Person Centered Care Midterm Prep PDF

1 Person Centered Care Midterm Prep Week 1: Introduction and Overview of Course and Canada Nursing Practice What are the seven categories that have been identified by CNO as capturing the components necessary for nursing practice? Can you recognize skills and abilities that are included in these ca...

1 Person Centered Care Midterm Prep Week 1: Introduction and Overview of Course and Canada Nursing Practice What are the seven categories that have been identified by CNO as capturing the components necessary for nursing practice? Can you recognize skills and abilities that are included in these categories? 1. Cognitive: ability to perform skills that demonstrate thinking ability remember information demonstrate problem solving skills demonstrate concentration skills use reasoning to develop professional judgement exercise critical thinking skills to develop professional judgement add, subtract, multiply, divide, calculate ratios, percentages, apply formulas 2. Communication: ability to express and receive written, verbal and/or non-verbal language and the ability to interact with others in a respectful and professional manner Speak, read, listen and write at a level that provides for safe and accurate understanding of the words and meanings Recognize own non-verbal signals and interpret those received from others while considering individual differences in expression and associated meaning Elicit and respond to information from clients, colleagues and others 3. Interpersonal: ability to create good relationships between oneself and other people Develop professional relationships and rapport with individuals and groups Recognize the importance of maintaining interpersonal boundaries Recognize the needs of clients and colleagues 4. Behavioural: ability to conduct oneself in a professional manner Manage own behaviour well enough to provide safe, competent and ethical nursing care  2 Engage with self and others to create a safe environment Respond appropriately in situations that are stressful or involve conflict React appropriately to giving and receiving physical touch and working in proximity with a full range of clients 5. Psycho-motor: ability to perform the following requisites well enough to provide client care and participate in educational activities: Stand and maintain balance Manual dexterity Move within limited spaces Push/pull Perform repetitive movements Perform hand-eye coordination Bend Reach Lift Walk Climb Carry objects 6. Sensory: ability to utilize each of the following senses well enough to provide care and participate in educational activities: Sight Hearing Touch Smell 7. Environment: ability to function in the presences of each of the following commonly encounters and unavoidable environmental factors: Noxious smells Disease agents Distractions  3 Noise Chemicals Unpredictable behaviour of others What are the six principles must nurses follow according to the Code of Conduct? Can you recognize the types of behaviours that are expected under each of the principles? 1. Nurses respect client’s dignity Nurses treat clients with respect, empathy and compassion Nurses prioritize health and well-being in the therapeutic nurse-client relationships Nurses act in client’s best interest by respecting their care preferences, choices and decisions 2. Nurses provide inclusive and culturally safe care by practicing cultural humility Nurses self-reflect on and identify how their privileges, biases, values, belief structures, behaviours and positions of power may impact the therapeutic nurse-client relationships Nurses assess and strive to meet client’s language, cultural and communication needs in ways clients understand Nurses continually seek to improve their ability to provide client’s culturally safe care 3. Nurses provide safe and competent care Nurses identify themselves to clients consistent with the CNO’s public register, using their name, title and their role within the healthcare team Nurses recognize and work within the limits of their legal scope pf practice and their knowledge, skill and judgment Nurses seek and use the best available evidence to inform their practice 4. Nurses work respectfully with the health care team  4 Nurses self-reflect on how their privileges, biases, values, belief structures, behaviours and positions of power may impact relationships with health care team members Nurses identify and do not act on any stereotypes or assumptions they may have about health care team members Nurses address health care team members by their preferred name, title and pronoun 5. Nurses act with integrity in client’s best interest Nurses fairly divide and advocate for resources. Nurses objectively arrange care, based on health-related needs Nurses protect the privacy and confidentiality of clients personal health information Nurses do not share clients personal health information, unless for therapeutic reasons and only in compliance with laws and standards of practice governing privacy and confidentiality 6. Nurses maintain public confidence in the nursing profession Nurses understand and practice in compliance with relevant laws and standards of practice and do not breach them Nurses are accountable for their own decisions, actions, omissions and related outcomes Nurses take accountability for their errors and learn from them What is the Regulated Health Professions Act? Nursing Act 1991? Regulated Health Professions Act Governing legislation for regulated health profession in Ontario Provides a consistent approach to regulation of health professionals through governance, registration, complaints/discipline, scope of practice and controlled acts Nursing Act (1991)  5 Specific to nurses in Ontario and sets the mandate of the CNO and scope of practice for nurses What concepts must the nurse consider to meet the expectations of the Scope of Practice Standard? Authority: nurses must know their legislated scope of practice, including controlled acts, and authorized mechanisms Context: nurses must determine if their practice environment or setting supports the performance of an activity and has the available resources to support safe client care Competence: nurses must ensure they have the individual knowledge, skill and judgment to perform an activity What are controlled acts, and which ones are authorized to RNs/RPNs? Controlled acts are acts which may be performed only by authorized regulated health professionals. The Nursing Act, 1991, authorizes nurses to perform specific controlled acts when providing health care services to an individual. Controlled acts are considered potentially harmful if performed by someone who does not have the required knowledge, skill and judgment. Controlled acts to RNs and RPNs: