N480 Exam Study Guide PDF

1 Study Guide for Exam 1 N480 Robinson Chapters: 1-5, 7-9 Denham Chapters: 1, 2, 5, 6, 7 There are twenty (30) questions and you will have 40 minutes to complete the exam. ​ Definitions of family, family focused care, family health ★​ Family: Family refers to two or more individuals who dep...

1 Study Guide for Exam 1 N480 Robinson Chapters: 1-5, 7-9 Denham Chapters: 1, 2, 5, 6, 7 There are twenty (30) questions and you will have 40 minutes to complete the exam. ​ Definitions of family, family focused care, family health ★​ Family: Family refers to two or more individuals who depend on one another for emotional, physical, and economic support. The members of the family are self-defined. ★​ Family Health: Family health is a dynamic, changing state of well-being which includes the biological, psychological, spiritual, sociological, and cultural factors of individual members and the whole family system. ⇒ Assessment of family health involves collecting data on the health and functional status of each individual as well as the whole family system. ★​ Family focused care: Families influence the process and outcome of health care. Knowledge of family structure, function, and process informs the nurse in how to: optimize nursing care, and provide individualized care in families. Therefore, this approach focuses on the assessment and care of the individual client in which the family is the context. ​ Influence of family on health/illness – consider education, resources, support a.​ Education ​ Families can influence health behaviors by providing knowledge about nutrition, disease prevention, and the importance of medical care. ​ Health literacy within a family determines how well members understand health conditions, medications, and treatment plans. ​ Misinformation or lack of awareness may lead to poor health choices, non-compliance with treatments, or delayed medical attention. b.​ Resources ​ Socioeconomic status affects access to healthcare, quality food, safe housing, and medical services. ​ Families with financial stability can afford health insurance, medications, and preventive care, while those with financial constraints may experience barriers to care. ​ Access to transportation, technology (e.g., telehealth), and community resources also plays a role in managing health conditions effectively. c.​ Support ​ Emotional and psychological support from family members can improve coping mechanisms during illness. ​ Family caregivers play a vital role in assisting with daily activities, medication adherence, and appointments. ​ A lack of support can contribute to stress, poor mental health, and non-adherence to treatment regimens. d.​ Impact on illness and recovery ​ Strong family support improves recovery rates, reduces hospital readmissions, and enhances overall well-being. ​ Dysfunctional family dynamics, such as neglect, stress, or enabling unhealthy behaviors, can worsen health conditions. ​ In chronic or terminal illnesses, family involvement in decision-making  2 and advance care planning is crucial. ​ Traits of a healthy (well-functioning) family ★​ Communicates and listens ★​ Fosters table time ★​ Affirms and supports each other ★​ develops trust ★​ laughs and plays ★​ balance of interaction ★​ teaches right and wrong ★​ has rituals and traditions ★​ shares religious core ★​ Respects the privacy of each member ★​ Values service to others ★​ Admits to problems and seeks help ★​ Manages conflict and crisis when they occur ★​ Offers forgiveness, comfort and support ​ ​ Family functions, family processes, family dynamics a.​ Family function ​ Reproduction: Ensuring the continuation of society by having children. ​ Socialization: Teaching children the norms, values, and customs of their culture. ​ Affective: Providing emotional support and nurturing to family members. ​ E ​ conomic: Offering financial support and resources to meet the needs of family members. ​ Health care: Taking care of the health and well-being of family members. b.​ family processes ​ Provider: Ensuring the family has the necessary resources, such as food, shelter, and clothing. ​ Housekeeper: Managing household tasks and maintaining a clean and organized home. ​ Child care: Taking care of the children’s needs, including education, health, and emotional support. ​ Socialization: Helping family members, especially children, learn social skills and cultural norms. ​ Sick or illness: Caring for family members who are ill or have health issues. ​ Sexual: Fulfilling the sexual needs of partners within the family. ​ Therapeutic: Providing emotional and psychological support to family members. ​ Recreational: Engaging in activities that promote fun and relaxation for the family.  3 c.​ family dynamics ​ Diverse Structures ​ Increased Mobility ​ Changing Roles and Expectations ​ Definition/understanding of “theory” and “framework” - how/why do we use them? a.​ In the context of family nursing, a "theory" is a set of concepts, definitions, relationships, and assumptions that project a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting phenomena. Theories provide a foundation for understanding the complex interactions within families and guide the development of nursing interventions. b.