Fundamentals Of Nursing PDF

FUNDAMENTALS OF NURSING CHAPTER 5: CONCEPT OF MAN HEALTH AND ILLNESS -​ Brain- Abstract reasoning, Language, Introspection, MAJOR ATTRIBUTES OF MAN Erect body carriage, Driven by instinct to survive,...

FUNDAMENTALS OF NURSING CHAPTER 5: CONCEPT OF MAN HEALTH AND ILLNESS -​ Brain- Abstract reasoning, Language, Introspection, MAJOR ATTRIBUTES OF MAN Erect body carriage, Driven by instinct to survive, reproduce and thrive Man- territorial -​ Basic needs -​ we belong to our family because we feel safe -​ Born to live and destined to die atomistic being, thinking and rational being. -​ Like all other man -​ has the ability to communicate. -​ Is unique, but like some other men. 2.​ Psychological being- man is like no other man 3.​ Social being- man is like some other man. ​ 4.​ Bio psychosocial and spiritual being who is in constant contact with the environment- Roy MAJOR ATTRIBUTES OF HUMAN BEING 5.​ Man is unique- different genetic and life experiences 6.​ Man is an open system in constant interaction with 1.​ Brain- capacity to think or conceptualize or a changing environment- Roy conceptualize on the abstract level. 7.​ Man is a unified whole composed of parts which are 2.​ Body shape to help survive hot and cold climate. interdependent and interrelated with each other - 3.​ Walking upright. Rogers 4.​ Family formation. 8.​ Man- composed of parts which are greater than and 5.​ Tendency to seek and maintain territory. different from the sum of all his parts. - Rogers 6.​ Social life- social network 9.​ Man is composed of subsystems and 7.​ Wear clothing suprasystems- Rogers 8.​ The ability to use language, verbal symbols as 10.​ Man is an individual with vital reparative language, a men s of developing and maintaining processes to deal with diseases an desirous of culture. health. -Nightingale 11.​ Man is a unity who can be viewed as functioning APPROACHES IN STUDYING MAN biologically, symbolically and socially and who 1.​ Atomistic approach- cells, tissues, organs, body institutes and performs self-care activities on own structures. behalf in maintaining life, health and well-being. 2.​ Holistic Approach - all living organisms are -Orem interacting unified whole that are more than some of 12.​ Man is a whole, complete, and independent being his parts. who has 14 fundamental needs. -Henderson -When you take care you are not only thinking about pain, but Henderson’s 14 basic needs how the person copes and how it perceives pain. 1)​ Breathe 2)​ Eat and drink SYSTEM 3)​ Eliminate Closed- or subordinate 4)​ Move and maintain posture -​ totally isolated from the other system 5)​ Sleep -​ doesn’t allow stimuli to enter it’s system nor allow 6)​ Dress and undress from within to go out from it’s systems boundaries. 7)​ Maintain body temperature Open- or Supra ordinate 8)​ Keep clean -​ man’s interaction with the environment. 9)​ Avoid danger -​ all forms of stimuli (Input) can enter inside it’s system 10)​ Communicate boundaries and allow anything from within (output) 11)​ Practice faith to go out from it’s system boundaries. 12)​ Find purpose in work -​ All living systems(human, animals are an open 13)​ Engage in recreation ​ system about since their survival depends on the constant exchange of energy, NURSING CONCEPTS OF MAN 1.​ Man as a biological being:cells ,Tissues, Organ, Organ systems Which makes him function as a human being FUNDAMENTALS OF NURSING -​ Health has also been defined in terms of role and performance. In 1953, the US. President's Commission on Health Needs of the Nation- made the statement "Health is not a condition; it is an adjustment. -​ It is not a state but a process. -​ The process adapts the individual not only to our physical but also our social environments" Acc. To The American Nurses Association- in its social policy statement (2010) states, "Health and illness are human experiences. -​ The presence of illness does not preclude health, nor does optimal health preclude illness" 14)​ Learn and discover Health- is a highly individual perception. Many people define and describe health as the following CONCEPT OF HEALTH 1.​ Being free from symptoms of disease and pain as -​ complete state of physical, mental, and social well much as possible being 2.​ Being able to be active and to do what they want or -​ Ability to maintain normal roles must -​ Developmental and behavioral potential is realized to 3.​ Being in good spirits most of the time. fullest extent possible -​ Striving toward optimal functioning These characteristics indicate that health is not something that -​ Personal definitions of health (individual perception of a person achieves suddenly at a specific time. It is an ongoing health) process-a way of life-through which a person develops and -​ Some individuals believe they are healthy even encourages every aspect of the body, mind, and feelings to though they have physical impairments +++ interrelate harmoniously as much as possible Traditionally: health- defined in terms of the presence or absence of disease. WELLNESS AND WELL-BEING Acc. To Florence Nightingale (1860/1969)- defined health as OLOF/ Optimum level of function- High level wellness a state of being well and using every power the individual Wellness- state of well being possesses to the fullest extent. -​ Basic aspects of wellness: -​ self-responsibility Acc. To World Health Organization (WHO) (1948)- takes a -​ an ultimate goal more holistic view of health. -​ a dynamic, growing process -​ health as "a state of complete physical, mental, and -​ dynamic physical, mental, social, and spiritual well social well-being, and not merely the absence of being that enable the person to achieve full potential disease or infirmity. and enjoyable life. -​ This definition reflects concern for the individual as a total person functioning physically, psychologically, Well-being - subjective perception of vitality and feeling well and socially. -​ Can be described objectively, experienced and measured. Mental processes- determine people's relationship with their -​ Can be plotted on a continuum. physical and social surroundings, their attitudes about life, and -​ It is a component of health. their interaction with others. BASIC COMPONENTS OF WELLNESS People's lives, and therefore their health, are affected by Anspaugh, Hamrick, and Rosato (2011)- propose seven everything they interact with— not only environmental components of wellness. To realize optimal health and influences such as climate and the availability of food, shelter, wellness, people must deal with the factors within each clean air, and water to drink, but also other people. component: 1.​ Environmental- ability to promote health measures Acc.to Talcott Parsons (1951)- an eminent American that improves standard of living and quality of life. sociologist and creator of the concept "sick role”, -​ food , water, and air. conceptualized health as the ability to maintain normal roles. -​ Good health by occupying pleasant, stimulating environments that support well-being FUNDAMENTALS OF NURSING 4.​ Environment- physical environment can increase the 2.​ Spiritual- belief in some force (nature, science, likelihood of certain diseases. religion, or a higher power) that gives life meaning 5.​ Lifestyles- habits, activities, behaviors, have positive and purpose or negative effects on health -​ Persons own morals, values, and ethics. 6.​ Socioeconomic conditions- if you are poor, you -​ We believe in the supernatural have different diseases to those who are rich. -​ expanding our sense of purpose and meaning in life 7.​ Health and family welfare services. 3.​ Intellectual- ability to learn DIMENSION OF HEALTH -​ ability to use information effectively 1.​ Physical dimension- bodily aspect of health. -​ Striving for continued growth -​ genetic, developmental level, race, sex, -​ Learning to deal with new challenges -​ Physiological perspective -​ recognizing creative abilities and finding ways to -​ the absence of disease and injury expand knowledge and skills -​ Intellectual wellness- involves striving for continued 2.