Health and Transitions review .docx

Health and Transitions Review What does nursing encompass: A professional discipline A moral discipline Promotes physical, emotional, social, and spiritual well-being of individuals, families, and groups Involves many activities, concepts, skills The goal is to enhance the quality of life...

Health and Transitions Review What does nursing encompass: A professional discipline A moral discipline Promotes physical, emotional, social, and spiritual well-being of individuals, families, and groups Involves many activities, concepts, skills The goal is to enhance the quality of life defined by clients The process is interpersonal between a person in need of health services and another educated to respond An art and a science Florence Nightingale: Made a movement to improve standards of nursing care Considered the founder of modern nursing Cared for the wounded of the Crimean War Applied principles of cleanliness and comfort Elevated status of nursing Jeanna Mance: Sailed to New France with 40 others (1641) Established a settlement at Ville Marie, and remained in Quebec once they learned of the governor's suspicion of their mission Learned about nursing and health in new France from the Augustinian nuns in their hospital Built houses and founded and managed hotel dieu Canadian Nurses Association awards its highest honor in the name of this pioneer College of Nurses (CNO): Regulates the nursing profession in Ontario (NP’S, RN’s, and RPN’s) by implementing the specifics of the RHPA and the nursing act (1991) Registration and Membership CNO discusses, educates, investigates, and disciplines nurses Publishes information pertinent to nurses in Ontario: compendium of standards Scope of practice: Refers to the legal limits of a professional role The Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991 provide the legislative framework for nursing practice Components of the legislative framework: Scope of practice statement List of controlled acts authorized to nursing Regulated Health Professions Act (RHPA) (1991): Sets out common elements for all professional colleges Nursing act: One of 26 profession-specific acts Sets specific provisions relevant to the regulation of nursing practice Controlled acts: The nursing act, 1991 authorizes nurses to perform the following controlled acts: Performing a prescribed procdue below the dermis or mucous membrane Adminstering a subtance by injection or inhalation Putting an instrument, hand or finger: Beyond the external ear canal Beyond the point in the nasal passages where they normally narrow Beyond the larynx Beyond the opening of the urethra Beyond the labia majora Beyond the anal verge, or into an artifical opening in the body Exceptions to the RHPA: Acuptuncture Ear-piercing or body piercing Electrolysis Tattooing Male circumcision as part of a religious tradition or ceremony Taking a blood sample by a person employed by a laboratory Self regulation: Nurses partcipate in self-regualtion by: Knowing and practiicng according to standards of practice and legislation Mainting contininung competence Assuring quality of practice Evidence based practice “Best practice” Partcipatting in CNO activites Fcous groups Electrons (running, voting) Authorizing mechanism: Controlled act authorizing mechanis Require an order from a physician, dentist, chiropodist, midwife or NP to perform one of the five controlled acts which apply to nurses OR Delegation Entry to practice competencies: Professional practice Ethical practice Legal practice Foundations of practice Collaborative practice The client, the nurse, and the environment: Client factors Nurse factors Environment factors Roles and functions: Roles: exceptation that the profession and/or society has of a person Caregiver Advocate Coordinator Communicatior Teacher Leader Decision maker/ critical thinker Function: actual tasks that are completed by the individual Giving medications Bathing Assessing Estasblishing the relationship Knowing the client Respecting privacy and confidentiality Knowing procedures Documenting Reporting Health: Health is the absence of illness/ disease “Health is a state of complete physical, mental, and social well being and not merely the absense of disease or infirmity” Health is the effective performance of valued roles and tasks for which the individual has been socialized Actualization of inherent and acquired human potential through goal directed behaviour, competenet self-care and satisfying relationships with others, adjusting to the environment to maintain structural integrity and harmony The extent to which people are able to realize aspirations, satisfy needs, change or cope with the environment A resource for everday living, not an object for living A positive concept emphasizing social and personal resources as well as physical capabilities More than health care Health is: Feeling vitalized and full of energy Having good social relationships Experiencing a sense of control over ones life and ones living conditions Being able to do things that one enjoys Experiencing a sense of connectedness to community Health: Multidimensional Mulitlevel Contextual Subjective Objective Statisical Individual Environmental Influenced by: Policy and research Approaches to health: Medical approach (last ½ of the 20th century) Body conceptualized as a machine: medical interventions restore health Disease (breakdown) - treatment (fix it) model *treatment of disease Behavioural apprach (mid 70s) Lalonde report - a new perspective on the health of canadians (1974) Lifestyle and environment were key determinants Population health Uses epidemiologial data to determine etiology (cause) of health and disease Focus on social and individual factors that influence a populations health Focus on determinants of health Principle players are goverment and non-government organizations Approach can be downstream, mid-stream or upstream Socioenvironmental approach (mid 80s) Health related concerns cannot be seperated from the social contexts in which they occur Health is closely tied to social