​ A ​ "framework," on the other hand, is a structure that provides a systematic way of looking at phenomena. It outlines the key concepts and variables and the presumed relationships among them. Frameworks help organize and interpret information, guiding the assessment and intervention processes. ​ We use theories and frameworks in family nursing to: Guide Assessment: They help nurses systematically collect and analyze family data. Inform Interventions: They provide a basis for designing and implementing effective nursing interventions tailored to family needs. Enhance Understanding: They offer a structured way to understand family dynamics, health behaviors, and the impact of health events on the family. Promote Consistency: They ensure a consistent approach to family nursing care, improving communication and collaboration among healthcare providers. ​ Theoretical foundations a.​ Family systems theory ⇒ is an approach that allows nurses to understand and assess families as an organized whole and / or as individuals within family units who form an interactive and interdependent system. ⇒ this theory is constructed of concepts and propositions that provide a framework for thinking about the family as a system. (Family nursing looks at three-generational family systems). ⇒ family system features are designed to maintain stability weather they are adaptive or maladaptive. ⇒ family systems increase in complexity over time and increase their ability to adapt and to change. ⇒ Family systems theoretical perspective encourages nurses to see individual clients as participating members of a larger family system. ⇒ any change in one family member affects all members of the family. ⇒ the goal of nurses is to help maintain or restore the stability of the family in order to help family members achieve the highest level of functioning that they can. Emphasis is on the whole, rather than the individual.  4 Concept 1: All Parts of the System are Interconnected → When one family member experiences a health event, it impacts the entire family system.For example, one parent takes on more parenting duties, while the other parent sacrifices activities to help another child, and that child misses his mother's care.Another child struggles to focus on college work. Each family member's roles shift, showing how one person’s illness influences the whole family. Concept 2: The whole is More than the sum of its parts → A family is more than just its individual members; it is an interconnected system where each person’s experiences impact the whole.one family member's chronic illness affects everyone, creating stress and uncertainty about their future. The disruption of their traditions and day to day highlights how the family's sense of unity and identity is challenged by her illness, making the loss greater than just an individual experience. Concept 3: All systems have some form of boundaries or borders between the system and its environment. → Families manage the flow of information and people into their system through boundaries, which can be closed, flexible, or too open. Closed boundaries limit outside help, while flexible boundaries allow selective support, like the Jones family accepting a pastor’s visit but declining others. Too open boundaries can lead to chaos if not managed carefully. Each family’s boundary permeability varies, influencing how they handle stress and external support. b.​ Developmental & life cycle theory ⇒ Is a framework for nurses to understand normal family changes and experiences over a member's lifetimes. ⇒ the theory assesses and evaluates both individuals and families as a whole because individual family members and family as a whole develop and change over time. ⇒ this approach views the evolving needs and priorities of family members and the family. ⇒ Family developmental theories are specifically geared to understanding families and not individuals. Duvall used normative families (two-parent, white, heterosexual parents with two or more biological children). Carter and McGoldrick (2005) expanded this view to include diverse families. They replaced the term nuclear family with immediate family. Instead of legal marriage as the time stone for the beginning formation of families, they suggested using commitment of a couple as the beginning of the family. Identifiable transition: parent takes kid to school, then kid drives themselves to school Systematic and predictable transitions→ adolescence kids wanted more autonomy there will be stress during these transitions → when parents get older they move back in with you. Move from being cared for to being cared for. This is expected and disruptive. Family life cycle theory identifies this as a typical phase. As nurses, if we know…its actually  5 expected and you can give them some coping strategies. You can assess where they are in the life cycle phase, anticipate changes, provide interventions, and validate their feelings within their phase. Help them adjust in a healthy manner. Concept 1: Families Develop and Change Over time → Families evolve over time through predictable stages, as outlined in the Developmental and Family Life Cycle Theory. These changes affect family structure, roles, and interactions, creating stresses that vary depending on the stage of development. One perspective on family development focuses on expected life transitions, such as marriage, child-rearing, and aging, aligning with societal norms. Another perspective considers how long a family remains in a particular stage, influencing the stresses experienced, such as the decision to remain childless. Overall, families follow a natural trajectory, becoming more complex with new members and adjusting as members leave or pass away. Concept 2: Families Experience Transitions from One Stage to Another.  