​ Mental Dimension- cognitive aspect of health growth and learning to deal with new challenges (functioning of the brain) effectively. -​ ability to use brain and think clearly and coherently 4.​ Occupational- ability to achieve balance between 3.​ Emotional dimension- affected by person’s mood work and leisure. -​ ability to recognize and express feelings, cope. With -​ personal satisfaction and enrichment derived from conflicts one’s work, beliefs about education, employment, -​ balance between body and mind and home influence -​ coping effectively with life 5.​ Social- interact successfully 4.​ Social dimension- level of society skills and -​ develop and maintain intimacy relationship to society -​ Develop respect and tolerance for others with -​ ability to make and maintain meaning relationships different opinions or beliefs with others -​ developing a sense of connection, belonging, and well-developed support system 5.​ Spiritual dimension- overall sense of purpose in life -​ belief, faith 6.​ Emotional- ability to manage stress -​ Ability to express emotion INTERNAL VARIABLES -​ coping effectively with life and creating satisfying 1.​ Biological dimension - genetic makeup relationships A.​ Gender- influences biologic characteristics -​ It has been related to susceptibility to specific 7.​ Physical- carry out daily tasks disease, such as diabetes and breast cancer -​ Achieve fitness -​ Genetic predisposition- for health or illness is -​ Maintain nutrition enhanced when parents are from the same ethnic -​ Avoid abusing substances genetic pool. -​ Practice positive lifestyle habits. -​ influences the distribution of disease. -​ Recognizing the need for physical activity, diet, sleep -​ Disorders more common among females: and nutrition 1.​ osteoporosis 2.​ rheumatoid arthritis (autoimmune disease) Nurses need to clarify their understanding of health, wellness, -​ More common among males: and well-being for the following reasons: 1.​ stomach ulcers ​ Nurses' definitions of health largely determine the 2.​ abdominal hernias scope and nature of nursing practice. 3.​ respiratory diseases. ​ People's health beliefs influence their health practices. Nurses need to ensure that a plan of care B.​ Age- is also a significant factor. developed for an individual relates to the client's -​ arteriosclerotic heart disease is common in concept of health rather than the nurses belief middle-aged males but occurs infrequently in system. younger people; -​ Whooping cough and measles are common in DETERMINANTS/ FACTORS AFFECTING HEALTH children but rare in older adults 1.​ Physiological- physical functioning of the body 2.​ Heredity- genetic predisposition 3.​ Age- increased susceptibility to certain diseases FUNDAMENTALS OF NURSING C.​ Developmental level- has a major impact on health Ex: Jehovahs Witnesses oppose blood transfusions: status. -​ some fundamentalists believe that a serious illness is -​ Ex: Infants lack physiological and psychological a punishment from God maturity so their defenses against disease are lower -​ some religious groups are strict vegetarians during the first years of life. -​ Toddlers who are learning to walk are more prone to EXTERNAL VARIABLES falls and inJury than are older children. 1.​ Environment- geographic location -​ Adolescents who strive to conform to peers are -​ Hazards and contamination more prone to Take taking behavior and subsequent -​ Geographic location determines climate, and climate injury than adults are, affects health. -​ Defining physical and sensory-perceptual abilities -​ Environmental hazards: limit the ability of older adults to respond to -​ Pollution of the water, air, and soil affects the health environmental hazards as stressors. -​ radiation (medical x-rays, sun’s ultraviolet rays) -​ acid rain (contains sulfur dioxide) 2.​ Psychologic Dimension -​ greenhouse effect A.​ Mind-body interactions- can affect health status positively or negatively. 2.​ Standards of living- reflect occupation, income, and -​ Emotional responses to stress affect body function. education -​ Prolonged emotional distress- may increase -​ related to health, morbidity, and mortality susceptibility to organic disease or precipitate it. -​ environmental conditions of impoverished areas have -​ it may influence the immune system through central a bearing on overall health. nervous system and endocrine alterations. -​ Occupational roles also predispose people to certain -​ Emotional reactions also occur in response to body illnesses. conditions 3.​ Family and Cultural beliefs- pass on patterns of daily B.​ Self-concept- how a person feels about self (self-esteem) living and perceives the physical self (body image), needs, -​ how a person perceives, experiences, and copes with roles, and abilities. illness. -​ affects how people view and handle situations. -​ People of certain cultures may perceive home -​ Such attitudes can affect health practices and remedies or tribal health customs as superior to and responses to stress and illness, more dependable than the health care practices of North American society. 3. Cognitive Dimension 1.​ Lifestyle- refers to a person's general way of living, 4.​ Social support networks- family, friends, and/or including living conditions and individual patterns of confidant. behavior that are influenced by sociocultural factors -​ provide the motivation for an ill person to become and personal characteristics. well again. -​ considered to be the behaviors and activities over which people have control. MODELS OF HEALTH AND WELLNESS -​ Lifestyle choices- may have positive or negative 1.​ Clinical Model- provides narrowest interpretation of effects on health. health -​ Risk factors- Practices that have potentially negative -​ people viewed as physiologic systems effects on health are often referred to as this. -​ Health identified by absence of disease or injury -​ State of not being “sick” Examples of Healthy Lifestyle Choices -​ Absence of disease Regular exercise Weight control -​ Opposite of health- disease or injury. Avoidance of saturated fats Avoidance of excessive alcohol Medical practitioners have used the clinical model in their Abstaining from use of tobacco products focus on the relief of signs and symptoms of disease and Seat belt use elimination of malfunction and pain. Bike helmet use -​ When these signs and symptoms are no longer Immunization updates present, the medical practitioner considers the Regular dental checkups individuals health restored. Regular health maintenance visits for screening examinations or tests 2.​ Role performance model -​ Able to fulfill societal roles Spiritual and religious beliefs- can significantly affect health -​ Viewed as healthy even if clinically ill, if still able to behavior fulfill roles FUNDAMENTALS OF NURSING -​ In this model, sickness is the inability to perform ​ Environment- All actors external to the host that one's work role may or may not predispose the person to the -​ For example, a man who works all day at his job as development of disease expected is healthy even though he is partially deaf. A.​ Physical environment- includes climate, living conditions, sound (noise) levels, and economic level. 3.​ Adaptive model- creative process B.​ Social environment- includes interactions with -​ Disease is failure in adaptation or maladaptation. others and life events, such as the death of a spouse. -​ aim of treatment is to restore the ability of the person to adapt, that is, to cope 6.​ Health Promotion Model -​ According to this model, extreme good health is -​ Based on the idea that people's experiences affect flexible adaptation to the environment and interaction their health outcomes. with the environment to maximum advantage. -​ Illustrates the “multidimensional nature of persons Ex: Roy adaptation model of nursing views the person as an interacting with their environment as they pursue adaptive system. health” -​ The focus of this model is stability, although there is -​ Incorporates individual characteristics and also an element of growth and change. experiences and behavior- specific knowledge and beliefs, to motivate health-promoting behavior. 