Performing a prescribed procedure below the dermis or a mucous membrane Administering a substance by injection or inhalation Putting an instrument, hand or finger: o Beyond the external ear canal o Beyond the point in the nasal passages where they normally narrow o Beyond the larynx o Beyond the opening of the urethra o Beyond the labia majora o Beyond the anal verge o Into an artificial opening into the body  6 treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning dispensing a drug What are the authorizing mechanisms by which RNs or RPNs obtain authority to perform a controlled act? Orders - prescription for a procedure, treatment, drug or activity. Orders include direct orders and directives. An order is required when an activity: is a controlled act authorized to nursing, except for those controlled acts that a nurse may initiate on their own authority is delegated and does not fall under a controlled act authorized to nursing does not fall within a controlled act, but is required as part of the client’s plan of care and/or practice-setting policies is a requirement of other legislation Delegation - occurs when a regulated health professional, who is legally authorized and competent to perform a controlled act, temporarily grants their authority to perform that act to another individual What are the restrictions on delegation? Nurses cannot delegate a controlled act that has been delegated to them. This is referred to as sub-delegation12 Nurses in the Temporary Class and the Emergency Class are not permitted to delegate or accept delegation Nurses in the Special Assignment Class are not permitted to delegate to other health care professionals Registered Nurses and RPNs cannot delegate these controlled acts: Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood,  7 emotional regulation, perception, or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning Dispensing a drug Registered Nurses with prescribing authority cannot delegate these controlled acts: Prescribing a medication communicating to a client or a client’s representative a diagnosis made by the RN where the purpose of that communication is for prescribing the medication What does the term “Initiation” mean with respects to Scope of Practice? Initiation: occurs when RNs or RPNs are permitted by regulation to independently assess and perform specific controlled acts without an order What are accountabilities must nurses demonstrate with respects to competence? demonstrate the knowledge, skill, and judgment to perform an activity safely and effectively, including o understanding the client’s overall condition and needs o understanding the purpose of the intervention o understanding the indications and contraindications o assessing the risks and benefits o demonstrating cognitive and technical competence to perform the activity o managing potential outcomes and modifying actions as appropriate determine if the client’s condition warrants the performance of the activity perform an activity that is based on the best interests of the client and includes the client’s wishes consult or transfer care to another care provider when necessary for safe client care refrain from performing any activity when not competent to perform and, as needed, escalate to an appropriate health care provider self-reflect, identify learning needs and continuously seek out and integrate learning to improve their knowledge, skill and judgement in relation to their practice participate in CNO’s Quality Assurance Program  8 Under the RHPA, what are the exemptions and exceptions that allow persons who are regulated/unregulated health professionals and members of the public to perform controlled acts? Exemptions: Ear or body piercings Electrolysis Tattooing Male circumcision as part of a religious tradition Taking a blood sample by a person employed by a licenced laboratory Diagnostic ultrasound Acupuncture Prescribing normal saline for venipuncture Exceptions: First aid or emergency temporary assistance under the supervision or direction of a member of the profession, a student is learning to become a member of that profession and the performance of the procedure is within the scope of the professional’s practice treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment treating a member of a person’s household and the procedure is within the second29 or third30 controlled act authorized to nursing assisting a person with their routine activities of living and the procedure is within the second or third controlled act authorized to nursing What is the Nursing Act? What is the purpose of the Nursing Act? The Nursing Act determines how the nursing profession is regulated in Ontario. The Nursing Act establishes the mandate of the CNO and defines the scope of practice. What are the categories of nursing in Ontario? Classes within each category? RNs and RPNs  9 General Class: Most of CNO’s RNs and RPNs are registered in this class. Extended Class: RNs in this class are Nurse Practitioners (NPs). They have met additional competency requirements beyond those required in the General Class. There are three specialty certificates in the Extended Class: NP-Adult, NP-Paediatrics, NP-Primary Health Care Temporary Class: RNs and RPNs in this short term class are recent graduates, or applicants from outside the province, who have met all entry-to practice requirements except successful completion of the registration exam. They practise as an RN or RPN subject to specific terms. Special Assignment Class: A short-term, non-renewable registration for RNs and RPNs, usually from outside of Canada, who have an appointment or assignment with an approved facility in Ontario. Emergency Class: RNs and RPNs, usually from outside of Ontario, are registered in this class when the provincial government or CNO determines that it is in the public interest to issue certificates of registration in this class to qualified individuals to practice nursing under emergency circumstances. Non-Practising Class: available to current and previous members of CNO’s General or Extended classes, members in this class are not allowed to practice, or represent themselves as qualified to practice, nursing in Ontario. What are the requirements to enter into the general class in Ontario? successfully meet the nursing education requirement provide evidence of nursing practice successfully complete the national registration examination successfully complete the jurisprudence examination demonstrate they are proficient in either English or French provide proof of citizenship, permanent residency or authorization under the Immigration and Refugee Protection Act (Canada) to engage in the practice of nursing in Ontario complete a Declaration of Registration Requirements form.  10 What