Mid Term Health Care PDF

Health Promotion the process of enabling people to increase control over their determinants of health, and to improve, their health (WHO encompasses health, wellness, disease, and illness represents a comprehensive, social and political process it not only embraces actions directed at s...

Health Promotion the process of enabling people to increase control over their determinants of health, and to improve, their health (WHO encompasses health, wellness, disease, and illness represents a comprehensive, social and political process it not only embraces actions directed at strengthening the skills and capabilities of individuals action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health- participation is essential - efforts to approach or move toward higher level of health and well- being Population Health health outcomes of a defined group of people along with the distribution of health outcomes within the group Patient Education Patient education is “anything that provides patients and families with information that enables them to make informed choices about their care, health, and wellbeing, and that helps them gain knowledge and skills to participate in care or healthy living processes.” (Marshall, 2016) (AKA patient teaching) Leadership Leadership is “an interactive process that provides needed guidance and direction Nurses are expected to exhibit leadership when delivering patient care and when working with others to address issues that affect the practice of nursing Three dynamic elements: leader, follower, and situation Communication process of interaction between people in which symbols are used to create, exchange and interpret messages about ideas, emotions and mind states Collaboration development of partnerships to achieve the best possible outcomes reflect the particular needs of the patient, family, or community, requiring an understanding of what others have to offer. Strengths-Based Nursing (SBN) An approach to care – promotes empowerment, self-efficacy, and hope. The nurse focuses on inner and outer strengths Fosters the capacity for health and innate mechanisms of healing Based on 8 core values: (however unlikely Halloween some people still like candy) 1. Health and healing 2. Uniqueness 3. Holism and embodiment 4.Subjective reality and creative meaning 5. Person and environment are integral 6. Self determination 7. Learning, timing, readiness 8. Collaborative partnership Social Determinants of Health Health is determined by circumstances and environment Broad range of personal, social, economic and environmental factors that determine individual and population health Main Determinants of Health Include: Income and social status Employment and working conditions Education and literacy Childhood experiences Physical environments Social supports and coping skills Healthy behaviours Access to health services Biology and genetic endowment Gender Culture Race/Racism Health Disparities are differences in health status among different population groups that are unavoidable Racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention. Differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities, or sexual orientation.” National Institute of Health has two separate definitions related to health care disparities Healthcare disparities: “Differences in access to or availability of facilities and services.” Health status disparities: “The variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups.” HRSA replaced “health disparities” with “health equity” Health Inequities refers to health inequalities that are unfair or unjust and modifiable often due to unfair distribution of underlying SDOH Wilkinson Hypothesis Health Equity The absence of disparities or avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.” If having trouble finding differences in these three terms here’s a easy way to remember: Health Disparities: The existence of differences in health outcomes. Health Inequities: Unjust differences in health outcomes that are preventable, often caused by social inequalities. Health Equity: The goal of eliminating health disparities and inequities to create fair and just opportunities for all people to achieve optimal health. Social Justice the equitable, or fair, distribution of society’s benefits, responsibilities and their consequences focuses on the relative position of social advantage of one individual or social group in relation to others in society as well as on the root causes of inequities and what can be done to eliminate them Social injustice is killing people on a grand scale (a lot of people are dying) Canada Health Act: is a federal law that sets the framework for the delivery of healthcare in Canada. -Passed in 1984, it ensures that all Canadians have access to medically necessary hospital and physician services without direct charges at the point of care. Act is designed to uphold the principles of universal healthcare and promote fairness and equality in access to health services. articulates the five principles of our national health insurance system: public administration comprehensiveness universality portability, accessibility—and forbids extra billing and user fees. Alma Ata (WHO/UNICEF Report on Primary Health Care) Expressed: “the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world”. Ottawa Charter The Ottawa Charter (1986) influential HP document identified 5 strategies to achieve “health for all by the year 2000” milestone document (places responsibility for health on society as a whole) Health promotion as: enable people to increase control, key concept: empowerment identified prerequisites for health e.g., peace, shelter, income, food, etc viewed health as