States- Would you be able to identify how a nurse can intervene? How would you apply the nursing process to clients who use/abuse/are addicted to substances? Alcohol Risk for alcohol use disorder, liver disease, heart disease, cancer (mouth, liver, breast, etc.), stroke, brain damage Nursing Interventions: ➔ Assess using screening tools like CAGE or AUDIT ➔ Provide education on the effects of excessive alcohol use ➔ Offer resources (e.g., counseling, support groups) ➔ Refer for alcohol treatment programs if necessar. Nursing Process → ADPIE Assessment: Gather history of alcohol use, screen for alcohol use disorder Diagnosis: Impaired coping, risk for injury Planning: Set goals (e.g., reduce alcohol consumption) Intervention: Offer brief intervention, educational materials, and resource. Evaluation: Track progress with follow-up Tobacco/Nicotine (Including E-cigarettes) Risk for Lung cancer, heart disease, stroke, chronic obstructive pulmonary disease (COPD), respiratory infections, secondhand smoke risks. Nursing Interventions: ➔ Assess tobacco use and readiness to quit ➔ Discuss nicotine replacement therapies and other cessation aids ➔ Provide resources Nursing Process→ (ADPIE) Assessment: Identify smoking history, e-cigarette use. Diagnosis: Risk for respiratory issues, ineffective health management. Planning: Set quit date, provide behavioral therapy options. Intervention: Motivational interviewing, education on smoking cessation methods. Evaluation: Monitor for relapse and ongoing support. THC/Marijuana Risk for impaired memory, concentration, motor coordination, lung damage, mental health issues (anxiety, paranoia), marijuana use disorder. Nursing Interventions: ➔ Assess marijuana use, including frequency and impact on daily life ➔ Discuss risks, especially for teens and those with mental health conditions Nursing Process → (ADPIE) Assessment: Screen for marijuana use, assess mental health. Diagnosis: Risk for impaired cognitive function. Planning: Discuss treatment options for marijuana use disorder. Intervention: Provide support and refer to counseling. Evaluation: Monitor adherence to treatment plan and improvements in cognitive function. CBD (Cannabidiol) Risk due to limited evidence on long-term effects. Possible liver damage, interactions with medications. Nursing Interventions: Assess CBD use and educate on potential risks and benefits. Nursing Process → ADPIE Assessment: Obtain detailed history of CBD use, including dosage and frequency. Diagnosis: Risk for adverse effects (e.g., liver damage, drug interactions). Planning: Advise on safe CBD use, consult with a healthcare provider about drug interactions. Intervention: Educate on risks, ensure appropriate monitoring of liver function. Evaluation: Follow-up on liver function tests and overall health. Describe the prevalence of tobacco, nicotine, alcohol, THC, and CBD use in the United States- Can you identify statistics or risk factors for specific populations? Substance Prevalence At-Risk Populations Alcohol 56% of U.S. adults drink regularly Men, younger adults, people with low socioeconomic status, and those with mental health disorders. Tobacco 14% of U.S. adults smoke Lower-income individuals, individuals with mental health issues, LGBTQ+ population. Nicotine 20% of teens use e-cigarettes (2023) Adolescents, young adults, and (E-cigarettes) those in social circles where vaping is normalized. THC/Marijuana 18% of U.S. adults >12 use marijuana regularly Young adults, particularly in states where marijuana is legal. CBD 26% of U.S. adults have used CBD People with chronic pain, sleep disorders, and anxiety. Utilize the CAGE and SBIRT tools to help identify alcohol use disorder-Could you apply these? CAGE Questionnaire is used to identify potential alcohol use disorder. A positive response to 2 or more questions suggests a higher likelihood of alcohol use disorder and further assessment is needed. C: Have you ever felt you should Cut down on your drinking? A: Have people Annoyed you by criticizing your drinking? G: Have you ever felt Guilty about your drinking? E: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? SBIRT (Screening, Brief Intervention, and Referral to Treatment) is a comprehensive approach to identifying and managing substance use disorders. Screening: Use AUDIT or CAGE to assess the extent of alcohol use. Brief Intervention: Brief counseling to motivate the patient to reduce or stop drinking. Referral to Treatment: If the patient’s drinking meets criteria for alcohol use disorder, refer to specialized treatment programs. Apply the 5A's and 5R's to assist a client in quitting or making behavior changes-Could you apply the 5A’s and 5R’s to clients? For instance, if a nurse uses one A, what happens next? 5 A’s → Ask, Advise, Assess, Assist, Arrange Ask: Identify if the patient uses the substance (e.g., smoking, alcohol). Advise: Strongly recommend quitting. Assess: Determine the patient’s willingness to quit. Assist: Offer resources such as quitlines, medications, or therapy. 5 R’s → Relevance, Risks, Rewards, Roadblocks, Repetition Relevance: Ask the patient how the substance use is affecting their health. Risks: Discuss the risks of continued use (e.g., “Smoking increases your risk for cancer”). Rewards: Highlight the benefits of quitting (e.g., improved lung function, better overall health). Roadblocks: Identify obstacles to quitting (e.g., social pressure, stress). Repetition: Revisit these discussions regularly for sustained motivation. Differentiate between the health effects associated with the use of each substance-Could you identify short- and long-term effects and how the nurse would support clients? Substance Short-Term Effects Long-Term Effects Alcohol Impaired judgment, accidents, violence, Liver disease, heart disease, stroke, cancer, brain dehydration damage, fetal alcohol spectrum disorders (FASD) Tobacco Increased heart rate, coughing, shortness of breath Chronic obstructive pulmonary disease (COPD), lung cancer, heart disease, stroke, secondhand smoke risks Nicotine Increased heart rate, addiction, respiratory issues Lung disease, cardiovascular issues, impaired lung function THC/Marijuana Impaired motor coordination, drowsiness, memory Cognitive impairment (especially in teens), lung issues damage, marijuana use disorder, mental health issues CBD Drowsiness, dry mouth, dizziness Unknown long-term effects, potential liver damage, drug interactions Identify strategies to encourage behavior change in clients who use, overuse, or misuse these substances-How could you use motivational interviewing techniques and/or the nursing process to strategize care for clients? Open-Ended Questions → Encourage the client to reflect on their behavior and express their feelings Example: “What do you think would be the benefits of quitting smoking?" Affirmations → Acknowledge and reinforce the client’s strengths, efforts, and positive behaviors to build their self-efficacy Example: “I really appreciate how honest you’ve been about your drinking habits.” Reflective Listening → Demonstrate understanding and empathy by reflecting what the client has