4.​ Eudaimonistic Model- exuberance well being (extreme -​ Personal, biological, psychological, and sociocultural happiness) factors are predictive of a certain -​ being in good spirit -​ Actualization or realization of a person’s potential 7.​ Transtheoretical Model -​ Striving towards divine state of being -​ Health is seen as a condition of actualization or realization of a person's potential. Ex: ​ Actualization- apex of the fully developed is based on the personality, described by Abraham Maslow theory that -​ In this model the highest aspiration of people is individuals follow a fulfillment and complete development, which is circular rather than actualization. linear path as they -​ Illness- in this model, is a condition that prevents flow through a self-actualization. series of stages to ​ Pender, Murdaugh, and Parsons (2011) include modify behavior. stabilizing and actualizing tendencies in their definition of health -​ The realization of human potential through goal directed behavior, competence, self-care, and satisfying relationships with others adapting to 8.​ Theory of Reasoned Action maintain structural integrity and harmony with the social and physical environments. ​ Margaret Newman (2008) who states that health is the expansion of consciousness. 5.​ Agent- Host Environment Model- also called the ecologic model -​ each factor constantly interacts with -​ when in balance, health is maintained -​ When not in balance, disease occurs. Ex: Leavell and Clark (1965) and has been expanded into a general theory of the multiple causes of disease. 1.​ The model is used primarily in predicting illness rather than in promoting wellness and has 3 interactive 9.​ Social Cognitive Theory elements: -​ it focuses on the impact of an individual’s social ​ Agent- Any environmental factor or stressor that by environment, expectation, observations, as well as its presence or absence can lead to illness or disease their self efficacy. ​ Host- Person(s) who may or may not be at risk of ​ acquiring a disease. ​ FUNDAMENTALS OF NURSING 2) belief that one is vulnerable to a serious health problem or personal factors its consequences Behavior environmental influences 3) belief that following a particular health recommendation would be beneficial. HEALTH BELIEF MODELS -​ Several theories or models of health beliefs and behaviors INDIVIDUAL PERCEPTIONS have been developed to help determine whether an individual 1.Perceived susceptibility-A family history of a certain is likely to participate in disease prevention and health disorder, such as diabetes or heart disease, may make the promotion activities. individual feel at increased risk. -​ These models can be useful tools in developing -​ Awareness of personal high risk lifestyle behaviors programs for helping people with healthier lifestyles aso increases perceived susceptibility. and more positive attitudes toward preventive health measures. 2. Perceived seriousness- the perception of the individual. does the illness cause death or have serious consequences? Health Locus of Control Model Ex: concern about the spread of acquired immunodeficiency Locus of control- a concept from social learning theory that of the syndrome (AIDS) reflects the general public's perception nurses can use to determine whether clients are likely to take of the seriousness of this illness. action regarding health, that is, whether clients believe that their health status is under their own or others' control. 3. Perceived threat- Perceived susceptibility and perceived seriousness combine to determine the total perceived threat Internals- People who believe that they have a major of an illness to a specific individual. influence on their own health status-that health is largely Ex: a person who perceives that many individuals in the self-determined. community have AIDS may not necessarily perceive a -​ People who exercise internal control are more likely personal threat of the disease; if the person is a drug addict or than others to: a homosexual,, the perceived threat of illness-is likely to -​ take the initiative on their own health care increase because the susceptibility is combined with -​ be more knowledgeable about their health seriousness. -​ make and keep appointments with primary care providers MODIFYING FACTORS -​ maintain diets -​ Factors that modify a person's perceptions include -​ give up smoking. the following: Demographic variables- include age, sex, race, and Externals- people who believe their health is largely controlled ethnicity. by outside forces (eg., chance or powerful others). infant- does not perceive the importance of a healthy diet adolescent- perceive peer approval as more important than - locus of control plays a role in clients choices about health family approval and as a consequence may participate in behaviors and in their health experiences. hazardous activities or adopt unhealthy eating and sleeping - high external health locus of control- has been related to a patterns. better quality of life in clients with cancer - individuals who had heart attacks who returned to work had Sociopsychological variables- Social pressure or influence stronger internal locus of control beliefs than those who did from peers or other reference groups may encourage not return to work. preventive health behaviors even when individual motivation is low. - Locus of control is a measurable concept that can be used -​ Expectations of others may motivate people: not to to predict which people are most likely to change their drive an automobile after drinking alcohol. behavior. Structural variables- Knowledge about the target disease Multidimensional Health Locus of Control (MHLC) Scale and prior contact with it are structural variables that are -​ most recently expanded to Form C presumed to influence preventive behavior. -​ Public domain versions and scoring instructions for these scales are available on the Vanderbilt University Cues to action- Cues can be either internal or external. School of Nursing website. Internal cues- include feelings of fatigue, uncomfortable symptoms, or thoughts about the condition of an ill person Rosenstock and Becker's Health Belief Models who is close. -is based on the assumption that health-related action depends on the simultaneous occurrence of three factors: 1) sufficient motivation to make health issues be viewed as important FUNDAMENTALS OF NURSING LIKELIHOOD OF ACTION DUNN’S HIGH LEVEL WELLNESS GRID likelihood of a person taking recommended preventive health Dunn (1959) described a health grid in which a health axis and action an environmental axis intersect. = -​ Grid- demonstrates the interaction of the perceived benefits of the action - perceived barriers to the environment with the illness-wellness continuum action -​ Health axis- extends from peak wellness to death Perceived benefits of the action- In order to prevent lung -​ Environmental axis- extends from very favorable to cancer one refrains from smoking, and to maintain weight, one very unfavorable. eats nutritious foods and avoids snacking. The intersection of the two axes forms four quadrants of health and wellness: Perceived barriers to action- cost, inconvenience, 1.​ High level wellness in a favorable environment- unpleasantness, and lifestyle changes. protected poor health in favorable environment -​ Ex: is a person who implements healthy lifestyle Nurses- play a major role in helping clients implement healthy behaviors and has the biopsychosocial, spiritual, and behaviors. economic resources to support this lifestyle. -​ They help clients monitor health, they supply 2.​ Emergent high-level wellness in an unfavorable anticipatory guidance, and they impart knowledge environment- Ex: woman who has the knowledge to about health. implement healthy lifestyle practices but does not -​ can also reduce barriers to action (e.g, by minimizing implement adequate self-care practices because of inconvenience or discomfort) and can support family responsibilities, job demands, or other factors. positive actions. 3.