dynamic and positive, having both social and individual dimensions Ottawa Charter 5 Strategies: Strengthen community action — encourage people to get involved and take action in decisions that affect their community’s health Build health public policy— make public laws and rules that keep health in mind Create supportive environments— create safe and satisfying environments for work and play Develop personal skills —provide support, education, and information to help people make healthy choices Reorient health services— create services which change the focus from illness to prevention Ottawa Charter for Health Promotion 1986 Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. Health is created by caring for oneself and others, by being able to make decisions and have control over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members. Epp Report/Framework achieving health for all: a framework for health promotion identified 3 major challenges not met by current health care practice and policies: disadvantages groups have lower life expectancy, poorer health, higher disability preventable disease continues to decrease health of canadians increase chronic disease/lack of community support Shifting Paradigm Conference challenged the healing paradigm of Western Medicine gave rise to 2 ideas: Self-responsibility for health health and lifestyles are affected by social structures and conditions Beyond Health Care Conference international think tank that brought HP into the political arena 2 ideas: health public policy health cities/communities projects Population Health Promotion Model Lalonde Report Lalonde Report (1974) A new perspective on the health of Canadians: response to 3 crises: growth in expenditures did not match gains in life expectancy sick care expenditures created budget problems medicine not successful at curing chronic conditions break from medical to holistic perspective recognized dynamic nature of health 4 key areas: human biology, environment, lifestyle, health care organization Lalonde Report: Health field concepts….1974 started focusing on lifestyle decreasing behavioural risk factors populations at risk (how we can support) entire population rather that individual (why make those choices) recognized value of research smoking, substance abuse, lack of exercise and unhealthy eating Health Belief Model Health Belief Model (Rosenstock’s) Developed to explain individual decisions for health screening opportunities, the three primary points of his model are: The individual's perception of his/her susceptibility to and the severity of the disease are the primary motivators to learn and change behaviour A belief must exist that the illness can be avoided, and that taking action can reduce the risk The individual must also believe that he/she is capable of making the necessary changes Designed to explain health behaviour and health behaviour change Focuses on individual Try to understand beliefs about health Framework for motivating people Negative consequences are the prime Health Promotion Model Developed by Pender, this model depicts a complex process associated with behavioural change for health promotion Focus is on optimizing wellness versus avoiding disease (big difference from first model) Patient motivation is influenced by social support and competing priorities Patient perceptions of benefit and the ability to succeed affect outcomes ** DO NOT get confused with the cube model Social Cognitive Theory Social Cognitive Theory (Learning Theory): Bandura (1997) Emphasizes the influence of efficacy beliefs on health behaviour Self Efficacy: individuals belief in their ability to influence own health Includes roles of reinforcement and observational learning in explaining health behaviour Modelling Provides opportunities for imitating behaviours Useful to demonstrate desired behaviours Example: parents model behavior for their child Transtheoretical Model of Change (Stages of Change Model) AKA “Stages of Change Model” Determine where person is in terms of behaviour change Readiness for change Respect the person's right to choose Stages Precontemplation: not considering behaviour change Contemplation: seriously considering a specific behaviour change in next 6 months Planning: starting to change or seriously thinking about making change in next month Action: made behaviour change; change persisted for 6 months Maintenance: 6 months after change; continues indefinitely **DO NOT NEED TO BE IN ORDER Stages of Change Model Few go through in orderly fashion Relapse is not a failure Can go backwards and forwards Smoker may stopd smoking several times before quitting Differs from other models as it is about how people change and not why people do not change (not focusing on the negative) ** Real life example would be MAID Diffusion of Innovation Model Individuals adopt innovation at different rates and are classified into one off these 5 categories: (Ian ate Erica like lizards) Innovators (quick adopters) Early adopters (keeners) Early majority Late majority Laggards (resistant to adopting the innovation) Diffusion of Innovation Theory Clients are more likely to adopt health-related practices if the following conditions exist: Compatibility Flexibility Reversibility Simplicity Advantageousness cost-efficiency SMART Goals Specific: Should provide the who and what Use only one action verb Avoid verbs with vague meanings Greater the specificity greater the measurability Measurable: How much change is expected the amount should be quantified provides a reference point Achievable: Should be attainable within given time frame and a viable resources Realistic: Accurately address scope of the problem/issue Need to directly relate to context