is meant by “Title Protection” under the Nursing Act (1991). In Ontario, only members of CNO can use the titles of nurse, Registered Nurse, Registered Practical Nurse, or any variation, abbreviation or equivalent in another language. Individuals who refer to themselves as nurses or attempt to work as nurses in Ontario without being registered with CNO are illegal practitioners and can be prosecuted under the Nursing Act, 1991 and RHPA. What are the Controlled acts authorized to Registered Nurses with prescribing authority? RNs who have completed CNO’s Council-approved education are authorized to perform the following additional controlled acts, in accordance with conditions set out in the regulation, and as authorized in their practice setting: prescribe a medication, or a drug from within a category of medications, set out in the regulation communicate to a client or a client’s representative a diagnosis made by the RN where the purpose of that communication is for prescribing the medication. Additionally, RNs with prescribing authority may dispense or administer by injection or inhalation a medication that they are authorized to prescribe without an order from another authorized provider. What are the five levels of care across which Canadian Nurses practice? 1. Health promotion 2. Disease and injury prevention 3. Diagnosis and treatment 4. Rehabilitation 5. Supportive care What are two kinds of trust and what are the roots of trust in professional nursing practice? 1. The publics collective trust in the profession  11 Regulated and trained to provide safe, evidence-based care according to standards Guided by a code of conduct 2. Trust in individual nurses Nurses provide intimate personal care, teaching and emotional support from cradle to grave Present in the most vulnerable moments of life with a mandate to reduce suffering, promote comfort, support self-care Trained specifically to provide this care inside of an empathetic therapeutic relationship focused on the unique needs and wished of the client What are the six criteria of a profession? 1. Body of knowledge 2. Specialized education 3. Service orientation 4. Professional organization 5. Autonomy and self-regulation 6. Code of ethics What are the seven Standards of Practice set out for nurses by the college of nurses of Ontario? Guidelines? What is the difference between a “Standard” and a “Guideline”? 1. Accountability 2. Continuing competence 3. Ethics 4. Knowledge 5. Knowledge application 6. Professional relationships 7. Leadership Standards: mandatory and define the minimum acceptable level of performance for the nursing practice. They outline requirements that nurses must meet to ensure safe and competent care  12 Guidelines: advisory and provide recommendations for best practices. They offer direction on how to achieve the standards and improve patient care but are not compulsory Through what regulatory activities does the College of Nurses of Ontario (CNO) fulfill its mandate of regulating nurses in Ontario and protecting the public? Registration Standards and guidelines of nursing practice and education Continuing competence Quality assurance What are purposes of the RHPA (1991)? Protecting the public from harm Promoting high quality care Making regulated health professional accountable to the public Giving provincial residents access to the health care professions of their choice Equality where all health professions adhere to the same principles How many professional groups are regulated? 26 regulated health professionals How many different colleges are there? 24 colleges that regulate these professionals What are three ways that professionals are regulated? Exclusive scope of practice Right to title Controlled act system What is scope of practice? Outlines the expectations for all nurses when determining if they have the authority to perform a specific activity, if it is appropriate for them to perform and if they are competent to safely perform the activity How many categories of nurse?  13 2 – RN and RPN Identify the various certificates of registration. General Class: Most of CNO’s RNs and RPNs are registered in this class. Extended Class: RNs in this class are Nurse Practitioners (NPs). They have met additional competency requirements beyond those required in the General Class. There are three specialty certificates in the Extended Class: NP-Adult, NP-Paediatrics, NP-Primary Health Care Temporary Class: RNs and RPNs in this short term class are recent graduates, or applicants from outside the province, who have met all entry-to practice requirements except successful completion of the registration exam. They practise as an RN or RPN subject to specific terms. Special Assignment Class: A short-term, non-renewable registration for RNs and RPNs, usually from outside of Canada, who have an appointment or assignment with an approved facility in Ontario. Emergency Class: RNs and RPNs, usually from outside of Ontario, are registered in this class when the provincial government or CNO determines that it is in the public interest to issue certificates of registration in this class to qualified individuals to practice nursing under emergency circumstances. Non-Practising Class: available to current and previous members of CNO’s General or Extended classes, members in this class are not allowed to practice, or represent themselves as qualified to practice, nursing in Ontario. What are the entry requirements to enter the profession? successfully meet the nursing education requirement provide evidence of nursing practice successfully complete the national registration examination successfully complete the jurisprudence examination demonstrate they are proficient in either English or French  14 provide proof of citizenship, permanent residency or authorization under the Immigration and Refugee Protection Act (Canada) to engage in the practice of nursing in Ontario complete a Declaration of Registration Requirements form. What is title protection? In Ontario, only members of CNO can use the titles of nurse, Registered Nurse, Registered Practical Nurse, or any variation, abbreviation or equivalent in another language. Individuals who refer to themselves as nurses or attempt to work as nurses in Ontario without being registered with CNO are illegal practitioners and can be prosecuted under the Nursing Act, 1991 and RHPA. How many controlled acts are there and how many and which are authorized to nursing? 