​ Protected poor health in a favorable environment- Ex: an ill person (eg., one with multiple fractures or Pender et al. (2011) have modified this health belief model to severe hyperten-sion) whose needs are met by the develop a health promotion model. health care system and who has access to -​ According to her, health belief model explains appropriate medications, diet, and health care health-protecting or preventive behaviors but does instruction. not emphasize health-promoting behaviors. 4.​ Poor health in an unfavorable environment- -​ In addition to applying these models, the nurse uses emergent high level wellness in unfavorable other resources to evaluate options in planning environment interventions to maximize wellness. -​ Ex: young child who is starving in a drought-stricken country. HEALTH-ILLNESS CONTINUA. -​ measures the person’s perceived level of wellness -​ Health and illness or disease is at opposite ends of the health continuum -​ From a high level of health a person's condition can move through good health, normal health, poor health, and extremely poor health, eventually to death. -​ Person move back and forth within this continuum day by day ​ Family wellness- enhances wellness in individuals. -​ How a person perceives themselves and how others In a well family that offers trust, love, and support, the see them affects the placement of the person in the individual does not have to expend energy to meet continuum. basic needs and can move positively on the wellness -​ ranges in which people can be thought of as healthy continuum. or ill are considerable. ​ Environmental wellness- is related to the premise that humans must be at peace with and guard the environment. ​ Societal wellness- is significant because the status of the larger, social group affects the status of smaller groups ILLNESS-WELLNESS CONTINUUM -​ The illness-wellness continuum developed by Anspaugh, Hamrick, and Rosato (201 1) ranges from optimal health to premature death. FUNDAMENTALS OF NURSING -​ model illustrates arrows pointing in opposite directions and joined at a neutral point. Factors Influencing Adherence -​ Movement to the right of the neutral point indicates 1.​ Client motivation to become well increasing levels of health and wellness for an 2.​ Degree of necessary lifestyle change individual. This is achieved through health 3.​ Perceived severity of the healthcare problem knowledge, disease prevention, health promotion, 4.​ Value placed on reducing the threat of illness and positive attitude 5.​ Ability to understand and perform specific behaviors -​ In contrast, movement to the left of the neutral point 6.​ Degree of inconvenience of the illness indicates progressively decreasing levels of health. 7.​ Beliefs that the prescribed therapy or regimen will or will not help 8.​ Complexity, side effects, and duration of the Health status- State of health of an individual at a given time. proposed therapy -​ can also describe such specifics as pulse rate and 9.​ Cultural heritage, beliefs, or practices that support or body temperature. conflict with the regimen Health beliefs- Concepts about health that an individual 10.​ Degree of satisfaction and quality and type of believes are true. relationship -​ Such beliefs may or may not be founded on fact. 11.​ Overall cost of therapy -​ In this system, health is viewed as a balance of hot and cold qualities within a person ILLNESS, SICKNESS AND DISEASE Health behaviors- The actions people take to understand Illness- subjective feeling of discomfort their health state, maintain an optimal state of health, prevent -​ highly personal state because only the person can Illness and injury, and reach their maximum physical and say be or she is ill mental potential -​ Subjective sense of feelings of discomforts -​ intended to prevent illness or disease or to provide -​ Persons physical emotional intellectual social for early detection of disease. developmental or spiritual functioning is diminished -​ Not synonymous with diseases Internal variables- include biologic, psychologiel, and -​ A person's subjective experience of their symptoms cognitive dimensions. that the patient will bring to the doctor -​ often described as non modifiable variables because, for the most part, they cannot be changed. 2 Ways to classify Illness: A.​ Acute illness- symptoms of relatively short duration HEALTHCARE ADHERENCE -​ Symptoms appear abruptly, subside quickly Adherence- extent to which an individual’s behavior coincides -​ May or may not require intervention by healthcare with medical or health advice professionals and can subside with over-the-counter -​ Degree of adherence may range from disregarding medications every aspect of the recommendations to following the -​ Most people return to a normal level of wellness. total therapeutic plan. -​ To enhance adherence, nurses need to ensure that B.​ Chronic illness- usually slow onset and last for 6 the client is able to perform the activities, months or longer understands, and willing to participate in establishing -​ Nurses are involved in caring for chronically ill goals individuals of all ages in all types of settings Upon recognizing non adherence: 1.​ Establish why client not following the regimen- Sickness- social and cultural conceptions of illness reevaluate the suitability the health advice provided -​ covers what is considered a disorder suitable for 2.​ Demonstrate caring- Show sincere concern about medical treatment the clients problems and decisions 3.​ Encourage healthy behaviors through positive Disease- pathological condition reinforcement- nurse might say "You are really doing -​ pathological process that may or may not produce well with your walking” symptoms 4.​ Use aids to reinforce teaching- nurses can leave -​ alteration in body function or underlying pathology pamphlets for the client to read later or make a "pill -​ Reduction of capacities or shortening of normal life calendar? span 5.​ Establish therapeutic relationship of freedom, -​ intervention by primary care providers has the goal of mutual understanding, and mutual responsibility eliminating or ameliorating disease processes. with the client and support persons- nurse gives -​ Primitive People thought forces or spirits caused clients control over their health and establishes a disease. cooperative relationship, which results in greater -​ Etiology- causation of a disease or condition adherence FUNDAMENTALS OF NURSING Syndrome- set of groups of symptoms that occurs frequently enough to form recognized patterns. Stage 2: Assumption of the sick role -​ individual now accepts the sick role and seeks ILLNESS BEHAVIORS confirmation from family and friends. Illness behavior- a coping mechanism -​ Often people continue with self-treatment and delay -​ involves ways individuals describe, monitor, and contact with health care professionals as long as interpret their symptoms, take remedial actions, and possible use the health care system -​ When symptoms of illness persist or increase the -​ highly individualized state in which an individual feels person is motivated to seek professional help. ill and behaves in a particular way. Stage 3: Medical care contract Client’s Rights: -​ Sick people seek the advice of a health professional 1. Clients are not held responsible for their condition. either on their on initiative or at the urging of 2. Clients are excused from certain social roles and tasks. significant others. -​ When people seek professional advice, they are really Client’s Obligations: asking for three types of information 3. Clients are obliged to try to get well as quickly as possible. Validation of real illness specialized diet or activity restrictions that could help with Explanation of the symptoms in understandable terms recovery. Reassurance that they will be all right or prediction of whate 4. Clients or their families are obliged to seek competent help. outcome will be. 5 STAGES OF ILLNESS -​ health professional may determine that the client 1)​ Incubation- exposure to the disease/microorganism does have an illness or that an illness is present until appearance of the first signs and symptoms -​ If diagnosis is