Time-phased: Should provide a time frame indicating when the objective will be measured Can be short or long term Social Cognitive Theory Already done above Protection-Motivation Theory Behaviour can be influenced by intra- and interpersonal beliefs, social norms, and networks (including online influences), as well as by policies. The protection motivation theory (PMT) was developed by Ronald W. Rogers’ (1975). He extended the health belief model in 1983, with several adaptations in 1984 and 1985, which surmises that engagement in health-promoting behaviour is based upon three factors: one’s beliefs about the severity of the illness; perceived benefits of change; and barriers and confidence levels (self-efficacy) in creating change. PMT theory builds upon this and focuses on how fear influences change. The perceived severity and vulnerability of the threat is the first appraisal, and the perceived coping of the threat is the second appraisal the individual processes before attempting change. Social marketing is an example of how the use of fear utilizes the PMT, such as with stop-smoking campaigns, where the threat to health is a stimulus to protection motivation. Code of Ethics (For nursing): central foundation and provides guidance for ethical relationships, behaviours, and decision making to be used with professional standards, best practice, research, laws, and regulations that guide practice A code of ethics tends to offer guidelines not only about responsibilities for ensuring good care but also about responsibilities for recognizing and addressing barriers to service. It also serves as an ethical basis for nurses to advocate for quality practice environments that support the delivery of safe, compassionate, competent, and ethical care. As the societal context in which nurses work is constantly changing, which can significantly influence nursing practice, nurses need to anticipate future health needs and political activity when necessary to ensure health promotion Biomedical Approach health is defined by the absence of signs and symptoms of disease and illness is defined by the presence of signs and symptoms of disease. The target for intervention is high-risk individuals. Examples of health promotion strategies that use a biomedical approach include such activities as immunization and screening. Goals of the biomedical approach include decreased morbidity and prevalence of physiological risk factors, like high blood pressure. Behavioural Approach Lalonde report Limited list of determinants of health Epp report and Ottawa Charter expand Lalonde’s work Place responsibility for health on individuals Social marketing and health education campaigns Refinement of health promotion practices Some success with anti-smoking campaigns and exercise campaigns (participACTION) Socio-environmental Approach social context of health social determinants of health looks beyond the individual recognizes the complexity of health (not just making good choice other factors affect health 1996: the medical care act…..later canada health act (1980s) 1972: first Canada wide campaign, participACTION Primary Health Care What is Primary Health Care? Essential health care made accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford to maintain in the spirit of self-reliance and self-determination. World Health Organization (WHO) Primary Health Care Foundation of Canada’s healthcare system Continuity of care Model for improving health that supports essential health services Emphasis on health promotion and disease prevention Primary Health Care Encompasses range of community-based services essential to maintaining and improving health and well-being throughout lifespan Delivered in many settings: Workplace, home, schools, health care institutions, the family physician;s office, nursing homes, day-care centers, and community clinics It is also available by: Telephone, health information services, and the internet Primary Health Care examples in NL NL healthline 811 Collaborative clinics Community based services Health hubs (gander, grand-falls windsor) Health neighbourhoods Cancer patient navigator Benefits of a Primary Health Care Approach A team approach will improve care The health care team will have a better understanding of what other healthcare providers do, thereby enhancing their ability to connect people to appropriate services Keep people well and prevent people from getting sicker Better management of chronic disease and illness Improved access to services and provides when and where they are needed Support and enabling self care Barriers to Primary Health Care Individual-level barriers Practice-level barriers System-level barriers Principles of Primary Health Care Accessibility Public participation Health promotion Appropriate technology Intersectional collaboration Primary Health Care and Primary Care Primary care, Focus is on personal health services Primary health care, Includes primary care and health education, nutrition, maternal and child health care, family planning, immunizations, and control of locally endemic disease Primary Care Focus is on personal health services 5 types of care: Promotive Preventive Curative Rehabilitative Supportive/palliative Social marketing Definitions of Social Marketing Social marketing may be defined as a process to influence the acceptability of a social idea or cause A planned process for influencing change The application of marketing technologies developed in the commercial sector to the solution of social problems where the bottom line is behavior change These programs are designed to influence voluntary behaviour of certain people (target population) to improve their personal welfare and societies as a whole