14 controlled acts 5 are authorized to nursing What does it mean to initiate a controlled act? Initiation: occurs when RNs or RPNs are permitted by regulation to independently assess and perform specific controlled acts without an order Describe Professional Misconduct. Contravening a standard of practice of the profession or failing to meet the standard of practice of the profession. Why are nurses obligated to self-report criminal offences and incapacity proceedings? Public safety Professional accountability Regulatory compliance Protection of the profession Support and resources Week 2: Canadian Nursing Practice  15 How do the roles of federal and provincial/territorial governments differ with respects to healthcare in Canada? Federal: Sets and administers national principles of the Canada Health Act Assists in financing of health care services through transfer payments Delivers health services for Indigenous people, veterans, federal inmates, and Royal Canadian Mounted Police Provides national policy and programming to promote health and prevent disease Provincial/Territorial: Develop and administer their own health care insurance plans Manage, finance, and plan insurable health care services and delivery, in alignment with CHA principles Determine organization and location of hospitals or long-term care facilities; employ health providers in various specialties; and determine amount of money dedicated to health care services Reimburse physician and hospital costs and some rehabilitation and long-term care services, usually on the basis of copayments with individual users What are the five Principles of the Canada Health Act (1984)? 1. Public administration: operate on non-profit basis through public authority 2. Comprehensiveness: cover medically necessary services 3. Universality: free of discrimination 4. Portability: coverage across Canada for insured residents 5. Accessibility: reasonable access, regardless of ability to pay What are the levels of service of healthcare in Canada? In what types of settings are these levels of service typically offered? Primary: first point of contact to the healthcare system that provides provision of care, focused on prevention and self-care Physician offices, nurse practitioner led clinics, primary care clinics  16 Secondary: specialized services that clients are referred to Hospitals, log term care homes, palliative care/hospice, home care, rehabilitation Tertiary: Specialized care that is offered in regional, teaching, university or specialized hospitals Specialized and highly advanced health care facilities, that offer care of complicated health issues, Southlake Regional Cardiac program, UHN transplant services Supplementary: provincial/ territorial coverage that is provided to specific groups (e.g., seniors, low-income residents, children) for services not generally covered under the publicly funded system Prescription medication, dental care, vision care, medical equipment What are the five levels of care in Canada’s health systems? Level 1: Promotive Health promotion activities that enable more control over individual health through better health literacy and knowledge Ex. Anti-smoking programs, well baby clinics Level 2: Preventative Activities and care to reduce risk for disease and injury Ex. Immunization clinics, support groups Level 3: Curative Diagnosis and treatment of health conditions, through all three levels of care Ex. Hip replacement surgery, wound care at home Level 4: Rehabilitative Improvement of health for people experiencing health conditions. Goal is to maintain and improve health function and quality of life Ex. Cardiac rehabilitation programs, pre-surgery hip and knee physiotherapy programs Level 5: Supportive Care of chronic and progressive health conditions that may not improve  17 Ex. Palliative care, hospice care, home care nursing supports What are the 8 dimensions/principles of patient-centred care in Appendix D of the RNAO BPG? Students must be able to identify these 8 dimensions using exact language (from memory) and state and/or recognize specific actions or activities that would be classified under each of these dimensions? 1. Patients’ preferences: Respect for Patients’ Values, Preferences, and Expressed Needs Treating individuals with respect, in a way that maintains their dignity and demonstrates sensitivity to their cultural values Keeping individuals informed about their condition and involving them in decision making Focusing on the person’s quality of life, which may be affected by their illness and treatment 2. Emotional support: Emotional Support and Alleviation of Fear and Anxiety Helping to alleviate fear and anxiety the person may be experiencing with respect to their health statute (physical status, treatment, and prognosis), the impact of their illness on themselves and others (family, caregivers, etc.), and the financial impacts of their illness 3. Physical comfort Enhancing individuals’ physical comfort during care, especially with regard to pain management, support with the activities of daily living, and maintaining a focus on the hospital environment (e.g., privacy, cleanliness, comforts, accessibility for visits) 4. Information and education Providing complete information to individuals regarding their clinical status, progress, and prognosis; process of care; and information to help ensure their autonomy and their ability to self-manage, and to promote their health  18 5. Continuity and transition: Alleviating anxiety about the person’s ability to self- manage after discharge by: Providing information regarding medication, physical restrictions, nutrition, etc.; Coordinating ongoing treatment and services and sharing this information with the person and their family; and Providing information regarding access to supports (e.g., social, physical, and financial) on an ongoing basis 6. Coordination of care Coordinating and integrating clinical and patient care and services to reduce feelings of fear and vulnerability 7. Access to care: Ensuring, mainly with respect to ambulatory care: Access to multiple health-care settings and services Availability of transportation Ease of scheduling and availability of appointments Access to specialists and specialty services when needed 8. Family and friends: Acknowledging and respecting the role of the person’s family and friends in their health-care experience by: Accommodating the individuals who provide the person with support during care Respecting the role of the person’s advocate in decision making Supporting family members and friends as caregivers, and recognizing their needs What are the seven Standards of Practice set out for nurses by the college of nurses of Ontario? Guidelines? 