accepted, client usually follows the (infectious diseases) prescribed treatment plans -​ usually fever Some diseases would have: Stage 4: Dependent client role Latency- pre infectious period -​ client becomes dependent on the professional for -​ Time of infection to the time of becoming infectious- help, after accepting the illness and seeking period of communicability treatment -​ No signs and symptoms of the disease -​ Role obligations-such a those of wage earner, -​ Usually for chronic diseases parent, student, sports team member, or o member - -​ Microorganism lies hidden or dormant( inactive in the complicate the decision to give up independence. body) Stage 5: Recovery or rehabilitation 2)​ Prodromal- appearance of first signs and symptoms -​ client is expected to relinquish the dependent role until appearance of characteristics of diseases. and resume former roles and responsibilities. -​ fever to rashes -​ For clients with a permanent disability, this final stage 3)​ Illness period- when you feel all the pain and may require therapy to learn how to make major discomfort and all the signs and symptoms adjustments in functioning. -​ manifest of symptoms 4)​ Decline period- the diminishing of the signs and EFFECTS OF ILLNESS symptoms 1.​ Impact on the client 5)​ Convalescence - acute symptoms disappear -​ Ill clients may experience behavioral and emotional -​ recovery process changes -​ changes in self concept and body image, and lifestyle 5 STAGES BY SCHUMANN (1979) changes(dependence on others/ change diet, activity Stage 1: Symptom experiences and exercise, rest and sleep patterns). -​ person comes to believe something is wrong -​ behavioral and emotional changes -​ person experiences some symptoms -​ Sometimes clients are no longer involved in making -​ an unwell person usually consults others about the family decisions or even decisions about their own symptoms or feelings, validating with support people health care that the symptoms are real. -​ Try home remedies. 2.​ Impact on the family 3 aspects: The physical experience of symptoms -​ Role changes The cognitive aspect- the interpretation of the symptoms in -​ Task reassignments and increased demands on time terms that have some meaning to the person) The emotional response (eg, fear or anxiety). FUNDAMENTALS OF NURSING -​ Increased stress due to anxiety about the outcome of 2.​ High-risk Strategy the illness for the client and conflict about -​ it aims to bring preventive care to individuals at unaccustomed responsibilities special risk -​ Financial problems -​ this requires detection of individuals at high risk by -​ Loneliness as a result of separation and pending loss the optimum use of clinical methods -​ Change in social customs. SECONDARY PREVENTION LEVELS OF PREVENTION -​ Defined as “the action which halts the progress of a Prevention- aimed at eradicating, eliminating or minimizing disease as its incipient stage and prevents the impact of disease and disability, or if none of these are complications” feasible, retarding -​ the specific interventions are: early diagnosis (ex. screening tests, and case finding programs…) and NATURAL HISTORY OF DISEASE adequate treatment Disease- evolves overtime from pre pathogenesis -​ This attempts to arrest the disease process, restore pathogenesis to its termination, recovery, disability, death. health by seeking unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious disease -​ It protects others from in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts -​ Screening to identify diseases in the earliest stages, before the onset of signs and symptoms. -​ Early diagnosis and prompt treatment -​ Minimizing serious consequences Leavell & Clark’s Levels of Prevention A.​ Early diagnosis and Prompt treatment STAGE OF LEVEL OFF TYPE OF RESPONSE -​ mass screening Screening test (mammography) DISEASE PREVENTION -​ Papanicolau Smear Test (Pap’s smear test) -​ regular blood pressure reading Pre-pathogenesis Primary Health promotion and -​ Prevent spread of communicable disease Prevention specific protection -​ prevent complication and sequelae -​ shorten period of disability Pathogenesis Secondary Pre-symptomatic Prevention diagnosis and B.​ Disability limitation (Goal of secondary prevention) treatment -​ adequate treatment to arrest disease process and prevent complication and sequelae Pathogenesis Tertiary Disability limitations -​ provision of facilities to limit disability and prevent Prevention for early symptomatic death disease and rehabilitation for late Curative- specific style of medical treatment and therapies symptomatic disease provided to a patient with the main intent being to improve or eliminate symptoms that the patient is experiencing and to APPROACHES FOR PRIMARY PREVENTION cure the patients overall medical problems. World Health Organization- has recommended the following -​ occurs in pathogenesis period approaches for the primary prevention of chronic diseases -​ Practice when you treat the disease after the where the risk factors are established: pathological process has started -​ It strives to reduce pain, improve function, and help 1.​ Population (mass) strategy improve the quality of life for patients. -​ “Population Strategy” is directed at the whole population irrespective of individual risk levels TERTIARY PREVENTION -​ For example, studies have shown that even small -​ Used when the disease process has advanced reduction in the average blood pressure or serum beyond its early stages cholesterol of a population would produce a large -​ defined as Intervention “all the measures available to reduction in the incidence of cardiovascular disease reduce or limit impairments and disabilities, and to -​ the population approach is directed towards promote the patient’s adjustment to irremediable socio-economic, behavioral and lifestyle changes conditions” FUNDAMENTALS OF NURSING -​ that should be accomplished in the stage of tertiary DISEASE ERADICATION prevention are disability limitation, and rehabilitation Eradication- literally means to “tear out by roots” -​ Managing disease post diagnosis to slow or stop -​ process of “termination of all transmission of infection disease progression through measure such as by extermination of the infectious agent through chemotherapy, rehabilitation, and screening for surveillance and containment” complications -​ an absolute process -​ Occurs after a disease or disability has occurred and -​ an ”all or none” phenomenon, restricted to the recovery process begun termination of an infection from the whole world. -​ Intent is to halt disease or injury process and assist -​ It implies that disease will no longer occur in the person in obtaining an optimal health status. population -​ To establish a high-level wellness. -​ To date, only one disease has been eradicated, that is -​ “To maximize use of remaining capacities” smallpox Restoration and Rehabilitation DISEASE MONITORING -​ work therapy in hospital -​ Monitoring- performance and analysis of routine -​ use of shelter colony measurements aimed at detecting changes in the -​ cardiac stroke rehabilitation program environment or health status of population" (Thus we -​ chronic disease management- have monitoring of air pollution, water quality, growth -​ support groups- that allow members to share and nutritional status, etc). strategies for living well -​ It also refers to ongoing measurement of -​ vocational rehabilitation programs- to retrain workers performance of a health service or a health for new jobs when they have recovered as much as professional, or of the extent to which patients possible comply with or adhere to advice from health professionals. DISABILITY LIMITATION Disease DISEASE SURVEILLANCE I Surveillance means to watch over with great attention, V authority and often with suspicion Impairment Surveillance is defined as the continuous scrutiny I (inspection) of the factors that determine the occurrence and V distribution of disease and other conditions of Disability i-health".Evaluation of control I V OBJECTIVES OF SURVEILLANCE Handicap The main objectives of disease surveillance are: 1.