Use of Social Marketing It is an integrated part of health promotion strategies at Health Canada It is used to deliver health promotion messages to specific Canadian populations It is designed to help Canadians make decisions related to maintaining and improving their health and well being Social Marketing Vs. Advertising Terms are often confused with advertising The message is based on promotion strategies It is so much more than just advertising Commercial marketing tries to change people's behavior for the benefit of the marketer; social marketing tries to change people's behavior for the benefit of the consumer, or of society as a whole Steps in Social Marketing Identify behaviour(s) which require change Identify audience Identify true barriers to change Reduce barriers to change Pre-test idea on small group Examples: Youth health campaigns The 4 p’s of social marketing Product Price Place Promotion #1 Products What is being promoted to the target audience? The actual product: specific behaviour being promoted (nontangible object) The augmented product: tangible objects offered The core products: the benefits that the target audience will experience #2 Price Can be monetary or non-monetary Intangibles: Time, effort Risk, embarrassment Disapproval #3 Place Where will the product reach consumers? When? #4 Promotion Persuasive communication The tool that ensures the target knows the offer, believes they will experience the stated benefits, and is inspired to act Promotion has 2 Components: Messages Tactics (media advertisements, posters, PSA) Other Ps Partnerships Policy Politics Challenges with Social Marketing Measuring Measuring outcomes too early before change occurs Failing Failing to measure exposure expecting too much from a limited intervention Measuring Measuring wrong outcomes Primordial Prevention newest level of prevention — before risk factor original three levels developed in the 1945s to 1950s reflects policy — level intervention aimed at affecting health before at risk lifestyle behaviors. Are adopted occurs at national, provincial, community levels examples: healthy eating school based programs, reduction of sodium in food supply, creating bike/walking paths (sidewalks) Primary Prevention precedes disease/dysfunction Interventions — health protection health promotion (e.g., education) vaccines are primary prevention interventions Focus: maintain/improve general individual, family, community health Health protection — reducing threats to health Health promotion — encouraging lifestyle change to move toward health Secondary Prevention focus on early detection earlier treatment results in more favorable outcomes limit disabilities from disease screening falls under secondary prevention individuals populations example: colon cancer screening, Pap tests Tertiary Prevention focus on restoration and rehabilitation minimize long term sequelae of disease restore function; prevent further injury/disease Example: cardiac rehab after MI, ROM to maintain mobility after CVA, turning q 2h to prevent pressure sores Domains of Learning Cognitive development of new facts or concepts, and building on and applying new knowledge to situations Affective expressions of feelings and acceptance of attitudes, opinions or values, spiritual beliefs, family interaction patterns and relationships that affect decisions and problem solving Psychomotor acquiring skills that require the integration of mental and muscular activity; developing skill from simple to complex actions (developing physical skills) Erikson Developmental Model Individual needs to develop sense of trust and personal worth. Based on eight critical stages. Each stage requires a solution of conflict between two opposing forces. Each stage depends on preceding stages must be successfully accomplished to proceed Piaget Theory of Cognitive Development: Piglets theory of cognitive devlopment. Uses term “scheme” to describe a pattern of action or thought. Schemes are used to assimilate (take in) or accommodate (modify) new expirences. Individuals strive to maintain balance between assimilation and accomadation. Piaget’s stages of cognitive development: must develop before they can learn. Encompasses brith to 15 years old. Seneorimotor: (0-24) refelxes, object permanence Preoperational (2-6 years)- advancing language and movement, egocentric, magical thinking. Concrete operations (7-11)- logical approaches to solving concrete problems, understand cause and effect. Formal operations (11-15)- true logical thought, abstract concepts, morality. Vygotsky Theory of Cognitive Development: Vygotsky proposed that learning preceded development (opposite of what Piaget proposed) Focus on cultural, social, political, and individual influences on learning/ develpment (vs biological universality)\ Zone of proximal development: distance between actual and potential developmental level: Children “pulled” toward new learning. Guidance from others called “scaffolding” Kohlberg Theory of Moral Development Preconventional (children, some animals) Conventuonal ( adolescents, adults) Postconventional (individuals vs society) Based on Piagets theory of cognitive development: Emphasizes an ethic of justice Stages of moral deleopemtns proceed, during school-age, adolescent, and youn adult years Gilligan Theory of Moral Development: Doctoral research student with Kohlberg noted women scored lower than men using Kohlbergs tool Gilligans theory of moral developent Suggests a different process of moral development exists in women Woman are relation so based vs come development Women think and act based on caring and relationships (vs ethics/justice of men) Behavioural-Biological Development: How does environmental stress