structures Unhelthy environments, poverty, air pollution, workplace Empowerment: The process of promoting informed self-care efforts of individuals,families or communities directed toward taking charge of such realms as health promotion and health protection Prerequisites for health: Peace Shelter Education Food Income Stable ecosystem Sustainable resources Social justice Equity Social determinants of health: The economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole Determine the extent to which a person possess the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment Determinants of health: Income and social status Social support networks Education Employment and working conditions Physical environments Biology and genetic endowment Personal health practice and coping skills Healthy child development Health services Gender Culture Social environments Health promotion: A way of being and a way of doing A process of enabling people to increase control Improve well-being and quality of life A mediating strategy between people and their environment, synthesizing personal choice, and social responsibility Health promotion means: People are able Socio-political and economic factors influence health “Power with” not “power over” relationships Health is individually defined and owned by the person expereicning the problem or issue Health professionals are partners “Different” not “right or wrong” Principles of health promotion - Ottawa charter (1986): Enablement Empowerment Equity Justice GOALS: Reduce morality and morbidity Provide resources for daily living Improve quality of life Health promotion guiding principles: Addresses health issues in context Supports a holisitic approach Requires a long-term perspective Mulity-sectorial Draws on knoweldge from social, econinc, political, environmental, medical, and nursing science, as well as from first-hand experiences Health promotion strategies - the ottawa charter: Build healthy public policy (ex, affordable housing) Create supportive envrionment (ex, flexible work, childcare) Strengthen community action (ex, safe injection sites) Develop personal skills (ex, educatoin, development of coping skills) Reorient health services (ex, improved access, community resources) Disease prevention: Directed toward decreasing the probability of experiencing health problems related to disease Focus is on prevention of one specific disease or health problem Action taken by the health sector to deal with individuals and populations recognized as having idetnifiable risk factors assoicared with risk behaviours (ex, immunization, routine screening) Primary prevention: Generalized health promotion and specific protection against disease Includes activities that protect against disease before signs and symptoms occur (ex, immunization, reduction of risk factors, teaching) Secondary prevention: Emphaszies early detection of disease, prompt intervention, and health maintenance for individuals expereincing health problems Includes halting the disease, llimiting disability and/or preventing complications (ex, BSE, TSE, blood pressure screening, COVID screening) Tertiary prevention: Beings after an illness, when a defect or disability is fixed, stabilizded, or irreversible Focus is to help rehabilitate individuals and restore them to an optimum level of functioning within the constraints of the disbaility (ex, cardiac rehabilitation, brain injury rehabilitation) Phenomenology: Understanding of the lived experience “Reality” is created and lived based on those meanings Each person’s reality is unique Feminism: Concerned with gender equality, equal rights, individual persons, and change Humanism: Seeks to facilitate the capabilities of individuals Individuals can overcome restrictions if certain conditions (genuineness, empathy, and unconditional positive regard) are present leading to self actualization Critical social theory: Critical: requiring careful judgment Social:concerned with human society Seeks to expose the underlying social relationships that are often concealed Jeans watsons theory of caring: Focus on holism Calls for a balance between the high tech environments of the typical hospital setting with a high touch environment Systematic use of a creative problem-solving caring process Promotion of a transpersonal teaching-learning Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment Assistance with gratification of human needs Allowance for existential-phenomenological-spiritual forces Swanson caring of patients: Caring is growth and health producing (nurturing) occurs in relationships (relating) to the one cared-for (a valued other), individualized and intimate (personal), with a sense of commitment (passion), accountability and duty (responsibility) Knowing Being with Doing for Enabling Maintaining belief Health promotion: A process of enabling people to increase control over and improve their health A mediating strategy between people and their environment, synthesizing personal choice, and social responsibility Carpers patterns of knowing: Empirics: science Asthetics: art Personal: knowing self Ethics: moral component Profession: A prestigious occupation with a high degree of identification among the members that requires a length and extensive education in an intellectually demanding and theory based course of study Professional: relating to, or characteristic of a profession Engaged in one of the learned professions Characterized by or conforming to the technica or ethical standards of a profession Following a line of conduct as though it were a profession Professionalism: The skill, good judgement, and polite behabior that is expected from a person who is trained to do a job well The conduct, aims, or qualities that charecterize or mark a profession or a professional person Professionalization: Social process by which any trade or occupation transforms itself into a true profession Process tends to involve establishing acceptable qualifications, a professional body or association to oversee the conduct of members of the profession, and some degree