​ To provide information about new and changing ​ Impairment- “any loss or abnormality of trends in the health status of a population ex. psychological, physiological, or anatomical structure Morbidity, mortality, nutritional statues or other or function” indicators and environmental hazards, health ​ Disability- “any restriction or lack of ability to perform practices and other factors that may affect health an activity in the manner or within the range 2.​ To provide feedback which may be expected to considered normal for the human being.” modify the policy and system itself. and lead to ​ Handicap- “a disadvantage for a given individual, redefinition of objectives, and resulting from an impairment or disability, that limits 3.​ provide timely warning of public health disasters so or prevents the fulfillment of a role in the community that interventions can be mobilized that is normal (depending on age, sex, and social and cultural factors for that individual” EVALUATION OF CONTROL -​ Evaluation is the process by which results are DISEASE ELIMINATION compared with the intended objectíves, or more -​ Between control and eradication, an intermediate simply the assessment of how well a program is goal has been described, called "regional elimination" performing. -​ The term "elimination" is used to describe -​ To analyze the effectiveness and efficiency of interruption of transmission of disease, as for program of activities example, elimination of measles, polio and diphtheria from large geographic regions or areas -​ Regional elimination is now seen as an important HEALTHCARE DELIVERY SYSTEM precursor of eradication -​ totality of services provided by all health disciplines. -​ Organized plan of health services FUNDAMENTALS OF NURSING -​ types of Health Care Services offered by Health Care 3.​ The 3rd prong is the Healthy People Federal delivery systems are categorized to type and level of Interagency Workgroup (HPFIW). prevention. -​ network of health facilities and personnel which HPFIW- develops guidance for the Healthy People 2030 carries out the task of rendering health care to the framework and objectives. people. -​ The charge to the committee is to ensure the -​ major purpose of a health care system was to provide selection criteria address the public health issues care to people who were ill or injured. shown to be high-impact priorities by current national -​ with increasing awareness of health promotion, data, to identify the leading health indicators, and to illness prevention, and levels of wellness, health care implement Healthy People 2030 systems are changing, as are the roles of nurses in these areas. The nurse and client work together as partners to: -​ services provided by a health care system are ​ Promote health commonly categorized according to type and level. ​ Prevente diseases/ illness 1) Primary Prevention ​ Alleviating suffering A.​ Health promotion ​ Restore health B.​ Disease prevention PRIMARY PREVENTION: HEALTH PROMOTION AND ILLNESS PREVENTION 2) Secondary prevention A.​ Diagnosis Healthy People- Based on the notion of maintaining an B.​ Treatment optimum level of wellness, the World Health Organization (WHO) developed this project. 3) Tertiary prevention A.​ Rehabilitation HEALTHY PEOPLE 2020 GOALS : B.​ Health restoration 1) Increase quality and years of healthy life C.​ Palliative care 2) achieve health equity and eliminate health disparities 3) create healthy environments for everyone Health care system- totality of services offered by all health 4) promote health and quality life across the life span. disciplines. -​ an organized plan of health services. Primary prevention programs- address areas such as 1)​ adequate and proper nutrition Health care services- multiple services rendered to 2)​ weight control and exercise individuals, families, or communities by agents of health 3)​ stress reduction service or professions for the purpose of promoting, maintaining, monitoring, and restoring health. Health promotion- enabling people to improve and have 1.​ Health Promotion greater control over their health 2.​ Preventive -​ makes it possible for people to. Increase control over 3.​ Curative the determinants of health thereby improve their 4.​ Rehabilitation health 5.​ Palliative -​ health risk appraisal and wellness assessment- screening tool that helps individuals identify and understand their health risks and monitor health Healthy people 2020- The foundation for Healthy People status 2020 is the belief that individual health is closely linked to -​ usually includes questions in the ff. Areas: community health, and the reverse. -​ Demographic characteristics -For example, community health is affected by the beliefs, -​ lifestyle behaviors attitudes, and behaviors of the individuals who live in the -​ emotional health community. As a result, partnerships are important to improve -​ physical health individual and community health. -​ current and previous health conditions -​ preventive screenings -​ readiness to change behaviors to improve Healthy people 2030- The 3 pronged-approach to its heath development: Illness prevention programs - directed at the client or the 1.​ Secretary's Advisory Committee on National Health community and involve: Promotion and Disease Prevention Objectives for 1)​ providing immunizations 2030. 2)​ identifying risk factors for illnesses 2.​ The 2nd prong is public comment 3)​ helping people take measures to prevent these illnesses from occurring. FUNDAMENTALS OF NURSING - included as a health promotion service is early detection of Ex. smoking cessation campaigns that both assist individuals disease. to stop smoking and protect the public from ill effects of -​ accomplished through routine screening of the secondhand smoke by regulating where people are permitted population and focused screening of those at to smoke. increased risk of developing certain conditions. -​ environmental programs that can reduce the incidence of illness or disability. Examples of early detection services: -​ to decrease air pollution, automobile exhaust 1)​ regular dental exams from childhood throughout life systems are inspected to ensure acceptable levelsof 2)​ bone density studies for women at menopause to fumes. evaluate for early osteoporosis. -​ Environmental protective measures are frequently Community-based agencies- become instrumental in legislated by governments and lobbied for by citizens providing these services. groups. -​ clinics in some communities provide mammograms and education regarding the early detection of cancer Health promotion- process of enabling people to improve of the breast. and have greater control over their health. -​ Voluntary HIV testing and counseling. -​ It makes it possible for people to increase control -​ malls and shopping centers walk-in clinics providing over the determinants of health thereby improve their diagnostic tests (screening for cholesterol and high health. blood pressure.) Health promotion activities- emphasize the important role Health risk appraisal and wellness assessment clients play in maintaining their own health and encourage Screening tool that+++ them to maintain the highest level of wellness they can achieve. TERTIARY PREVENTION: REHABILITATION, HEALTH RESTORATION, AND PALLIATIVE CARE Lifestyle and behavior change- requires the participation of Goal: help people move to their previous level of health (i.e., to the individual and is geared toward quality of life and their previous capabilities) or to the highest level, they are extending lifespan. capable of given their current health status. Environmental control program- have been developed in Rehabilitative- an activity or a series of activities to return the response to the continuing increase of contaminants of human former into the community, so that they can take part again as origin that have been introduced into our environment. the useful members of society for themselves and for the community as much as possible according to their ability. Disease prevention - activities designed to protect persons -​ Period of minimal care and increasing