said. This helps them feel heard and encourages deeper exploration of their thoughts. Example: Client: "I’ve tried to quit smoking before, but it’s so hard." Nurse: "It sounds like quitting has been really challenging for you, but you're still considering it.” Statistics of teen substance use Alcohol 55% of high school seniors have consumed alcohol 30% report binge drinking in the past month. Tobacco 20% of teens have used e-cigarettes 8% smoke traditional cigarettes THC/Marijuana 25% of high school seniors report marijuana use in the past month _____________________________________________________________________________________________ Nutrition Describe the general nutrition concepts around which meals should be built for optimal health- eCould you identify how to guide clients using the nursing process? What are important considerations when identifying the needs of particular populations? General Nutrition Concepts Adequacy: Ensuring enough nutrients (e.g., vitamins, minerals, fiber) Moderation: Avoiding excess of unhealthy components like added sugars, saturated fats, and sodium Balance: Including a variety of foods to provide all essential nutrients (fruits, vegetables, grains, proteins, and dairy) Variety: Eating a diverse range of foods to ensure nutrient sufficiency Nursing Process for Guiding Clients (ADPIE) Assessment: Gather dietary habits, preferences, and health status Diagnosis: Identify nutrition-related issues (e.g., risk for malnutrition, overweight) Planning: Collaborate with the client to set realistic dietary goals Implementation: Educate on healthy meal planning, portion control, and food choices Evaluation: Track progress and adjust the plan based on client feedback and outcomes Describe how these general guidelines might be adapted for specific populations and improved general health Children: Emphasize calcium, iron, and fiber. Focus on healthy snacks and balanced school meals Adolescents: Ensure sufficient protein and calcium for growth. Address body image issues and peer influences on food choices Older Adults: Focus on calcium and vitamin D for bone health, B-vitamins for cognitive function, and hydration due to reduced thirst sensation Pregnant Women: Ensure folic acid intake, increase iron and calcium Individuals with Chronic Diseases (e.g., diabetes, hypertension): Follow specialized diets (low sodium, low sugar, etc.) to manage conditions Would you know how to assess if a client is experiencing food insecurity? Food insecurity is the inability to access enough food for an active, healthy life. To assess: Hunger Vital Sign → A two-question screen: "In the past 12 months, did you worry that food would run out before you had money to buy more?" "In the past 12 months, did the food you bought not last, and you didn't have money to get more?" Responses of "often true" or "sometimes true" indicate food insecurity. Components of a food label. Serving Size: Indicates the recommended portion, essential for understanding calorie and nutrient intake. Calories: Total energy in one serving. Nutritional Values: Amounts of nutrients per serving (e.g., fats, carbohydrates, protein, vitamins, and minerals). % Daily Value (%DV): Tells you how much a nutrient in a serving of food contributes to a daily diet (based on a 2,000-calorie diet). Ingredient List: Ingredients are listed in order of quantity, from most to least. Health Claims: Claims about the relationship between food and health, such as "low sodium" or "high fiber." Trauma Informed Care Define Trauma and Trauma-Informed Care Trauma: Deeply distressing event or series of events that affects mental and emotional well-being, including abuse, violence, or assault Trauma-Informed Care: Recognizes trauma’s impact and creates a safe, supportive environment that avoids re-traumatization Understand the importance of trauma-informed care: Trauma-informed care (TIC) aims to reduce the impact of emotional and psychological trauma on individuals, enhancing care and support for those affected. Recognize the role of the nurse in working with patients who have experienced trauma: Nurses should identify signs of trauma, provide empathetic care, and support recovery by using trauma-informed approaches in assessments and interactions. Could you encourage communities in ways to be trauma-informed communities? Yes, communities can be empowered to recognize and respond to trauma, creating safe, supportive environments and fostering resilience. Acquire tools to implement trauma-informed care: Nurses should integrate TIC into practices by screening for trauma, using trauma-sensitive language, and ensuring policies avoid re-traumatization. 4 R’s of Trauma Informed Care: ➔ Realize: the widespread impact of trauma and paths for recovery. ➔ Recognize: trauma symptoms in patients, families, and staff. ➔ Respond: by integrating trauma knowledge into practices. ➔ Resist: re-traumatization through careful, compassionate care. What universal precautions for those with traumatic experiences? Universal precautions include using a trauma-informed approach with all patients, providing a safe environment, and offering support or referrals when needed. _____________________________________________________________________________________________ Resilience Develop an understanding of the concept of resilience Resilience is the ability to recover from or adapt to stress, trauma, or adversity, helping individuals bounce back to a baseline or "normal" state. Have awareness of the traits that predispose to being resilient Traits include strong social connections, self-regulation, problem-solving skills, optimism, and a sense of purpose. Childhood resilience can be influenced by supportive caregivers, safe environments, and community support. Have an awareness of the traits that predispose to being resilient Strengthen resilience by fostering supportive relationships, teaching coping strategies, promoting physical and mental well-being, and encouraging community connections and empowerment. Could you identify common personal factors someone exposed to ACEs may have? Common factors include difficulty managing emotions, behavioral problems, mental health issues (e.g., depression, anxiety), poor physical health, substance abuse, and challenges in forming stable relationships. Determine the use of the Adverse Childhood Experiences (ACEs) questionnaire and what the results may indicate for the individual's health. The ACEs questionnaire screens for traumatic experiences in childhood. Higher ACE scores are linked to increased risks of physical health problems, mental health issues (e.g., depression, PTSD), substance abuse, and early mortality. Analyze protective factors for ACEs (PACEs = Protective and Compensatory Experiences). Protective factors, such as positive relationships, safe environments, community resources, and supportive interventions, can buffer against the negative effects of ACEs. Identifying these factors can help in care planning and promoting resilience. _____________________________________________________________________________________________  Culture Intelligence/Racism Discuss the importance