alter biological development (genetics) Evidence suggests that environmental expiercnes can change gene functioning Implication for disease development Many regulatory changes occur in early childhood Epigentics: scientific investigation of capacity of cell to react to enviroment Infants Toddlers Pre-Natal Care Pregnancy Care Nutrition: Is the science of optimal cellular metabolism and its impact on health and disease. Self-Management Is the ability of individual and or their caregivers to engage in the daily tasks required to maintain health and well being or to respond to the physical, psychological, behavioural and emotional sequelae of a chronic disease based on their knowledge of the condition, its consequences, and the plan of care co- developed with their health care team. Canada Food Guide Dietary Reference Intakes Replaced recommended dietary allowances (RDAs) Reflect a range of values (lower and upper limits) Serve as a guide for good nutrition and health policy Controversy: limited data relating to genetic diversity, specific groups such as children and pregnant women and the elderly Macronutrients Nutrients needed in larger amounts These provide the body with energy (calories) Carbohydrates 45-65%: they fuel during high intensity exercise. Spares protein, preserves muscle mass during exercise. Fuel for CNS and Brain. Grains: choose mostly whole grains Dairy: choose low-fat/non-fat Fruit: choose whole fruits more often than fruits juices Proteins 10-35%: Tissue structure (organ tissues, hair, skin, nails, bones, tendons, ligaments and blood plasma). Part of cell plasma membranes. Metabolic, transport, and hormone systems. Make up enzymes that regulate metabolism. Acid/base balance neutral enviroment.  Food sources: meat, fish, tofu, dairy, legumes, eggs, nuts and seeds Fats 20-35%: Energy reserve, protect vital organs, insulation, transport fat soluble vitamins, fat soluble vitamins. Food sources: oils, margarine, butter, nuts, seeds, meat, fish, dairy, micronutrients. Micronutrients Evidence Qualitative Research Quantitative Research Quality Improvement Research Evidence-Informed Decision Making  Revised Version: Health Promotion: helping people gain more control over their health Encompassing health, wellbeing, disease, and illnesses Not only strengthening skills and capabilities of individuals, but also trying to implement change on a grander scale Participation is essential Population Health: the health outcomes of a defined population and the distribution of these outcomes within the population Patient Education: providing patients and families with education that can help them make more informed decisions, can also help them gain information on how to participate in the healthy living process Leadership: interactive process that provides needed guidance Nurses are expected to show this when delivering patient care or addressing anything in the field of nursing requires a situation, a leader, and followers Communication: an interaction using an exchange of symbols to create meaning in another in another person Collaboration: partnership to help achieve the best possible outcomes particularly within the needs of a patient, family, or community, also requiring an understanding of what the individual has to offer Strengths based nursing: an approach to care that promotes empowerment, self-efficacy, and hope The nurse will focus on the individual’s strengths Based on 8 core values: health and healing. - Self efficacy Uniqueness - Learning, time, and readiness Holism - Collaborative partnership Subjective reality and creative meaning People and environment Social Determinants of health: health is determined by one’s circumstances and environment Broad range of social, environmental, and economic factors that determine individual and population health Social determinants of health include: income and social status Education and literacy Employment and working conditions Childhood experiences Physical environment Social support and coping skills Healthy behaviours access to health services Biology and genetics endowment Gender Culture race/Racism Health Disparities: are differences in health status among populations that are unavoidable Example, a population may be more susceptible to heart disease or obesity Healthcare disparities: differences in availability or access to healthcare services Health status disparities: the variation in rates of disease occurrences between different populations Health inequalities: unfair circumstances due to unequal distribution of SDOH Example, people of lower income are less likely to own a home Example, people living in rural areas have less access to nutritional foods Health Equality: the absence of disparities or avoidable differences among groups in health status and health outcomes Example, no increased disease rate in a population Social Justice: the equal distribution of society’s benefits Looks at the root cause of inequalities to see what is causing them, then trying to eliminate them Social injustice is killing people on a grand scale Canada Health Act: federal law that sets a framework for the delivery of health care in Canada Passed in 1984 Designed to promote fairness in access to healthcare services made up the 5 principles of our nation insurance system: public administration Portability Universality Accessibility Comprehensiveness Alma ATA (WHO/UNICEF Report on primary health care): they said all the governments need to come together to protect the health of all the people in the world Ottawa Charter (1986): identified 5 strategies to achieve “health by the year 2000” thought health was affected but someone’s daily environment, and being able to take care of yourself and make your own