physical from disease and its consequences. activity necessary to restore patients to functional -​ behavior motivated with a desire to actively avoid health status and allow their return to duty or useful illness, detect it early, or maintain functioning within and productive life the constraints of illness. -​ emphasizes the importance of assisting clients to function adequately in the physical, mental, social, SECONDARY PREVENTION: DIAGNOSIS AND economic, and vocational areas of their lives. TREATMENT -​ Ex. Someone with an injured neck or back from an Past: largest segment of healthcare services was dedicated automobile crash may have restrictions in the ability to the diagnosis and treatment of illness. to perform work or daily activities. Hospitals and physicians’ offices - major agencies offering -​ If the injury is temporary, rehabilitation can assist in these complex secondary prevention services. return to former function. -​ If the injury is permanent, rehabilitation assists the Hospitals- continue to focus significant resources on clients client in adjusting the way activities are performed in who require emergency, intensive, and around-the-clock acute or- der to maximize the client’s abilities. care. -​ Rehabilitation may begin in the hospital, but will eventually lead clients back into the community for Freestanding diagnostic and treatment facilities - evolved further treatment and follow-up once health has been and served ever-growing numbers of clients. restored. -​ magnetic resonance imaging (MRI) and related radiologic diagnostic procedures are commonly Tertiary mental health prevention- an outreach performed at physician- or corporate-owned centers. program that follows individuals with mental disorders in the -​ Others exist in outpatient surgical units community to ensure that they adhere to their medication (surgi-centers). regimens. FUNDAMENTALS OF NURSING -​ These programs can reduce acute psychiatric -​ Specialty Hospitals/Hospitals with special hospital admissions and long-term institutionalization services- cater to specific conditions, age groups or and enable individuals with mental disorders to live other ways of grouping patients independently. -​ ex. Cancer, psychiatric, pediatric, rehabilitation hospitals Palliative- active total care of patients whose disease is not -​ Acute care hospital- provides assistance to clients responsive to curative treatments -​ whose illness and need for hospitalization are -​ control of pain, of other symptoms, and of relatively short term, for example, several days. psychological , social and religious problems. -​ Safety-net hospitals- provide a significant level of -​ Offers support system to help patients live as actively care to as++ -​ low-income, uninsured, and vulnerable populations. -​ Sometimes, people cannot be returned to health. -​ providing comfort and treatment for symptoms. -​ Joint commission of the credit action of End-of-life care may be conducted in many settings, healthcare organizations (JCAHO)- help hospitals including the home. maintain quality of care, establishes guidelines for the operation of hospitals, conducts inspections to Not all hospice can be palliative but palliative can be hospice. ensure that standards are being met. -​ Private hospitals- often operated by churches, companies,communities, and charitable Palliative care- life sustaining organizations. -​ in conjunction with other care -​ may be for-profit or not-for-profit institutions. -​ At home or in hospital -​ provide sources for health-related research and -​ Any time during the illness teaching. -​ Focus on quality of life -​ variety of health care services hospitals provide -​ Symptom management of a life limiting illness usually depends on their size and location. -​ Use at any point after diagnosis -​ Is paired with treatment of your condition 2. Public health- local health departments develop programs to meet the health needs of the people, providing necessary Both shared- symptom management nursing and staff to carry out these programs, continue -​ physical, emotional, and spiritual support fevaluating the effectiveness of the program, and monitoring -​ focuses on improving quality of life changing needs. -​ Government (official) agencies are established at the Hospice care- comfort care local, state, and federal levels to provide public health -​ at home or in a facility services. -​ Care is no longer life prolonging -​ Health agencies at the state, county, or city level vary -​ Focus on preparing for end of life according to the needs of the area. -​ Symptom management and comfort care at the end -​ Their funds, usually generated from taxes, are of life. administered by elected or appointed officials Curative- specific style of medical treatment and therapies 3.Physicians offices- family practice physicians specialists provided to a patient with the main intent being to improve or -​ does routine health screening, illness diagnosis, and eliminate symptoms that the patients is experiencing and to treatment. cure the patient’s overall medical problems -​ do not require the expertise of registered nurses -​ practice when you treat the disease. After the (RNs). pathological process has started -​ In offices w/ RNs, the RNs have a variety of roles -​ strives to reduce pain, improve function, and help and responsibilities, including client registration, improve the quality of life for patients preparing the client for an examination, obtaining health information, and providing information. TYPES OF HEALTH CARE AGENCIES AND SERVICES -​ obtaining specimens, assisting with procedures, and 1. Hospitals- private or public providing some treatments. -​ Private hospitals can be for profit or non profit -​ In offices without RNs, these tasks may be -​ Many different types and classifications performed by medical assistants. -​ General hospitals- treat a wide variety of illnesses and ages and admit clients requiring a variety of 4. Ambulatory care centers- diagnostic treatment facilities services, such as medical, surgical, obstetric, medical, nursing, laboratory, and radiologic services, and they pediatric, and psychiatric services may or may not be associated with an acute care hospital. -​ cater minor surgery -​ Also called “outpatient services” FUNDAMENTALS OF NURSING -​ Provide diagnostic and treatment services -​ Nurses here provide limited care to residents, usually that were previously performed in hospitals related to the administration of medications and -​ After surgery, the client returns home, often the same minor treatments day. -​ They permit the client to live at home while obtaining 9. Rehabilitation centers- usually independent community necessary health care, and they free up costly centers or special units. hospital beds for seriously ill clients. -​ helps clients to restore their health and recuperate. -​ The term ambulatory care center has replaced -​ Helps free clients of drug and alcohol dependence. -​ the term clinic in many places. -​ usually are independent community centers or Surgical clinics- surge enters outpatient surgery special units. -​ Urgent care centers -​ Outpatient clinics 10. Home health Care Agencies- became more common in -​ Optical centers the late 1980s now an area of tremendous growth. -​ Genetic counseling centers (fertility clinics) -​ nurse or other skilled professional visits patient in his or her home to provide treatment or education 5.Occupational health clinics- run by companies for -​ Less expensive than employees -​ Nurses here and other staff offer education to clients -​ The importance of employee health to productivity and families and also provide comprehensive care to has long been recognized. clients who are acutely, chronically, or terminally ill. -​ focused on health promotion activities for employees. -​ An industrial clinic as a setting for employee health 11. Day care centers- provide care for children and infants care while parents work. -​ Worker safety has always been a concern of -​ Other centers provide care and nutrition for adults occupational nurses. who cannot be left at home alone but do not need to -​ nursing functions in industrial health care: be in an institution. 