1. Code of conduct 2. Scope of practice 3. Confidentiality and Privacy: Personal Health Information 4. Documentation  19 5. Medication 6. Nurse Practitioner 7. Therapeutic nurse client relationship Why do we need standards of practice? To support nurses in providing safe and ethical nursing care to the people of Ontario What is the difference between a “Standard” and a “Guideline”? Standards: mandatory and define the minimum acceptable level of performance for the nursing practice. They outline requirements that nurses must meet to ensure safe and competent care Guidelines: advisory and provide recommendations for best practices. They offer direction on how to achieve the standards and improve patient care but are not compulsory What are the Entry-to-Practice Competencies and what are the nine roles under which they are organized? What is the overall purpose of the ETPs and how do they guide your curriculum and/or where is there evidence they are guiding the HBSN curriculum? Entry-to-practice competencies are the foundation for nursing practice They outline the competencies measured for entry-level registered nurses (RNs) upon initial registration with CNO and entry to practice in Ontario. The competencies also guide the assessment of members’ continuing competence for maintaining registration with CNO. They are the minimum expected level of knowledge a nurse is expected to possess upon entry to the profession. Every course, course concept, assignment, test and experience in this nursing program is linked to an ETP competency. Nine Roles: 1. Advocate 2. Coordinator 3. Communicator 4. Collaborator  20 5. Professional 6. Educator 7. Leader 8. Scholar 9. Clinician Professional Organizations ONA WeRPN RNAO CAN ICN Identify the six reasons for using the Caputi Clinical Judgment Framework to learn clinical judgment. 1. Preparing for the nurse licensing exam 2. Transforming your everyday thinking to clinical judgment to provide safe patient are and improve patient outcomes 3. Becoming resilient 4. Becoming a self-directed thinker 5. Using situation-based thinking 6. Dealing with unexpected occurrences and reducing errors in the healthcare setting Week 3: The Historical Foundations of Person-Centered Nursing Practice Why does the history of nursing matter? Understanding evolution of the profession Influencing current practices Advocacy and social change Identity and professionalism Research and education Impact on future directions  21 Who was Florence Nightingale and what were her major accomplishments and lasting impacts? Often referred to as the founder of modern nursing, was a British nurse, social reformer, and statistician. Her work laid the foundation for nursing as a profession and significantly impacted healthcare practices. Major Accomplishments Crimean War: organized care for soldiers, improving sanitary conditions and reducing the death rate from 42% to 2% Nursing Education: established the Nightingale School of Nursing in 1860, the first secular nursing school Healthcare Reform: Advocated for sanitation and public health, influencing healthcare policies Statistics Pioneer: Used statistical analyses to highlight the impact of hygiene on health, notably with her polar area diagram Publications: authored influential texts guiding nursing practice and education Lasting Impacts Professionalization: helped transform nursing into a respected profession with defined standards Public Health Advocacy: Laid the groundwork for modern public health initiatives focusing on sanitation and hygiene. Nursing Ethics: Promoted ethical practice centered on compassion and patient care. Educational Legacy: Shaped nursing curricula worldwide, emphasizing practical and academic training. Ongoing Recognition: Celebrated on International Nurses Day, honoring her lasting influence on nursing. Historical timeline in Canada-who are the key figures? Early 1800s Margaret E. McDonald: Early nurse in Canada, served during the War of 1812.  22 1850s Florence Nightingale: Influenced Canadian nursing through her reforms and writings. 1867 Canadian Confederation: Increased focus on nursing education and standards. 1874 First Nursing School: Established at Toronto General Hospital, modeled after Nightingale's principles. 1885 Nursing Sisters of the Canadian Army Medical Corps: Formed to serve during the Northwest Rebellion. 1900s Lillian (Lily) L. H. Maude: Advocate for nursing education and standards. 1914-1918 World War I: Canadian nurses served overseas, elevating the profession's status. 1920s Canadian Nurses Association (CNA): Gained prominence as the national voice for nurses. 1950s Dr. Helen Glass: Key figure in nursing education and research. 1965 CNA Code of Ethics: Developed to guide nursing practice. 1970s Nurse Practitioners: Emergence of advanced practice roles. 2000s-Present Cultural Competency: Focus on culturally safe care, especially for Indigenous populations. Key Figures Recap Margaret E. McDonald, Florence Nightingale, Lillian Maude, Helen Glass.  23 Infographic presentations- what are the contributions of an historical figure, other than the one your group presented? Mary Eliza Mahoney First African American nurse Advocacy for nursing equality Co founder of the national association of coloured graduate nurses Mentorship Legacy: Mary Eliza Mahoney Award for Outstanding Contributions to nursing What three organizations set the standards/expectations for education of nurses in Ontario today? CNO, RNAO, CNA Describe the meaning of the five major steps of the Caputi Clinical Judgment Framework and how they align with the nursing process steps. 1. Getting the Information Collecting data about a patient or healthcare situation Beginning to establish therapeutic relationship Assessing Gathering info from many sources (e.g. pt., health record, measurement, assessment techniques) Thoughtful questioning to explore ALL aspects of situation Determining if “all is well and going as expected” OR “something is not quite right” 2. Making Meaning of the Information Nurse making sense of (interpreting) all the info collected in Step 1 Analyzing data Recalling rules, guidelines (e.g. normal ranges), typical findings of a given disease & applying to current patient situation Determining issues, problems, concerns Key step - drives the actions the nurse will or will not take  24 3. Determining Actions to Take Prioritize patient concerns (i.e. most urgent, most likely to result in complications e.g. acute chest pain versus chronic hip pain) Determine Goals of Care/Expected Outcomes Determine which actions will meet the Goals/Expected Outcomes Consider alternative actions based on knowing the patient context from step 2 4. Taking Action Carrying out the actions planned in step 3 in a safe manner to achieve goals Highest priority actions are carried out first MUST individualize actions according to patient situation Taking action can include: Psychomotor skills (e.g. turning a patient off a developing pressure area); Assigning actions to another member of the team Communicating with members of interprofessional team Teaching the patient or others Documenting Week 4: Health, Wellness, Quality of Life and Well-Being How does the World Health Organization (WHO) define health? 