of the qualified form Professional nursing: CNO: self regulatory governing body for RNs, RPNs, and NPs in ontario Establishes requirements for entry to practice Articulates and promotes practice standards Enforces standard of practice standards WeRPN: Voluntary professional organization Concerned with professional issues, education and research Influences health policy Offers a network of profssional resources and supports Provinces professional liability insurance coverage - required by all practicing nurses Nursing profession: National professional association Government sponsored licensing legislation Professional examination Professional school separate from other professionals university/college based profession education Code of ethics Nation-level journal Accreditation program Image of nursing: Fosters self-esteem of nurses as professional Improves the way nursing is seen and regarded by the public Become role models for future nurses Image of nurses prepares the way for future nurses Impacts education Society’s views affects self image of each nurse Historical images of nursing: Angel or mercy (1854-1919) Moral, religious, virginal, ritualistic, self-sacrificing Girl friday (1920-1929) Subservient, cooperative, methodical, dedicated, modest, loyal The heroine (1930-1945) Brave, rational, dedicated, decisive, humanistic, autonomous The mother (1945-1965) Maternal, nurturing, sympathetic, passive, empressive, domestic Sex object (1965-???) Sensual, romantvic, hedonisitic, frivolous, irresponsible, promiscuous Present day Educated, autonomous, compassionate, vital to health care, empathetic, caring, dedicated Future Ideal image: An intelligent, logical, progressive, sophisticated, empathetic, and assertive man/ women who is committed to attaining higher standards of health care Nurses must learn to craft effective messages about nursing that convey understanding and respect for nursing philoophy, theory, and practice Nursing theory: To make sense of nursing knowledge, so that the nurses can use it in a professional and accountable manner Set of assumptions or propositions that identify the relationships between concepts Provide a systematic view for explaining, predicting, and prescribing phenomena Early nursing theories: Florence nightingale (descriptive theory) Provided nurses a way to think about nursing Used a frame of reference that focused on the client and the environment Became beginning work of nursing’s own body of knowledge Orlando (1961) Conceived of a problem solving approach that would allow nurses to appy general knowledge to unique and individualized patient situations Logical way to describe basic problem solving process in which knowledge was used effectively to guide nursing decisions Originally 4 phases: Assessment Planning Intervention Evaluation The McGill model: Developed by F. Moyra Allen (1921-1996) The main focus of the McGill model is health promotion Major focus of nursing care is in the family All families have strengths, motivation and resources that serves as the basis for health promotion The degree to which a family engages in health-related problem solving and goal attainment, reflects the process of family health promotion The outcomes of health promotion are competence in health behaviour and improved health status Found member of WHO (world health orrganizaton) develop criteria for accreditation of nursing schools Maslow hierarchy of needs: Maslows (1954) hierarchy of needs was one of the best known and most influential. The idea that complex human behaviour can be best explained as a response to the competing demands of various basic needs is featured prominently in many nursing models (NOT NURSING THEORY) Virginia henderson and dorothea Orem: Orem built on henderson’s work Maintaining sufficient intake of air, water, food Maintaining balance between activity, rest, solitude, and interaction Providing for elimination process Prevent hazards to life, functioning and well-being Promote functioning and growth in social groups - human potential Conceptualized the client as a compilation of 14 basic needs: Breathe, eat and drink, eliminate waste, move and maintain posture, dress and undress Maintain body temp, be clean, avoid danger, communicate, worship, play and learn Nursing practice involves assisting the individual in the performance of activities that contribute to health, recovery, or peaceful death Hildegard peplau and evelyn adam: Paplau: nursing is interactive and therapeutic relationship is the main focus - interprofessonal relationship Nursing roles - an investigator, prober, interpreter, reporter, using rich data from clients concerning their life Directed nurses toward preventing illness and maintaining health Adam: combined a variety of theories - looked at nursing as a helping process complementary/ supplementary role in supporting a clt strengths, knowledge and will How nurses applied knowledge in context of a helping relationships - characterized by empathy, caring and mutual respect Betty neuman and sister callista roy Neuman: coonceptualized the person to be a physiological, psychological, sociocultural, developmental, and spiritual being Nurses are attend to a client system in a health care oriented and holistic manner Client systems were both inherently human and unique to each individual person Nurse needs to focus on actual and potential stressors to the person Focus is on prevention Roy: person as a biopsychosocial being in constant interaction with a changing environment 4 modes of adaption - physicological, self concept, role function, interdependence Jean watson and rosemarie and parse: Watson: sa individuals as much more than simply a body and ego - an evolving embodied spirit Recognized unity of the mind-body-spirit and person-nature-universe as oneness Nurses must focus beyond physical illness through the function of caring Parse: human becoming - individual is indivisible, unmpredictable, ever-changing Caring presence of nurses support individuals in the human becoming process through explicating, dwelling with, and moving beyong