1)​ work safety and health education -​ Older adult care centers often provide care involving 2)​ annual employee health socializing, exercise programs, and stimulation. 3)​ screening for tuberculosis -​ Nurses employed in the center may provide 4)​ maintaining immunization information. medications, treatment and counseling. 5)​ screening for such health problems as hypertension and obesity, caring for employees following 12. Mental health services- counselIng centers -​ injury, and counseling. -​ Psychiatric clinics and hospitals -​ Chemical (drug and alcohol) abuse treatment centers Specialty hospitals- caters to specific conditional age groups -​ Physical abuse treatment centers, dealing with child or other ways of grouping patients. abuse, spouse abound and elderly abuse. -​ ex: cancer, psychiatric, pediatric,and rehabilitation hospital. 6. Subacute Care Facilities- subacute care is a variation of 13. Rural Care- created as a result of the 1987 Omnibus inpatient care designed for someone who has an acute illness, Budget Reconciliation Act to provide emergency care to injury, or exacerbation of a disease process. clients in rural areas -​ Patient does not depend heavily on high-technology -​ established a new classification called critical monitoring or procedures. access hospitals- which receive federal funding to -​ more intensive than long-term care and less intensive remain open and provide services needed for rural than acute care. residents -​ nurses here must be generalists 7. Extended (Long-term) care facilities- formerly called -​ NPs are suited here nursing homes -​ now often multilevel campuses 14. Hospice Services- interprofessional health care service -​ before only provided care for older adult clients, but for the dying, provided in the home or another health care they now provide care to clients of all ages who setting. require rehabilitation or custodial care. -​ distinct from the acute care model, is not saving life -​ disabilities or handicaps but improving or maintaining the quality of life until -​ Residential care (nursing homes) death. -​ Extended cadre. (Skilled nursing) facilities -​ nurses here serve primarily as case managers -​ Clients can be at home, hospitals, freestanding 8. Retirement and assisted living centers- for clients unable hospice facilities, or in skilled nursing facilities. to stay at home, but do not require hospital or nursing home. FUNDAMENTALS OF NURSING 15. Crisis centers- provide emergency devices for clients -​ Emergency medical technicians are trained to assess, experiencing life crises treat, and transport clients experiencing a medical -​ Counseling and support emergency accident or trauma. -​ Podiatrist -​ help people cope with an immediate crisis and then 7.​ Occupational Therapist- assist clients with impaired provide guidance and support for long term therapy. function to gain the skills necessary -​ Nurses here need well-developed communication and counseling skills. 8.​ Paramedical technologist- Paramedical means 17. Mutual Support and Self-Help Groups- may be for the having some connection with medicine. client or for the friends and family of the client, who also need -​ has 3 kinds: education, guidance, and support. a.​ Laboratory technologists- examine -​ arose largely because people felt their needs were specimens such as urine, feces, blood, and not being met by the existing health care system. discharges from wounds to provide exact information PROVIDERS OF CARE b.​ radiologic technologists- assists with a 1.​ Nurse- licensed wide variety of x-ray film procedures -​ assesses clients health status, identifies health c.​ nuclear medicine technologists- uses problems, and develops and coordinates care. radioactive substances to provide diagnostic -​ Licensed vocational nurse (LVN), in some states information and can administer radioactive -​ known as a licensed practical nurse (LPN)- materials as part of a therapeutic regimen. provides direct client care under the direction of an RN, physician, or other licensed practitioner. 9.​ Pharmacist-prepares and dispenses -​ role of the nurse varies with the needs of the client pharmaceuticals in hospital and community settings. -​ clinical pharmacist- is a specialist who guides 2.​ Alternative (Complementary) Health Care primary care providers in prescribing medications. Provider- refers to those practices not commonly considered part of Western medicine and in the 10.​ Physical Therapist-assists clients with temporary health care system musculoskeletal problems. -​ Ex. Chiropractors, herbalists, acupuncturists, -​ assessing client mobility and strength, providing massage therapists, reflexologists, holistic health therapeutic measures and teaching new skill healers 11.​ Physician- responsible for medical diagnosis, 3.​ Case Manager- ensures that clients receive sound treatment of disease and injury and appropriate care in the best setting -​ have different specialties (dermatologist, surgeons, -​ filled in by the member of the health care team who is etc) most involved in the client’s care. -​ hospitalist- physicians who specializes in the care of clients in the hospital 4.​ Dentist- diagnose and treat mouths jaw and dental -​ Intensivists- Hospitalist who specializes in critical problems care -​ actively involved in preventive measures to maintain healthy oral structures 12.​ Physician Assistant- perform certain tasks under the direction of a physician and are increasingly 5.​ Dietitian or Nutritionist positioned to provide primary care. -​ dietitian- special knowledge about the diets required to maintain health and to treat disease. 13.​ Case Manager- ensures that the clients receive -​ supervise the preparation of meals and design sound and appropriate care in the best setting special diets to meet the nutritional needs of clients -​ filled in by member of the healthcare team who is -​ nutritionist- is a person who has special knowledge most involved in client;s care about nutrition and food. -​ recommends healthy diets 14.​ Podiatrist- diagnose and treat foot and ankle -​ function at the preventive level. conditions either to perform surgery and prescribe medications. 6.​ Emergency Medical Personnel - providers are associated with ambulance or emergency medical 15.​ Respiratory Therapist- skilled in therapeutic services agencies that provide first responder care in measures used in the care of clients with respiratory the community. problems. FUNDAMENTALS OF NURSING 16.​ Social Worker- counsels clients and their support persons regarding problems such as finances, marital difficulties, and adoption of children. 17.​ Spiritual Support personnel- Chaplains, pastors, rabbis, priests, and other religious or spiritual advisers serve as part of the health care team by attending to the spiritual needs of clients. -​ nurse is often instrumental in identifying the client’s desire for spiritual support and notifying the appropriate person. 18.​ Unlicensed Assistive Personnel- health care staff who assume delegated aspects of basic client care. -​ These tasks include bathing, assisting with feeding, and collecting specimens. Healthy people 2020 and 2030 Key Points ​ The information that comprises the health history may be obtained from a person's previous records, the individual, or, in some cases, significant others or caretakers. ​ The depth and length of the history-taking process is affected by factors such as the purpose of the admission, the urgency of the complaint or condition, the person's willingness or ability to contribute information, and the environment in which information is sought. ​ When circumstances allow, a history may be holistic and comprehensive, but at times only a shallow or superficial review of the most pertinent facts is possible. Frameworks of care Managed care- aims to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for group of clients. FUNDAMENTALS OF NURSING Case management- involves interdisciplinary teams that assume collaborative responsibility for planning, assessing Filipi