of cultural intelligence from various perspectives (patient, administrator, researcher, provider, family) Patient: CQ builds trust, improves communication, and enhances treatment adherence. Administrator: Helps create inclusive policies and reduce disparities in care access. Researcher: Ensures inclusive, ethical research relevant to diverse populations. Provider: Facilitates patient-centered care, respecting cultural beliefs and needs. Family: Engages families in care by addressing cultural concerns. Explain how the Culturally and Linguistically Appropriate Services relate to health and health care disparities-How would you protect someone who has unique cultural considerations? i.e. non-English speaking in the US CLAS Overview: CLAS standards ensure healthcare services are culturally and linguistically appropriate for diverse populations. This includes offering language assistance, cultural training for staff, and developing accessible materials. Relation to Health Disparities: CLAS helps reduce health disparities by making healthcare accessible to those with limited English proficiency and other cultural needs, ensuring equitable care. 4 C’s Cultural Assessment ➔ What the patient calls their illness ➔ How they cope with it ➔ Concerns regarding the illness ➔ Causes of the illness Protecting Unique Cultural Considerations ➔ Provide language assistance (interpreters) ➔ Avoid using untrained individuals or minors as interpreters ➔ Provide written materials in the patient’s preferred language ➔ Educate staff on cultural competency to avoid miscommunication and enhance care delivery Understand how social determinants of health contribute to wide health disparities and inequities in areas such as economic stability, education quality and access, healthcare quality and access, neighborhood and built environment, and social and community context. Economic Stability: Low income and unemployment are linked to poorer health outcomes due to limited access to resources like healthy food, safe housing, and healthcare. Education Quality and Access: Poor education levels are associated with poorer health, higher stress, and lower health literacy. People with low education are less likely to engage in preventive care. Healthcare Quality and Access: Disparities in access to quality healthcare, especially among marginalized populations, lead to worsened health outcomes (e.g., delayed diagnoses, less preventive care). Neighborhood and Built Environment: Unsafe neighborhoods, poor housing, and lack of access to parks and transportation contribute to higher rates of chronic conditions, such as heart disease and diabetes. Social and Community Context: Strong social support networks improve health. Conversely, social isolation, discrimination, and exclusion increase stress and contribute to poor health outcomes, particularly for racial and ethnic minorities. Note: Health disparities are deeply tied to social determinants of health. Addressing economic stability, education, healthcare access, and social environment can reduce inequities. Understand ethnocentrism and its defining components Ethnocentrism: refers to the belief that one’s own culture or group is superior to others and the tendency to view other cultures from the perspective of one’s own. It can create barriers to understanding and respect across different cultural groups. Key Components ➔ Cultural Superiority: Believing your own cultural practices are the "correct" or "normal" way. ➔ Cultural Isolation: Viewing your culture as the standard, often disregarding the validity of other cultural norms and practices. ➔ Impact on Healthcare: Ethnocentrism can lead to misunderstandings, stereotyping, and failure to provide culturally appropriate care. Discuss various frameworks used to explain health and healthcare disparities Socio Ecological Model: Explains how multiple levels of influence (individual, interpersonal, community, and societal) interact to shape health outcomes. Critical Race Theory: Focuses on how racism and historical inequalities shape health disparities and access to healthcare. Social Determinants Framework: Explores how factors like income, education, and environment contribute to health disparities. Understand ableism and disparities role in health disparities Ableism: refers to discrimination or prejudice against individuals with disabilities. This can lead to unequal access to healthcare, inadequate accommodations, and health disparities. Health Impacts: People with disabilities often face higher rates of chronic conditions and poorer health outcomes due to limited access to care, lack of appropriate medical accommodations, and healthcare provider bias. Achieve understanding of how racism impacts long term health Chronic Stress: Exposure to racial discrimination leads to chronic stress, which can elevate blood pressure, increase inflammation, and contribute to conditions like hypertension, heart disease, and diabetes. Health Mistrust: Racial minorities may distrust healthcare systems due to historical abuses (e.g., Tuskegee study), leading to delays in seeking care, lower participation in preventive services, and worse health outcomes. Utilize CLAS in nursing practice CLAS Standards: Nurses should apply the 15 CLAS standards to ensure culturally and linguistically appropriate care. This includes providing interpretation services, training staff on cultural competence, and developing accessible healthcare materials. Apply nursing practices such as assessment, health promotion, access to care, and patient teaching support as ways to improve health outcomes while utilizing cultural humility Cultural Humility in Nursing Practice: Nurses should continually self-reflect, learn about the cultures of their patients, and recognize their own biases. Health Promotion: Nurses should provide culturally tailored health promotion and education materials to support patients in managing their health. Access to Care: Ensure equitable access to healthcare by removing barriers related to language, cultural understanding, and socioeconomic factors. Patient Teaching: Nurses should use culturally appropriate teaching methods, including family involvement, visual aids, and language assistance, to improve health literacy and outcomes. _____________________________________________________________________________________________ Levels of Prevention Understand the concept of levels of prevention Levels of Prevention (LOP) refer to the strategies used to prevent diseases or health issues at different stages: before, during, or after they occur. They are aimed at promoting overall health and reducing the burden of disease. Differentiate among the three levels of prevention. Would you be able to determine which LOP if given an example? Primary Prevention: Goal: Prevent the onset of disease or injury before it occurs. Interventions: Focus on health promotion and risk reduction. Examples: Vaccination programs Health education on healthy eating Regular exercise campaigns Smoking cessation programs Secondary Prevention Goal: Detect and treat disease early to prevent progression. Interventions: Early