1947: “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” 1980:” the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities.” How did Labonte (1993) conceptualize health?  25 developed a multidimensional conceptualization of health based on 1984 WHO dimensions Holism-health is more that the sum of parts; interrelationships between and among different components result in different aspects of Health What are Medical, Behavioral,& Socioenvironmental approaches to health? Medical: Consider biology, heredity, developmental norms, prevalent disease patterns Behavioural: Support patients to make behavioural changes that empower health and well-being Preventative and restorative Socioenvironmental: Recognizes that health condition, behavioural and resources are influenced by social and environmental conditions Social determinants of health, social responsibility, social justice, health environments Focus on population health Indigenous conceptualizations of health? The Medicine Wheel Teachings: Circular representation of the interconnectedness of life Core belief of sacredness Themes: direction, season, nature elements, age of development, traditional medicines Indigenous health: balance among emotional, physical, spiritual, and mental dimensions; poor health-disharmony between 4 components 7 teachings-the teachings are described as “twins” with a virtue of the light (good) and virtue of the dark (bad); good values or Seven Grandfather teachings correspond to the story of the Seven Grandfathers. Modes of treatment: include ceremonial, herbal and medicinal, and storytelling  26 What are the key ideas in the McGill Model of Nursing with respect to health and nursing? Health-is a dynamic, multidimensional construct; congruent with WHO’s 1984 definition Strengths based (strength’s, desires, aspirations, experience, meaning, talent) Coping and developing are key processes Coping- the effort of the individual and family to deal with a problematic situation by problem solving Developing-involves recognizing, mobilizing, maintaining and regulating the condition of the patient What determinant of health have biggest influence over Wellness? Social determinants of health: the conditions in which people are born, grow, work, live, age and the wider set of forces and systems shaping the conditions of daily life How is the health of a nation measured? What indicators are used? Human Development Index Long and healthy life Life expectancy at birth Life expectancy index Knowledge Expected years of schooling Mean years of schooling Education index Decent standard of living GNI per capita (PPP $) GNI Index What is the Human Development Index (HDI) (1990) and what is it used for? Measure and compare overall health and well-being of countries Life expectancy; Infant mortality  27 Men: 79.6 Women: 83.8 Infant Mortality: 4.5 deaths per 1000 live What are the leading causes of death in Canada? Cancer Heart disease Covid 19 Accidents Cerebrovascular disease Chronic lower respiratory disease Diabetes Flu and pneumonia Alzheimer’s disease Chronic liver disease NWI 6 Dimensions of Wellness-what are they? (must recall exact wording) 1. Occupational: satisfaction in one’s work. In this dimension, it is important to seek out a career which is consistent with one’s personal values, interests, and beliefs. Individuals are encouraged to develop functional, transferable skills through structured involvement opportunities, and to remain active and involved. 2. Social: making contributions to the common welfare of one’s community and thinking of others. In this dimension, it is important to live in harmony with others and the environment. 3. Intellectual: life-long learning. In this dimension, it is important to stretch one’s thinking and challenge one’s mind in both intellectual and creative pursuits, in addition to Identifying potential problems and choosing appropriate courses of action based on available information.  28 4. Physical: focus and emphasis on movement, fitness, sleep, relaxation, and maintaining a healthy lifestyle, including the consumption of foods and beverages that enhance rather than impair good health. 5. Emotional: degree to which one feels positive and enthusiastic about oneself and life. In this dimension, it is important to be aware of and accept one’s feelings & take an optimistic approach to life. 6. Spiritual: recognizes one’s search for meaning and purpose in human existence. In this dimension, it is important to be true to oneself, live each day in a way that is consistent with one’s values and beliefs, go beyond faith and religion to ponder the meaning of life, and be tolerant of the beliefs of others. What is Quality of Life? An individuals perception of their position in life based on their standard of health, comfort and happiness What influences growth and development? Genetic/Natural Factors: Hereditary Temperament Environmental Family Peer group Health environment Nutrition Rest, sleep, exercise Living environment Political and policy environment Interacting Factors Life experiences  29 Prenatal health State of health What is the difference between Cognitive versus Psychosocial development? Cognitive: Explain reasoning and thinking processes How people learn within their world Perceiving, reasoning, remembering, believing Development occurs within the person Psychosocial: Explain the development of personality, thinking, behaviour and emotions Influenced by the person, but also external factors What are the 5 needs categories in Maslow’s pyramid? 1. Physiological needs 2. Safety needs 3. Love and belonging 4. Esteem 5. Self-actualization What is self-actualization and how is it achieved according to Maslow? The desire to become the most that one can be Ideal state/ a journey When would you apply Maslow’s Hierarchy when answering questions on the NCLEX exam? When prioritizing care from the perspective of the person-clarifying needs What are some criticisms of Maslow’s model? ethnocentric, based on individualistic societies, and not necessarily taking into account diversity in culture, gender, and age It should not be arbitrarily applied to all healthcare encounters. Although you may initially focus on physiological needs to ensure the client is stable, the client may have different priorities that are more important to them.  30 By drawing upon Indigenous knowledge, it is vital to recognize the role of community and advocacy in reaching self- actualization at every level. This is particularly important in the context of systemic racism and oppression and the existing disparities among racialized populations including Black communities and Indigenous People. What are the three levels of disease prevention? Provide examples of each. Primary: before signs and symptoms occur; protects against disease Ex. Immunization, reduction of risk factors, education Secondary: pathogenesis stage; promote early detection Preventative screening Tertiary: convalescence stage; minimize disability Ex. Cardiac rehabilitation after myocardial infraction What is health promotion? the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. the process of implementing a range of social and environmental interventions that enable people and communities to increase control over and to improve their health. We offer expertise and resources on health promotion including promoting healthy behaviours, creating supportive environments and encouraging healthy public policies. What are five health promotion strategies? 