decisions Ottawa Charter 5 strategies: strengthen community action: encourage people to get involved Create public health policy: make public rules that keep health in mind Create a supportive environment: create safe environments for work and play Developed personal skills: provide the proper education to help people make informed decisions Reorientation of healthcare services: create services where the focus is not illness but prevention Epp Report/ Framework: wanted to achieve health for all Identify 3 challenges not met by current healthcare practices and policies: disadvantaged groups have a lower life expectantly, poor health, etc Preventable disease continues to decrease Increase chronic illness/ lack of community support Shifting Paradigm Conference: challenged western medicine Gave rise to 2 ideas: self responsibility for health Health and lifestyle are affected by social structure and conditions Beyond Health Care Conference: brought HP into the political arena Gave rise to 2 ideas: health public policy Health cities/ community projects Population health Model: involves three questions With whom? On what? How? Lalonde Report (1974): a new perspective on health for Canadians Changed from biomedical to behavioural Started focusing around lifestyle Focused on whole populations rather then individuals 4 key areas: human biology Lifestyle Environment Healthcare organization Health Belief Model (Rosenstocks): developed to explain individuals decisions regarding health screening opportunities Focuses on individual Trying to understand beliefs about health Three primary points: the individuals perception of their susceptibility to and the severity of the disease (these are the primary motivations for change) A belief must exist that the illness can be avoided, and that taking action can reduce this risk The individual must also believe they are capable of making the needed change Health Promotion model (Pender): talks about the complex process associated with behaviour change and health practices Focusing on optimizing wellness versus avoiding illness NOT THE CUBE Social Cognitive Theory (Bandura 1997): emphasizes on how effective beliefs can affect healthy behaviours Example, parents model behaviour to their children Trans-theoretical Model of change: aka stages of change model Determines where a person is in terms of behaviour change few go in orderly fashion Relapse is not a failure Can go backwards and forwards Stages: Pre-contemplation: not considering behaviour change Contemplation: seriously considering a behaviour change within the next 6 months Planning: starting to change or seriously thinking about the change within the next month Action: made the behaviour change, stayed persistent for 6 months Maintenance: 6 months after change Diffusion of Innovation Model: individuals adopt innovation at different rates People are more likely to adopt new ideas if they are compatibility, flexibility, reversibility, simplicity, cost-effective Example, iPhones 5 categories: innovators (quick adopters) Early adopters (keeners) Early majority Late majority Laggers (resistant to adopting the innovation) SMART Goals: specific Measurable achievable Realistic Time-phased Protection- Motivation Theory (Ronald 1975, extended in 1983, 1984, 1985: behaviour can be influenced by intra and interpersonal beliefs, social norms and networks, as well as policies He extended on the health beliefs model Focuses on how fear can influence change Example, Social marketing (stop-smoking campaigns) Code of ethics for nursing: central foundation provides guidance for ethical relationships, behaviours, and decision making Offers guidance for responsibilities, proper care, recognizing and addressing barriers to service Providers and ethical basis for nurses to advocate Biomedical approach: health is defined as the absence of illness HP strategies that could be used with this approach could be vaccinations Behaviour Approach: Lalonde Report Places responsibilities for health on individuals Some success with anti smoking campaigns and exercise campaigns (participACTION) Socio environmental approaches: looks beyond the individual SDOH Recognizes the complexity of health Primary Health care: essential healthcare made accessible to individuals and families and communities Foundation of Canadas healthcare system Continuity of care Model for improving health that supports essential healthcare made accessible services Emphasis on HP and DP Examples in NL: 811 Collaborative clinics Cancer patients navigator Community based services Benefits: a team approach will improve care The healthcare team will better understand of what other healthcare providers do, thereby enhancing their ability to connect with people to appropriate services Improved access to services Barriers: individual level barriers Practice level barriers System level barriers Principles: accessibility Public participation Health promotion Appropriate technology Intersectional collaboration Primary Care: focuses on personal health services 5 types of care: promotive Preventive Curative Rehabilitation Supportive/ palliative Social marketing: process to influence the acceptability of a social idea or cause A planned process to influence change These programs are designed to influence voluntary behaviour change in a targeted population to improve their personal wellbeing and society as a whole A HP strategy not advertising Steps: identify behaviour which requires change Identify change Identify true barriers to change Reduce barriers to change Pre-test idea on small group The 4p’s: products (what is being promoted) Price (time/effort, risk/embarrassment) Place (where will the product reach consumers) Promotion (persuasive