detection and prompt intervention for those at risk or in the early stages of a disease. Examples: Screenings (e.g., mammograms, blood pressure checks, cholesterol screenings) Early treatment for high blood pressure or diabetes Regular check-ups for early detection of cancer Tertiary Prevention Goal: Manage and reduce the impact of an established disease or injury. Interventions: Focus on rehabilitation, preventing complications, and improving quality of life for those with chronic diseases. Examples: Rehabilitation programs for stroke or heart attack patients Physical therapy after surgery or injury Chronic disease management (e.g., diabetes management, cancer treatment) Apply the three levels of prevention to patient interventions and service provision across the lifespan Primary Prevention across the Lifespan Infancy/Childhood: Immunizations, breastfeeding promotion, child safety education. Adolescence: Anti-smoking campaigns, safe driving programs, education on mental health and substance use prevention. Adulthood: Lifestyle changes for heart disease prevention, weight management, exercise promotion, smoking cessation. Older Adults: Fall prevention programs, nutrition counseling, screening for chronic conditions (e.g., diabetes, hypertension). In Short → Primary Prevention aims to prevent disease before it starts (health promotion, vaccinations, education). Secondary Prevention across the Lifespan Infancy/Childhood: Newborn screenings (e.g., hearing, metabolic disorders), vision tests. Adolescence: Screenings for STIs, depression, substance abuse. Adulthood: Blood pressure checks, cholesterol screening, mammograms, cancer screenings (e.g., colonoscopy). Older Adults: Bone density tests, cancer screenings, annual check-ups for chronic conditions. In Short → Secondary Prevention focuses on early detection and treatment of disease (screenings, early interventions). Tertiary Prevention across the Lifespan Infancy/Childhood: Rehabilitation for developmental disorders, management of chronic conditions (e.g., asthma). Adolescence: Rehabilitation for injuries or accidents, mental health treatment for diagnosed conditions. Adulthood: Management of diabetes, stroke rehabilitation, cancer treatment, pain management for chronic conditions. Older Adults: Rehabilitation after surgery or injury, management of dementia, palliative care for terminal illnesses. In Short → Tertiary Prevention involves managing and improving the quality of life for those with chronic or long-term health issues (rehabilitation, disease management). _____________________________________________________________________________________________  Health Screening Objectives and Importance of Screening The primary objective of screening is to identify individuals at risk for specific diseases or conditions early, allowing for timely intervention to prevent progression and improve health outcomes. Screening helps in detecting diseases before symptoms appear, facilitating early treatment and better prognosis Types of Screening Universal Screening: For all individuals in a specific population (e.g., newborn screenings, blood pressure checks). Targeted Screening: For individuals at higher risk due to age, family history, or other risk factors (e.g., mammograms for women over 40, cholesterol screening for those with family history). Advantages and Disadvantages of Screening Advantages ➔ Early detection of disease ➔ Improved prognosis and quality of life with early treatment ➔ Reduced healthcare costs by preventing advanced disease Disadvantage ➔ False positives ➔ Overdiagnosis or labeling of individuals who may not develop the disease ➔ Psychological stress or anxiety related to screening results Sensitivity and Specificity Sensitivity: The ability of a test to correctly identify those who have the disease (true positives). High sensitivity means fewer false negatives. Specificity: The ability of a test to correctly identify those who do not have the disease (true negatives). High specificity means fewer false positives. False Positive: A test result that incorrectly suggests the presence of a disease. False Negative: A test result that incorrectly suggests the absence of a disease. Limitations and Implications of Screening Screening tests have limitations such as potential false positives and false negatives, and they may not detect all cases of a disease, especially in its early stages. Over-screening or unnecessary tests can lead to harm, increased healthcare costs, and anxiety for patients. The implications of screening should be considered, balancing the benefits of early detection with the risks of false results and overdiagnosis. _____________________________________________________________________________________________  Models/Theories Discuss why theory is used in nursing health promotion interventions Theory provides a systematic framework for understanding health behaviors, guiding the development of effective interventions, and evaluating their success. It helps predict and explain behaviors, ensuring that interventions are based on proven concepts, making them more likely to succeed. Describe and apply ecological models The Ecological Model views health behavior as influenced by multiple levels of interaction: Intrapersonal: Individual factors like knowledge, attitudes, and beliefs. Interpersonal: Social support from family, friends, and peers. Institutional: Organizational policies and practices that support or hinder health behaviors. Community: Norms, networks, and social structures. Public Policy: Laws or regulations that affect health behaviors. Application: When promoting healthy eating, interventions should target not only the individual (e.g., knowledge) but also social support (e.g., family), institutional factors (e.g., school policies), and public policy (e.g., nutrition regulations). Describe individual-level models and theories including the Health Belief Model (HBM) Health Belief Model: Focuses on individuals’ perceptions of risk, severity, benefits, and barriers to health actions. Self-Efficacy: (confidence in ability to act) is central to HBM. Application: If promoting condom use, assess the client’s perceived susceptibility to STIs and their self-efficacy in using condoms correctly. Apply individual-level theories to interventions and client-based cases Individual-level models focus on the psychological, cognitive, and emotional factors influencing health behavior. Key theories include: Health Belief Model: Focuses on individuals’ perceptions of risk, severity, benefits, and barriers to health actions. ➔ Self Efficacy (confidence in ability to act) is central to HBM ➔ Application: If promoting condom use, assess the client’s perceived susceptibility to STIs and their self-efficacy in using condoms correctly. Strengths: Focuses on changing individual attitudes and behaviors, useful in health education. Weaknesses: Can ignore larger systemic and environmental factors affecting health, like access to care or social inequalities. Transtheoretical Model (Stages of Change): Describes behavior change as a process across five stages: ➔ Precontemplation, Contemplation, Preparation, Action, Maintenance ➔ Application: For smoking cessation, assess the client’s stage (e.g., precontemplation or action) to tailor interventions accordingly. Strengths: Useful in guiding stage-based interventions for behavior change. Weaknesses: May oversimplify complex health issues, ignoring external determinants like environment or social support. Theory of Reasoned Action/Planned Behavior (TRA/TPB): Focuses on intentions and perceived control: ➔ Intention: Likelihood of behavior. ➔ Attitude: Belief about outcomes of behavior. ➔ Subjective Norms: Perceived social approval.  ➔ Perceived Behavioral Control: Confidence in ability to control behavior. ➔ Application: When promoting exercise, enhance intentions by addressing attitudes, social norms, and perceived control over exercise. Strengths: Provides insight into intentions and motivation, helping predict behaviors. Weaknesses: Focuses mainly on individual intentions and may not address broader social or economic barriers. Applying Individual-Level Theories to Interventions ➔ Use Health Belief Model to educate individuals about the risks of smoking and the benefits of quitting, while also addressing perceived barriers (e.g., withdrawal symptoms). ➔ In the Transtheoretical Model, assess the client’s readiness to change smoking behavior, offering tailored interventions based on their stage (e.g., motivational interviewing for contemplation, action plans for preparation). ➔ Apply Theory of Reasoned Action by influencing attitudes toward exercise (e.g., by highlighting benefits), adjusting perceived norms (e.g., group exercises), and boosting perceived control through small, achievable goals. Discuss and apply the 5 A's framework Ask: Assess health behaviors. Advise: Provide clear, personalized advice Assess: Evaluate readiness to change Assist: Offer resources and support Arrange: Plan follow-up for continued support Example of Application: Use the 5 A’s for smoking cessation: Ask about smoking habits, Advise on quitting methods, Assess readiness to quit, Assist with strategies (e.g., nicotine replacement), and Arrange follow-up appointments. _____________________________________________________________________________________________ Drivers of Health/SDOH Discuss the Importance of Cultural and Determinants of Health (DOH) from Various Perspectives: Cultural factors and Determinants of Health (DOH) are essential in shaping the health outcomes of individuals and populations. Cultural influences, such as beliefs, values, and practices, affect health behaviors, perceptions of illness, and healthcare utilization. For example, certain cultures may prioritize family support in managing illness, while others may focus on individual autonomy. These cultural nuances influence how people engage with health promotion activities, healthcare systems, and adhere to health interventions. What Are the Most Influential Determinants of Health Outcomes? Social Determinants Income and Social Status: Higher income and social status generally correlate with better health outcomes due to greater access to resources, healthier living environments, and better healthcare. Education: People with higher levels of education are more likely to engage in health-promoting behaviors and have better health literacy, leading to better health management. Social Support Networks: Having strong relationships with family and peers can mitigate stress, encourage healthy behaviors, and provide assistance in managing health conditions. Environmental Factors Housing and Living Conditions: Safe and stable housing improves physical and mental health. Poor housing conditions, such as overcrowding or exposure to environmental hazards, can increase the risk of chronic illness and injury. Access to Clean Water and Air: Environmental factors like pollution, toxins, and poor water quality significantly contribute to health disparities. Behavioral Factors Lifestyle Choices: Behaviors such as diet, physical activity, smoking, and alcohol use play a critical role in long-term health outcomes. These behaviors are often influenced by cultural norms and social environments. Healthcare System Access/Quality of Healthcare: Availability of timely and affordable healthcare services, along with the quality of care, is a major determinant of health outcomes. Cultural competence in healthcare delivery also plays a key role in reducing disparities and improving engagement with healthcare. Appraise Determinants of Health According to Various Levels of Influence The Determinants of Health (DOH) can be assessed across multiple levels of influence, highlighting the complexity of how factors interact to shape health outcomes: Intrapersonal Level (Individual): Factors like genetics, age, gender, and individual behaviors (e.g., smoking, diet, physical activity) are the most direct influences on health outcomes. Interpersonal Level: Social relationships with family, friends, and peers can provide emotional support, influence health behaviors, and affect access to resources. Social support networks can act as both a protective and risk factor. Institutional Level: Policies and organizational practices at schools, workplaces, and healthcare systems shape access to resources, services, and opportunities for health promotion. Examples include workplace wellness programs, school nutrition policies, or healthcare regulations. Community Level: Social norms, networks, and group dynamics at the community level can influence behaviors like exercise, nutrition, and substance use. Community-based initiatives or collective action can have a significant impact on health outcomes. Public Policy and Societal Level: Local, state, and national policies play a major role in determining health outcomes. Examples include health insurance regulations, healthcare funding, urban planning, environmental policies, and laws around tobacco or alcohol use. _____________________________________________________________________________________________  IPV Define intimate partner violence Intimate Partner Violence (IPV) refers to a pattern of abusive behaviors by one partner to gain or maintain power and control over another intimate partner. These abusive behaviors can include physical, sexual, emotional, economic, psychological, or technological actions, as well as threats or other forms of coercion. IPV often involves intimidation, humiliation, manipulation, isolation, and terrorization of the victim. Describe the epidemiology of violence, including risk and protective factors Prevalence ➔ 41% of women and 26% of men experience IPV in their lifetime. ➔ 16 million women and 11 million men experience IPV before age 18. ➔ IPV results in nearly 1,300 deaths and 2 million injuries each year in the U.S. ➔ Lower socioeconomic status, disability, and certain minority statuses (e.g., Black women, LGBTQ+ individuals) are higher-risk groups. ➔ Disabled individuals, transgender and non-binary people, and women in immigrant populations face additional challenges when it comes to IPV and seeking help. Risk Factors ➔ History of abuse (either as victim or perpetrator) ➔ Substance abuse and mental health issues ➔ Socioeconomic stress (poverty, unemployment) ➔ Isolation from family and community ➔ Cultural factors (e.g., societal acceptance of violence, gender inequality) Protective Factors ➔ Supportive relationships ➔ Economic stability and access to resources ➔ Education and awareness programs ➔ Access to healthcare and legal services ➔ Social support networks Critique theoretical approaches to intimate partner violence Power and Control Theory: This theory emphasizes the abuser's need for control over the victim through various forms of abuse. IPV is seen as a method of domination and subjugation in a relationship. Cycle of Violence Theory: This theory explains the recurring nature of IPV, where abusive behavior follows a pattern of tension building, an acute violent episode, and a honeymoon phase. Over time, the cycle becomes more frequent and severe. Ecological Model: The ecological model considers multiple levels of influence on IPV, including individual, relationship, community, and societal factors. It looks at the interactions between the individual and their environment. Social Learning Theory: Suggests that violence is learned through exposure to violent behavior in the home or community, and is perpetuated through social interactions and norms. Feminist Theory: Focuses on the role of gender inequality in IPV, asserting that patriarchy and traditional gender roles contribute to the perpetration of violence against women in intimate relationships. Discuss primary, secondary and tertiary interventions addressing intimate partner violence Primary Prevention Aimed at stopping IPV before it starts through education and societal changes. Example: Community education programs on healthy relationships, gender equality, and non-violent conflict resolution. Secondary Prevention Early detection and intervention to prevent further harm. Example: Screening for IPV in healthcare settings, emergency departments, and OB-GYN clinics. Immediate intervention strategies like safety planning and referrals to shelters or legal services. Tertiary Prevention Aimed at minimizing long-term consequences for survivors. Example: Ongoing mental health care, support groups, and access to housing and employment resources for survivors. What are some considerations from the presentation in class? i.e. times someone tries to leave before actually leaving, strangulation, gun violence, etc. Escalating Danger: Victims often attempt to leave an abusive relationship several times before successfully leaving. The period immediately after leaving is particularly dangerous due to the increased likelihood of violence, including strangulation or homicide. Strangulation: One of the most lethal forms of IPV, often a precursor to eventual murder. Victims of strangulation are at a significantly higher risk for future fatal violence by their partner. Gun Violence: The presence of firearms in IPV situations greatly increases the likelihood of homicide. It is important to assess whether a partner has access to guns during IPV screening. Leaving the Relationship: Many victims experience barriers to leaving due to financial dependence, fear of retaliation, lack of social support, or cultural factors such as stigma around divorce or separation. What are some factors many receivers of IPV/DV have in common? ➔ Fear and Isolation: Victims often feel socially isolated, both physically and emotionally, from family and friends. ➔ Low Self-Esteem: IPV victims commonly have low self-worth and may be emotionally manipulated to feel they are to blame for the abuse. ➔ Chronic Stress and Trauma: Many victims experience complex trauma due to ongoing violence, which can lead to symptoms of PTSD and depression. ➔ Economic Dependency: Many victims, especially women, face financial dependency on the abuser, making it difficult to leave or seek help. ➔ Children in the Home: Many victims are concerned about the safety and well-being of their children, which can complicate the decision to leave. IPV Screening and Responses Screening ➔ All patients should be screened for IPV, especially in healthcare settings like OB/GYN, ER, and urgent care. ➔ Use a private, nonjudgmental approach to screen for IPV. ➔ Employ tools like the Lethality Assessment Protocol (e.g., asking about weapons, jealousy, or threats of death). Trauma-Informed Care ➔ Always prioritize safety and confidentiality. ➔ Use a strengths-based approach, focusing on empowering the patient and respecting their autonomy in decisions. ➔ Avoid re-traumatization by explaining procedures and obtaining consent before taking any action. Reporting Duties Mandated Reporting ➔ IPV not involving children or vulnerable adults generally is not mandated for reporting. However, abuse involving children, elderly adults, or vulnerable individuals requires reporting to authorities (e.g., CPS). ➔ Gunshot wounds, stab wounds, and other injuries from suspected crimes must be reported to law enforcement. _____________________________________________________________________________________________ Exercise Define exercise for populations. Exercise: Exercise is any physical activity that is planned, structured, and performed with the goal of improving or maintaining physical fitness, health, and overall well-being. Discuss the benefits of exercise including prevention for chronic illness/diseases Lower risk of all-cause mortality, cardiovascular disease mortality, developing hypertension, developing type 2 diabetes, and developing several cancers. Describe exercise recommendations for children, adolescents, adults, and pregnant women Preschool-Aged Children: Everyday throughout the day via active play Children and Adolescents: ages 6-17: 60 mins (1hr) or more of moderate-to-vigorous physical activity daily Adults: 150 mins (2hrs 30mins) a week of moderate intensity, or 75-150 mins a week of vigorous/intensity aerobic physical activity, or an equivalent combination of moderate and vigorous-intensity aerobic activity. Older Adults: When older adults can no longer do 150 mins of moderate-intensity aerobic activity a week because of chronic conditions, they should be physically active as their abilities and conditions allow. Pregnancy and Postpartum: 150 mins of moderate-intensity aerobic activity a week during pregnancy and the postpartum period. Describe how to measure exertion in adults and children BORG Score: Scale (6-20) to gauge perceived exertion. It is a scale of 6-20 to estimate HR. Multiple BORG Score by 10 for approx HR for particular activity. Moderate Activities: 11-14 Vigorous Activities: 15 or higher Discuss behavioral counseling for increasing exercise and steps to help assure success Behavioral counseling for increasing exercise helps individuals set achievable goals, overcome barriers, and build lasting habits through support and motivation. Key steps for success include goal setting, regular follow-ups, and self-monitoring to track progress. Describe components of an exercise (FITT) prescription The FITT prescription is tailored to an individual's fitness level and goals to create an effective exercise