1. Build healthy public policy 2. Create supportive environments 3. Strengthen community engagement 4. Develop personal skills 5. Reorient health services What are four key roles for the nurse engaged in health promotion?  31 1. Addressing: Addressing the health needs of all clients, and ensuring health interventions and care address all facets of healthy development 2. Advocating: Advocating for clients, on a personal and system level scope 3. Working: Working to reduce barriers to health, access to care and disparity/inequities 4. Keeping: Keeping the client at the centre of the care; ensuring that they can meet their health goals, have appropriate resources and supports Week 5: Wellness Dimension – Physical: Activity/Exercise; Nutrition Examples of Nutritional Roles for Nurses? Medical/surgical Primary/acute care NP Public health Schools Community programs Government Long term care settings Homecare What are examples of factors in 4 key domains affecting eating and food behavior in Canada (physical environment; macroeconomic; individual factors; social environment)? Physical Environment: Home Work sites Schools Child care  32 Neighbourhoods Communities Restaurants Fast food outlets Food production programs Macroeconomic Framework: Food and beverage industry Food marketing and media Food and agricultural policies Economic systems Food production and distribution systems Food assistive programs Health care systems Land use and transportation Effects of public policy Individual Factors: Individual thoughts and believes Skills and behaviours Lifestyles Biological Demographics Social Environment: Friends Family Peers What is food security versus food insecurity? Food security: when all people have, at all times, physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life  33 Food insecurity: ack of consistent access to enough food for an active, healthy life What are the three levels of food insecurity and what are the defining characteristics of each? 1. Mild: worrying about running out of food or having to compromise on the quality or variety of food 2. Moderate: experiencing actual reductions in food intake or disrupted eating patterns due to a lack of resources 3. Severe: going without food or experiencing hunger due to a lack of access to sufficient food What is the meaning of Obesogenic environments ? Total influence of surroundings and opportunities on promoting obesity What are the health risks of excess body fat? Abdominal fat (apple shape)? Associated with increased cardiovascular risk, obstructive sleep apnea, non-alcoholic fatty liver disease, impaired glucose tolerance, increased bullying What is the role of key nutrients (carbohydrates, proteins, fats, water, vitamins, minerals)? Carbs: Recommended source of dietary energy (1 gram-1 kcal) Simple CHO=sugars; mono and disaccharides added to foods and beverages by manufacturer, cook, consumer; Complex CHO=polysaccharides; starch (stored in plants (e.g. dietary fibre decreases cholesterol); glycogen (stored in animals and humans) Glycemic index (GI) -ranking of foods for effect on blood glucose and insulin response (e.g. candy, white bread high; barely, lentils low); low GI foods associated with decrease risk of diabetes and heart disease Proteins: Essential for building tissue, growth, maintenance and repair (e.g. collagen, hormones, enzymes, immune cells, DNA, RNA, clotting factors)  34 Simplest form of protein- essential amino acids (AAs)-must be provided in diet Nonessential AAs-can be synthesized in body Complete proteins-(high quality)contain all 9 essential Aas (e.g. chicken, fish, soybeans, cheese) Incomplete proteins-lack one or more essential AAs (e.g. cereals, legumes (beans, peas), cereals Complementary proteins-pairing incomplete to make complete e.g. Grains (M) + Legumes (T, L) = complementary proteins; Nuts/Seeds (T, M) + Legumes (T, L) = complementary protein Protein is spared as an energy source (4 kcal/g) when diet contains adequate CHO Fats: Most calorie-dense nutrient (9 kcal/g); only 30% of calories should come from fats (WHO Supplies fuel (energy); cushions vital organs, lubricates body tissue, insulates, protects cell membranes Water: Cells depend on a fluid environment, body temperature, solvent Vitamins: Essential to metabolism, antioxidant, fat-soluble, water-soluble Minerals: Catalysts for biochemical reactions, microminerals, microminerals What are the key features of Canada’s Food Guide (Health Canada 2019)? Have plenty of vegetables and fruits Eat protein foods Make water your drink of choice Choose whole grain foods What are the four key components of the Dietary Reference Intake (DRI) tables? 1. Estimated average requirements (EAR)-Recommended amount for 50% of population  35 based on age & gender 2. Recommended dietary allowance (RDA)-Average need of 97-98% of pop’n 3. Upper Intake Level (UL)-Highest level to pose no threat 4. Adequate intake (AI)-Suggested intake when inadequate evidence for an RDA What information is on Canadian food labels and what does it tell us? Calories Serving size Daily values List of minerals and amounts What are key nutritional considerations for growth & development across the lifespan? Infants – school aged children: Breastfeeding Formula Introduction to solid food Childhood obesity Adolescents: Nutritional deficiencies Eating disorders Physical activity Pregnancy Young and middle aged adults: Obesity Pregnancy Lactation Older persons: Nutritional deficiencies Health status Dehydration  36 What are signs of malnutrition that nurses would identify in their assessments? Integumentary Skin-dry flaky, pale, bruising, ↓ s/c fat Nails-brittle, pale, ridged, spoon-shaped Hair-dull, dry, brittle, color loss Gastrointestinal Mouth-swollen red corner cracks, fissures in lips; gums spongy, red, bleed easily; tongue beefy red, swollen Anorexia, constipation, diarrhea, swollen abdomen, enlarged spleen Musculoskeletal Muscles-flaccid, wasted, poor tone, difficulty walking Skeleton-bony deformities, prominent scapulae, poor posture Teeth-caries, mottling, missing Neurosensory Confusion, depression, sensory & motor difficulties, ↓ reflexes Eyes-pale conjunctiva, dull or scarred cornea, xanthelasma (yellow lumps around eyes) Cardiovascular Cardiomegaly, hypertension, tachycardia What is the Canadian Nutrition Screening Tool and when would a nurse use this tool? Used to identify older adults at risk of malnutrition Consists of questions about weight loss, appetite, medication Used during assessments of older patients to evaluate nutritional needs How is BMI calculated? What are the BMI risk categories? BMI = weight in kilograms divided by height in metres squared Waist circumference – what measurement places women versus men at high risk for developing diabetes, high blood pressure, heart disease and stroke? 