communication, has 2 components: messages, tactics) Other P’s: partnerships Policy Politics Challenges: measuring outcomes to early before change occurs Measuring wrong outcomes Failing Primordial Prevention: newest level of prevention (before risk factor) Example, healthy eating programs in schools, creating bike/walking paths Primary prevention: involves HP Example could be vaccines Focus: maintain or improve the general health of an individual, family or community Health protection: reducing threats to health Health promotion: encouraging lifestyle change to move toward health Secondary Prevention: focuses on early detection earlier the treatment the more favourable outcomes Limit disability from disease Example, mammogram, Pap test Tertiary prevention: focusing on rehabilitation Restore function/prevent further injury Example, Cardiac rehab after MI, turning every 2h to prevent pressure sores Domains of Learning: Cognitive: developing of new facts or concepts, building and applying new knowledge to situations Affective: expression of feelings, beliefs, attitudes, opinions, that affect decision making and problem solving Psychomotor: acquiring skills that involve mental and muscular activity, developing skills from simple to complex actions Erkison Developmental Model: each stage has a solution and a conflict Must successfully complete the stage before to move on 8 critical stages: infancy: trust vs mistrust Toddler: Autonomy vs shame and doubt preschool: initiative vs guilt School-age: industry vs inferiority adolescence: identity vs role confusion Young adult: intimacy vs isolation middle adult: generativity vs stagnation Older adult: ego integrity vs despair Piaget Theory of cognitive development: must develop before they can learn Involves birth - 15y old Stages: sensorimotor (0-24m): reflexes, object permeance Pre-operational (2y-6y): advancing language and movement, magical thinking Concrete operational (7y-11y): logical approaches to solving problems, cause and effect Formal operational (11y-15y): true logical thoughts, abstract concepts, morality Vogotsky Theory of cognitive development: proposed that learning exceeded development (opposite of Piaget) Focused on cultural, social, political, and individual influences on learning Kohlberg Theory of moral development: emphasizes on ethic of justice Stages: pre-conventional: (children, some animals) Conventional: (adolescents, adults) Postconvential: (individuals vs society) Gillian Theory of moral development: noted women scored lower on the Koehler tool Suggest different process of moral development exist in women Woman think and act on caring and relationships Behavioural- biological development: genetics Evidence suggests that environmental experience can change gene function Implication for disease development Infants (Slideshow 10): Developmental task of infancy: physiological equilibrium Stimulation and environmental intervention Infant should have auditory/ visual stimuli Concepts of infant development: trust vs mistrust Sensorimotor period Nutrition- metabolic pattern: breastfeeding “the perfect food”: exclusive, preferred for first 6 months. Continued, first year and beyond Introduction to solid foods: at 4-6 months, recommendation is to wait until 6m to lower change of food allergies Essential infant nutrients: vitamin D supplementation (if breastfed) Iron fortification by 6m Elimination: breasted: softer, clean smell Bottle fed: harder, smellier Urinary elimination 6-12 times/day Defection/voiding involuntary Sleep: 80% at birth 12 hours daily for first 12 months Naps (2-3 Tim’s per day) Not a firm schedule crib death Toddler (slideshow 10): years 1-3 Great growth change Gain command of motor, cognitive and behavioural skills at a rapid rate Stages: sensorimotor (no longer repeats behaviours, begins to solve problems) Autonomy vs shame and doubt “me do it” Pre natal Care and Pregnancy care (Class 9, Slides 36-60) Nutrition: science of optional cellular metabolism and its impact on health and disease Self management: ability of an individual to take part in the required activities to maintain health This can be a plan of care developed by the healthcare team Canadas food guide: supports healthy eating habits Simplifies nutrition information Online resource and mobile friendly Eat a variety of food each day: fruit and veggies (1/2 of your plate) Protein (1/4 of your plate) Whole grain foods (1/4 of your plate) Make water your drink of choice Healthy eating is more the the foods you eat: be mindful of your eating habits Cook more often Enjoy your food Eat meals with others Dietary reference intake: replaced recommended dietary allowances (RDAs) Serve as a guide for good nutrition and healthy policy Macronutrients (class 8): nutrients needed in large amounts These provide the body with energy Proteins (10-35%), fats (20-35%), carbohydrates (45-65%)= 100% Carbohydrates: fuel high intensity exercise Fuel CNS and brain Food sources: grain Dairy Fruit Protein: Food sources: meat Fish Tofu Dairy Eggs Nuts Seeds Fats: energy reserve Protects vital organs Food sources: oils Butter Nuts Seeds Meat Fish Dairy Micronutrients (class 8): needed in smaller amounts Vitamin B1: Thiamin: needed to release energy in food prevents beriberi Food sources: meat Whole grains Dried beans Peas Peanuts Vitamin B2: Riboflavin: needed to build and maintain body’s tissues Food sources: organ meats Meat Eggs Green and yellow veggies Enriched flower Vitamin B6: Pyrdoxine: helps develop the nervous system Involves in reproduction of blood Helps break down things to produce energy in the body Food sources: meat, fish, nuts, beans Veggies Yeast Rice Vitamin B12: Cobalamin promotes proper growth and development