program. It includes four key components: Frequency → How often Intensity → How hard Time → Duration Type → Form of exercise _____________________________________________________________________________________________ Nurse Health/Wellbeing and Self-Care Plan Understand the importance of a self- care plan. ➔ A self-care plan is essential for maintaining physical, emotional, and mental well-being, especially in high-stress fields like nursing. It helps prevent burnout, improves resilience, and enhances overall health. ➔ Benefits: Reduces stress, boosts energy, increases job satisfaction, and fosters a sense of balance between work and personal life. Can you identify ways to practice self-care in your personal life? ➔ Physical: Regular exercise, healthy eating, adequate sleep, hydration. ➔ Emotional: Setting boundaries, practicing mindfulness, engaging in hobbies. ➔ Mental: Continuing education, reading, solving puzzles, managing time effectively. ➔ Social: Spending time with loved ones, social support networks, setting boundaries in relationships. ➔ Spiritual: Meditation, prayer, connecting with nature, engaging in activities that align with personal values. Utilize the wellness literature and synthesize the findings. ➔ Wellness Literature highlights strategies for physical, emotional, and mental health improvement. Research shows a balanced lifestyle, including regular exercise, healthy nutrition, social connections, and stress management, significantly improves overall wellness. ➔ Evidence: Studies indicate mindfulness practices, like deep breathing and meditation, reduce stress and improve cognitive function. Develop an evidence-based plan to promote health. Plan: Incorporate exercise (30 minutes, 3-5 times/week), balanced nutrition (whole foods, reduce processed foods), and stress management (daily mindfulness or meditation). SMART Goals: Set Specific, Measurable, Achievable, Relevant, and Time-bound goals, e.g., “Walk 20 minutes daily for the next 2 weeks.” Apply interventions to improve one area of your personal wellness and health. Choose one wellness area (e.g., physical health). Intervention: Start a 20-minute daily walk and gradually increase the duration. Considerations: Include social support (exercise with a friend), ensure it’s realistic for your schedule, and monitor progress. What are some appropriate considerations to develop a self-care plan? Time: Ensure interventions fit your schedule and lifestyle. Resources: Identify available resources, such as community support or online tools. Support: Engage family, friends, or a support group for encouragement and accountability. Realism: Set goals that are achievable and allow for flexibility. To instruct you in the nursing process, which provides a context for how we teach you to “think like a nurse”. The nursing process (assessment, diagnosis, planning, implementation, evaluation) is used to assess self-care needs, create a plan, and monitor progress. Assess: personal wellness and identify areas for improvement. Diagnose: (e.g., stress overload, poor nutrition). Plan: self-care strategies (e.g., exercise, sleep). Implement: the plan and monitor progress. Evaluate: effectiveness and adjust as needed. Evaluate and reflect on the self-care plan successes and areas for improvement. Successes: Did you meet your goals (e.g., increased exercise, better sleep)? Improvements: What barriers did you face (e.g., time constraints, stress)? How can you adjust the plan to overcome these? Reflection: Regularly reassess and adjust the plan as needed to maintain balance and improve overall wellness. _____________________________________________________________________________________________ MI/Shared Decision Making Define shared decision making Shared decision making is a collaborative process where clinicians and patients work together to make healthcare decisions. It involves the clinician providing information about treatment options and the patient expressing their preferences and values, ensuring both are involved in the decision-making process Discuss the role of health coaching in personalizing behavioral change Health Coaching helps patients set individualized health goals, identify barriers, and develop strategies for behavior change. Personalization: Health coaches tailor interventions to the patient’s specific needs, lifestyle, and motivations, making behavioral change more achievable and sustainable. Define Motivational Interviewing (MI) Motivational Interviewing (MI) is a patient-centered, directive counseling approach designed to enhance motivation to change. It focuses on exploring and resolving ambivalence to promote positive health behavior changes. Core Elements: MI is based on the principles of partnership, acceptance, evocation, and compassion, with the patient being viewed as the expert on their own life List 3 ways MI assists health care workers (i.e., the "MI guarantee") 1. MI helps overcome resistance and ambivalence, allowing healthcare workers to engage patients more effectively. 2. MI fosters empathy and enhances rapport, helping healthcare workers better understand patients' perspectives. 3. By focusing on collaboration and patient-centered care, MI reduces clinician frustration and enhances job satisfaction. Social Cognitive Theory Emphasizes the role of observational learning, social influences, and self-regulation in behavior change. It suggests that individuals learn by observing others and are influenced by their environment, personal factors, and behaviors. Key Points → Self-efficacy (confidence in one's ability to change), observational learning, and the dynamic interaction between personal, behavioral, and environmental factors. _____________________________________________________________________________________________ Health Education/Literacy Analyze the goals of health education Goal: To improve health literacy and help individuals, families, and communities achieve optimal health by providing tools for informed health decisions and voluntary behavior changes. Focus: Promoting health, preventing disease, and improving the quality of life through education-driven behavior change. Discuss learning principles that affect health education Considerations: ➔ Developmental stage (age and cognitive ability) ➔ Cognitive level (knowledge and learning capacity) ➔ Individual interests and learning styles (visual, auditory, kinesthetic) ➔ Health literacy (ability to understand and use health information) ➔ Cultural beliefs and communication styles (how to approach education effectively based on cultural context) Apply strategies to promote health literacy to a wide variety of populations Plain Language: Use simple, common language for medical terms (e.g., "high blood pressure" instead of "hypertension"). Teach-Back Method: Ask the patient to repeat information in their own words to confirm understanding. Visual Aids: Use pictures, diagrams, and multimedia to supplement information. Create a Shame-Free Environment: Avoid judgment and make sure the learner feels comfortable asking questions. Assessment: Regularly assess the learner's understanding, especially for