102cm for men  37 88cm for women Identify different ways to perform diet assessment? 24 food recall Food diary Photo analysis Healthy eating quiz What activities can be implemented to support healthy eating? Meal planning and grocery shopping with our families. Becoming involved in a community garden with our neighbors. Advocating for healthy foods in our workplaces and schools. Keeping food diaries. Making healthy, nutritious meals with friends and family. Consult a registered dietician What are the specific recommendations for physical activity, sleep and sedentary behaviour in The Canadian 24-hour movement guidelines (18-64 years)? Physical activity: accumulation of at least 150 minutes of MVPA per week Sedentary: 8 hours or less per day Sleep: 7-9 hours What are the six steps in the CSEP Path Movement Counselling Tools? 1. Ask 2. Assess 3. Advise 4. Agree 5. Assist 6. Arrange Week 6: Mental Health and Wellness, Sleep and Rest  38 What is the Dual Continuum Model of Mental Wellness and Mental Illness and what does is mean? Mental health exists on two separate but interconnected continua: one for mental wellness and one for mental illness. What are four key pathways to mental wellness? 1. Activity and creativity 2. Growth and nourishment 3. Rest and rejuvenation 4. Connection and meaning What are risk factors that can contribute to mental illness? Social factors Family history Unresolved traumatic experiences Stressful life events Environments What is the Positive Mental Health Surveillance Indicator Framework (PMHSIF) and why was it developed? Assess and monitors the mental health and well-being of the population. It focuses on positive mental health rather than solely on mental illness, emphasizing the strengths and protective factors that contribute to mental wellness. What is stress? Fight or flight response? Stress: a stimulus, a process, a response and a state which often leads to confusion and ambiguity Fight or Flight Response: Automatic (involuntary) physiological reaction to an event that is perceived as stressful or frightening. Perception of threat activates the sympathetic nervous system and triggers an acute stress response that prepares the body to fight or flee.  39 Phobias-example of false activation e.g. acute stress when exposed to trigger that others do not experience as stressful Panic attack-body going into alarm node with a severe response What are possible symptoms of stress? Feelings of irritability, sadness or guilt Change in sleep patterns Change in weight or appetite Difficulty in concentrating or making decisions Negative thinking Loss of interest, enjoyment or energy in something you used to enjoy Restlessness What is the relationship between stress and health? Effects of prolonged stress? Heart disease Types of bowel disease Mental illness Impacts people with diabetes Risk factor in alcohol and substance abuse Risk factor in weight changes Can affect immune system What are some examples of reliable and valid stress screening tools? Perceived stress scale Stress can drag you down GAD – 7 What is the relationship of sleep to health? A lack of sleep effects/impairs decision-making and concentration abilities. Sleep deprivation is associated with increased risk of car crashes, injuries and deaths Adults with insufficient sleep report being more sedentary then those with adequate sleep  40 Adults who report insufficient sleep also report greater levels of chronic stress Adults with insufficient sleep report having poorer mental health then those adults with adequate sleep What is the Athens Insomnia Scale? Self-reported questionnaire designed to assess the severity of insomnia symptoms. It was developed to provide a reliable and valid measure of sleep difficulties in various populations. What are the components of a nursing sleep assessment? Nature of the problem Signs and symptoms Onset and duration Severity Predisposing factors Effect on patient What is sleep hygiene? Avoid alcohol, caffeine and nicotine before bed Maintain a regular bedtime and waketime Practice relaxation and mindfulness-based stress reduction techniques Reduce noise in the sleeping environment Exercise regularly Review medications with physician/pharmacist Reduce use of cell phones before bed (blue light emission/reduces melatonin) What behaviours and nursing assessment findings are associated with poor self- concept? Avoidance of eye contact Slumped posture Unkempt appearance Being overly apologetic Hesitant speech  41 Being overly critical or angry Frequent or inappropriate crying Negative self-evaluation Being excessively dependent Hesitancy in expressing views or opinions Lack of interest in what is happening Passive attitude Difficulty in making decisions What can nurses do to promote health self-concept? Reinforce the patient’s expression of thoughts and feelings; clarify meaning of verbal and nonverbal communication. Encourage opportunities for self-care. Elicit the patient’s perceptions of strengths and weaknesses. Convey verbally and behaviourally that the patient is responsible for their own behaviour. Identify relevant stressors with the patient and ask for the patient’s appraisal of these stressors. Explore the patient’s adaptive and maladaptive coping responses to problems. Collaboratively identify alternative solutions; encourage the patient to use alternatives not previously tried. Continue to reinforce the patient’s strengths and successes. What are the components of a Spirituality Assessment in the NWI assessment tool? I feel that my life has a sense of direction or meaning to it I have sense of peace about my life. I accept events and others as they are and do not make judgments I feel a sense of connectedness with creation and all other living beings. Prayer and/or meditation are a regular part of my daily routine I live each day in a way that is consistent with my values 42