of the nervous system Food sources: meats Dairy Eggs Vitamin C: Ascorbic Acid: heaps form growth hormones Needed to build strong gums, thresh and bones Food sources: citrus fruits Cabbage Berries Peppers Folic acid: helps build DNA and protein Helps maintain intestinal tract AIDS in bone growth Food sources: dark green leafy vegetables Yeast Wheat germ Vitamin A: Retinal: vision Healthy skin and hair Food sources: milk Butter Eggs Cheese Liver Vitamin D: strong theta and bones Prevents rickets Food sources: milk Cod liver oil Tuna Salmon Egg yolks Produced by body when exposed to sun Vitamin E: prevents damage to cell membranes Works with vitamin A AIDS in blood production Food sources: seeds and nuts Vegetable oil Vitamin K: aids in blood clotting Food sources: green leafy vegetables Produced by bacterial in large intestine Baby’s/ newborn will get a vitamin K injection right away to aid with blood clotting Calcium (Ca2+): maintains teeth and bone Helps blood clot Helps nerve and muscle function Food sources: cheese Milk Sardines Clams Oysters dark green vegetables Potassium (K): regulates cellular water balance Healy’s nerves function Important in heart rhythm Food sources: oranges Bananas Meat Fish Cereal Potatoes Dried beans Sodium (Na): regulates water balance Stimulates nerves Food sources: table salt Meat Fish Eggs Milk Iron (Fe): forms blood cells Transports oxygen throughout the body Food sources: liver’red meats Dark vegetables Whole grain cereals Shellfish Zinc (Zn): aids in transport of carbon dioxide Aids in healing wounds Forms enzymes Food sources: meats Shellfish Whole grains Milk Antioxidants: substances that may prevent or delay cell damage Found in many food, including fruits and vegetables Examples: beta- carotene Lutein Lycopene Selenium Vitamin A, C, and E Evidence: testimony of facts tending to prove or disapprove a conclusion Used to guide practice Qualitative Research: poses question about nursing phenomena that cannot be quantified or measured Designs: phenomenology: learning and constructing the meaning of human experience ground theory: method of systematically collecting data on events as they happen Ethnography: focuses on scientific description and interpretation Participatory Action research: combines exploration, reflection and action Social and health problems: Participants are studied Case study: review commonalities of a particular case Quantitative Research: can be measures and quantified Involves numbers Designs: Experimental: pre-test, post-test clinical trail Quasi experimental: the researcher initiates and experimental treatment Non experimental: survey studies Quality improvement research: gathers data on a health outcome as a way to gauge the quality of care provided Is a goal of nursing research Levels of research evidence: Level I (best): systematic review Evidence based clinical practice Three or more RTCs of good quality that have similar results Level II: one or two well designed RCTs Level III: one or more well designed controlled trails without randomization Level IV: one or more well designed case control or cohort studies Level V: systematic reviews or qualitative studies Level VI: single descriptive or qualitative study Level VII (worst): opinions Evidence informed decision making: the use of evidence from research using a variety of methodologies within the framework of clinical judgment utilizing research in the nursing practice More Notes: Infants: weaning: introducing infant to cup (usually 5-6m) Delay to lite training until 18m urinary elimination should occur 6-12 times per day for the first few months Tummy time is needed to prevent flattening of head from sleeping supine can differentiate odor of mother milk from others at 2 weeks Salivation at 3m Cooing by 2m Babbling at 6m Single words by 12m differentiates self in mirror at 4m Immunization for children 2, 4, 6, 12m scheduled Maternal Mental Health: 1/5 mothers experience anxiety or depression A women is at high risk to develop mental illness within the first year of her baby being born 20-80% of moms experience anxiety”baby blues” Toddlers: 2y (2 word sentences) 3y (3 word sentences) At 2y (50 words) at 3 (1000 words) 1 1/2y simple verbal instructions, identifying 3 body parts, point to want, 5 simple pictures 2y identifies 5 body parts, points to 10 pictures, obeys simple commands 2 1/2y points to 15 pictures, obeys 2-3 simple commands Sleep and rest: need 12-14h, usually 1 nap per day, maintain schedule, night terrors/nightmares three meals and two snacks per day vaccines 12 & 18m Pre Natal Care: thalidomide, the biggest man made medical mistake Fetal development: germinal stage: last approximately 10 days to 2 weeks after fertilization Embryonic stage: from 2-8 weeks. A time of rapid growth and development of body and organ systems fetal stage: 8 weeks- birth, raid growth and changes. Different body parts grow faster then others Duration of pregnancy: full term: 9 solar months- 10 lunar months, 40w, 3 trimesters Trimester 1: 1-12w Trimester 2: 13-28w Trimester 3: 29-40w 25-28 weeks, jumps due to loud sounds 29-32 weeks, thumb sucking Recommend weight gain: healthy women: 25-35lb Underweight: 28-40lb Overweight: 15-15lb Obese: 11-20lb obese women may have complications along with their baby Labour and birth: four stages dilation stage: onset labour to cervix dilation, three stages Pushing stage: from complete dilation of cervix to birth Placental stage: birth to delivery of placenta Recovery stage: first 4 hours after childbirth Nutritional- metabolic pattern: well balanced diet 8-10 glasses of water per day 70g of protein Activity exercise patten: 16 weeks kicks occur Pregnant women need at least 30min of aerobic exercise per day