high-risk groups (elderly, minorities, immigrants). Describe the domains of learning and associated teaching strategies Cognitive Domain (Thinking) Focus: Memory, problem-solving, and decision making Teaching Strategies: Lectures, discussions, discovery, role modeling, and simulations Example: "By discharge, the patient will describe three types of exercise to do at home." Affective Domain (Feeling) Focus: Attitudes, values, feelings, and emotions. Teaching Strategies: Role modeling, discussion, and personal reflection. Example: "By discharge, the patient will express two positive feelings about engaging in exercise." Psychomotor Domain (Doing) Focus: Physical skills like movement, dexterity, strength, and coordination. Teaching Strategies: Demonstrations, practice, and hands-on activities. Example: "By discharge, the patient will demonstrate two exercises for home care." Writing SMART Objectives/Goals Specific - Measurable - Achievable - Time-bound Example: "By the end of the session, 75% of students will correctly write a SMART objective about hygiene for a school wellness fair." Teaching Plan Development & Evaluation Assess Learner Needs Developmental stage, literacy level, cultural factors, learning style. Example: Assess the learner’s health literacy, education level, and cultural background. Develop SMART Outcome Objectives Define clear, measurable goals (e.g., "By discharge, the patient will demonstrate proper inhaler technique"). Implement Teaching Plan Choose appropriate content and strategies based on the domain of learning (cognitive, affective, psychomotor). Evaluate Learning Methods: Return demonstration, surveys, pre/post tests, teach-back. Example: Teach-back: “Can you show me how to take this medication?” Determining Teaching Topics Assess Learner Needs: Begin by evaluating the learner's health status, cultural background, literacy level, and specific learning needs. For example, if you're teaching a diabetic patient, the topic might be insulin administration or blood sugar monitoring. Identify Learning Objectives: Define clear, measurable outcomes that align with the learner's needs. Use SMART objectives (Specific, Measurable, Achievable, Relevant, Time-bound). Example: "By the end of this session, the patient will demonstrate proper insulin injection technique." Prioritize Topics: Focus on the most critical health issues or skills that are necessary for the patient’s well-being or discharge plan. Example: For a post-surgical patient, you might prioritize pain management and wound care. Teaching Methods to Best Teach the Topics Cognitive Domain: Use lectures, reading materials, and discussions for teaching information that requires thinking and understanding (e.g., explaining the purpose of medications or diet changes). Affective Domain: Incorporate role modeling, personal reflection, and group discussions to address attitudes, feelings, and values. For example, discussing the emotional impacts of chronic illness or the importance of self-care. Psychomotor Domain: Use demonstrations, hands-on practice, and return demonstrations. For example, demonstrating and practicing proper hand hygiene or using medical equipment (e.g., inhalers, blood glucose monitors). Multimodal Approaches: Combine methods when appropriate (e.g., demonstrate the procedure, then ask the patient to repeat the steps themselves). How can you promote health literacy in the nursing role: i.e.: return demonstration, teach back Use Plain Language: Avoid medical jargon and use simple, everyday language to explain health concepts. For example, use "high blood pressure" instead of "hypertension" and "low blood sugar" instead of "hypoglycemia." Teach-Back Method: This is a critical tool to assess and confirm understanding. After explaining a topic, ask the patient to explain it back to you in their own words. This helps identify areas of confusion and ensures comprehension. Example Script → "I want to make sure I explained everything clearly. If you were trying to explain how to take your medicine to a family member, how would you say it?" Visual Aids: Supplement verbal instruction with visual tools like diagrams, pictures, or videos. For example, show a diagram of the body’s circulatory system to explain how high blood pressure affects the heart. Use Written Materials with Pictures: Offer written handouts with simple, easy-to-read instructions, and include visuals. This can help reinforce learning, especially for those with low literacy. Cultural Sensitivity: Tailor your teaching to the patient’s cultural beliefs and practices. For example, if working with a patient from a non-English-speaking background, ensure information is translated, and be aware of cultural health beliefs. Create a Shame-Free Environment: Establish trust by avoiding judgment. For example, never assume someone doesn’t understand based on their appearance. Instead, assess their literacy level by asking open-ended questions and using strategies like teach-back. How would you assess their literacy? Ask Direct Questions: Ask patients about their comfort level with reading or understanding medical instructions. For example, "Do you feel confident reading your medication labels?" Observe Patient Behavior: Be mindful of signs that a patient may have difficulty with literacy, such as avoiding reading instructions, not asking questions, or showing confusion about medications or treatment instructions. Use Screening Tools: Use validated health literacy screening tools like the REALM (Rapid Estimate of Adult Literacy in Medicine) or TOFHLA (Test of Functional Health Literacy in Adults) to assess literacy levels. Ask for Teach-Back: After providing instructions, ask patients to explain or demonstrate back what they’ve learned. This confirms their understanding of both health concepts and literacy.  Example of Assessing Literacy You are teaching a patient about insulin administration. After demonstrating how to inject insulin, ask them to show you how they would do it themselves. This not only assesses their skill but also confirms whether they understand the instructions. _____________________________________________________________________________________________ Toddler/Preschool Objective Toddler (1-3yrs) Preschool (3-5yrs) Analyze Developmental Tasks Developmental Tasks: Developmental Tasks: Initiative vs. Guilt & Behavioral Indicators Autonomy vs. Shame & Doubt Cognitive: Cognitive: Preconceptual to intuitive thought (magical thinking, Sensorimotor to preoperational (imitation, parallel egocentrism) play) Physical: Physical: Riding tricycles, cutting with scissors, dressing Walking, running, stacking blocks independently Behavioral Indicators - Increased independence - Mastering self-care tasks (dressing, brushing - Tantrums teeth) - Self-feeding; language development - Complex motor skills, (50-1200 words receptive, 20-270 words - Social play (associative play) expressive) Nutritional Needs, Activity & - Nutritional Needs: Parents decide what to Nutritional Needs: Sleep Patterns serve, children decide how much to eat. Balanced meals, potential for lactose intolerance or - Limit milk to