6 c.​ Bioecological systems theory ​ Microsystem vs Mesosystem vs Exosystem vs Macrosystem ​ → Microsystems: immediate / direct environment that affects the child such as family, school, and friends where direct interactions occur. ​ Mesosystems: Interactions: relationship between family and school / teacher. If teachers and parents communicate well then the kid will have a positive experience. ​ Exosystem: External environments that indirectly affect a person, like a parent’s job or government policies. ​ Macrosystems: The broader cultural and societal beliefs that shape a person’s life, such as religion or political systems. ​ Chronosystem: The influence of time, life events, and historical changes on development, live divorce or economic shifts. ​ ​ This theory emphasizes that people don’t develop in isolation but are influenced by multiple layers of their environment interaction over time.  7 d.​ Family Nursing Assessment & Intervention Model ​ Jones Levels of Racism a.​ Jones' Three Levels of Racism Model is a theoretical framework mentioned in the document that helps in understanding health disparities. b.​ This model considers the individual, families, communities, and the broad economic, social, cultural, and physical environment, and how each system improves understanding and treatment of disease and promotion of health. And it includes the following: 1. Institutionalized Racism (Structural/Systemic Racism) Definition: Differential access to goods, services, and opportunities based on race, embedded in laws, policies, and societal structures. Examples in Healthcare: Disparities in access to quality education, housing, and employment opportunities, which affect health outcomes. Unequal access to healthcare facilities and insurance coverage. Environmental injustices, such as predominantly Black communities facing higher exposure to pollutants. 2. Personally Mediated Racism (Interpersonal Racism) Definition: Prejudice and discrimination based on race, where individuals are  8 treated differently based on racial biases. Examples in Healthcare: Healthcare providers having biases that lead to differences in pain management (e.g., Black patients receiving less pain medication than white patients). Assumptions about patient noncompliance or risk factors based on race. Unequal treatment in clinical decision-making, leading to worse health outcomes. 3. Internalized Racism Definition: When individuals of marginalized racial groups accept and believe negative stereotypes about their own race, leading to self-doubt, hopelessness, or limiting their aspirations. Examples in Healthcare: A person believing they don’t deserve good healthcare or hesitating to seek medical attention due to past discriminatory experiences. Lower self-esteem or chronic stress due to societal messages that devalue their racial identity. Internalized stress leading to physiological impacts such as hypertension and increased disease risk. ​ Roles nurses play in family health nursing a.​ Join institutional committees to change relevant policies b.​ Join professional associations and advocate for needed family policies c.​ Contact elected representatives regarding needed policies or changes to those that are harmful d.​ Join community advocacy groups e.​ Join boards of directors for agencies ​ Culturally-sensitive family-centered care a.​ Nurses are encouraged to: Conceptualize and assess the health status of families using sociopolitical determinants of health. Join institutional committees, professional associations, and community advocacy groups to influence and advocate for family policies that may include cultural sensitivity. Promote health equity, which inherently involves being sensitive to the diverse cultural backgrounds of families. ​ Cultural factors that contribute to health status a.​ Social Address: Factors such as race, ethnicity, gender, national origin, age, residential tenure, sexual orientation, ability, and body size. b.​ Access and Use of Resources: Cultural norms and values can affect how individuals and families access and use health care resources. c.​ Social Meanings and Norms: Cultural beliefs and practices can shape health  9 behaviors and attitudes towards health care. d.​ Income and Employment: Economic opportunities and job conditions, which can be influenced by cultural and social factors. e.​ Education: Access to and the value placed on education within different cultural contexts. f.​ Housing: Living conditions and housing stability, which can vary across different cultural groups. g.​ Public Safety and Transportation: Availability and safety of transportation options, which can be influenced by cultural and community factors. h.​ Community-Based Resources: Availability and cultural appropriateness of community resources and support systems. ​ Health policy, family policy – implicit, explicit a.​ Implicit family policies are those that indirectly affect families through broader regulations and laws. Examples include: -Zoning ordinances -Traffic laws -Criminal laws -Environmental laws -Corporate laws -Voting laws b.​ Explicit family policies are those that directly address family-related issues. Examples include: -Policies, programs, and laws around marriage -Divorce -Adoption -Child care -Family leave -Reproductive rights *These policies are designed to promote, safeguard, and bolster families in various areas such as family creation, relationships, economic support, child-rearing, education, health care, and caregiving. ​ Social determinants of health a.​ Where an individual or family lives, learns, and works b.​ Social address (e.g., race, ethnic, gender, national origin, age, residential tenure, sexual orientation, ability, body size, and more) c.​ Access and use of resources d.​ Intentional or unintentional influence of policies, and social meanings and  10 norms—shape the health and development of individuals, families, and communities. ​ Health literacy, consequences of low health literacy a.​ Health Literacy ​ The degree to which individuals have the ability to find, understand, and use health-related information that they can use to make informed decisions about their health b.​ Low health literacy can be linked to: ​ Lower adherence to healthy lifestyles ​ Lower participation in health-screening programs ​ Poorer management of chronic disease ​ Poorer adherence to medical regimens and protocols ​ Less participation in community groups ​ Less use of primary-care services ​ Increased use of emergency and urgent-care services ​ Gene, genome a.​ Genes refer to individual units of heredity made up of DNA that determine specific traits or functions. The study of genes focuses on their impact on clinical disorders and how mutations in these genes can lead to genetic conditions. For example, a mutation in a single gene can cause Huntington’s Disease. *Huntington’s Disease: This is a single-gene disorder caused by a mutation in the HTT gene. It follows a Mendelian pattern of inheritance. Cystic Fibrosis: Caused by mutations in the CFTR gene, leading to severe respiratory and digestive problems. b.​ Genomes encompass the complete set of genes or genetic material present in a cell or organism. Genomics is the study of all the genes in the human genome and their interactions with each other, the environment, and other factors. This broader approach helps understand complex diseases that may involve multiple genes and environmental interactions, such as diabetes. ​ Genetic testing can be performed for several purposes, including: ​ -Prenatal testing ​ -Carrier testing Predictive testing / ​ -Pre-symptomatic genetic testing ​ -Pharmacogenetic testing (PGx) ​ -Direct-to-Consumer genetic testing  11 ​ Nurse's use of genetic knowledge (two main responsibilities) a.​ Understanding Risks: Nurses help families understand their genetic risks for certain diseases and conditions, which can be shared among biological family members due to genetic factors. b.​ D ​ ecision-Making Support: They assist families in making informed decisions regarding the management and surveillance of genetic conditions. c.​ ​This includes reproductive decisions, genetic testing, predictive testing, and treatment options. ​ Types of genetic testing Diagnostic s/s of a genetic condition are present. Confirms whether or not an individual has the suspected condition. Carrier Detects whether a person is a carrier of either an autosomal recessive or an x-linked disorder  12 Carriers of autosomal recessive condition usually have no s/s of the condition, and are at risk of having an affected child if the other parent is also a carrier. 1 normal copy, 1 mutated copy of gene. Female carriers of X-linked condition have one normal copy of the gene on the X chromosome and one mutated copy of the gene on the other X chromosome, usually w/out s/s (or very mild signs) of the condition. Her sons have a 50% chance of having the condition, and daughters have a 50% chance of being carriers. Predictive or presymptomatic Performed on healthy individuals. Detects whether they inherited a mutation in a gene and therefore whether they will or may develop a condition in the future. Prenatal Dx Genetic test performed on the fetus–indicates whether fetus has inherited the gene mutation that causes a specific condition and if the child will develop that condition Pharmacogenetic testing (PGx) Analyzes a person’s genes to understand how drugs may move through the body and be broken down. Purpose is to select drug tx that best suite each person DTC genetic testing Marketed directly to the general public via the internet. DTC genetic testing provides access to an individual’s genetic information, usually without involving a healthcare provider. ​ Ethical considerations with genetic disease ★​ PTs have the right to disclosure and privacy unless there is reasonable threat to the patient. ★​ Nurses must maintain the confidentiality of each family member’s generic testing information ★​ It is completely up to the individual to determine whether or not to reveal info about genetic risks, testing, disease or management. ★​ Consent must be given by tested patient to share information with other family  13 members (HIPAA) ★​ Reasons for family not sharing include: avoid disagreements, protect others in the family from sadness or worry, or prevent discrimination or bias. Example a patient with Huntington’s disease may be reluctance to talk about it with their provider as they fear it will be documented in the medical history and shared with future employers. ★​ Nurses must become aware of cultural values that differ from their own family cultural values–it is unethical for nurses to try to influence the decisions of the family / family members because of their own views. ★​ When obtaining a family genetic history, any information shared by the patient is personal, private and considered to be part of their personal health record.