Models of Health:
Clinical:
• Defined by the absence of illness, signs, and symptoms of disease.
• May not seek preventative care or
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• People who use this model may not seek preventive health services or they may wait until they are very ill to seek care.
• You go to the hospital if you need immediate help (such as a broken something not a cold you caught).
Role Performance945, with performance based on societal expectations.
• Illness would be the failure to perform roles at
the level of others in
society.
o EX: If you are sick, you get medicine to help you get back up and running
Adaptive:
• The ability to adjust positively to social, mental, and physiological change
• Illness occurs when the person is unable to adapt
o Go through a traumatic injury and then you get help with adapting to a
new injury (takes a slow process).
Eudemonistic:
• Emphasizes the interactions between physical, social, psychological, and spiritual aspects of life
• Goal attainment and meaning
• May seek out alternative therapies, council of priest, rabbi, or minister
• Strive for equilibrium
o A person dying of cancer may still be healthy if that person is finding
meaning in life at this stage of development.
Reasons why the Eudemonistic model is a better, more cost effective model to use today?
• This was adopted by the healthcare system because it pays the hospitals, doctors, etc more money because people only come when they are in dire need of medical care thus needing more tests, medicine, procedures done to them and since every little thing costs
money the hospital or facility gets paid either from the patient or insurance company. It is more expensive for the patient. Also it was adopted because people think they are healthy or they do not have enough money to go to the doctor for every little thing that happens to them.
Why the Affordable Care Act can move America towards a Eudemonistic model?
• This model is better because you are focusing on your health as a whole and emphasizes the interactions within social, spiritual, physical, and psychological aspects
of life. You seek out alternative therapies such as ministers, rabbis, etc. It is a more holistic approach to medicine and therefore costs less since you are using different types of holistic treatments instead of the big medications from the big pharmaceutical companies. They don't let their illness slow them down.
Healthy People 2020:
What are the Overarching goals?
1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
2. Achieve health equity, eliminate disparities, and improve the health of all groups.
3. Create social and physical environments that promote good health for all.
4. Promote quality of life, health development, and healthy behaviors across all life stages
What is the differences from Healthy People 2010?
• Healthy people 2010 had only two goals. Healthy 2010 is very vague. In Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy People 2020, that goal was expanded even further: to achieve health equity, eliminate disparities, and improve the health of all groups.
Define these terms and give two examples of each:
Primary Prevention
• Health promotion Specific Protection
• Catch it before it starts and make people aware of it.
o Examples: Periodic examinations, massive immunizations, nutritional
awareness and practice, exercise, safety precautions at workplace.
Secondary Prevention:
• Early Diagnosis, Prompt Treatment, and Disability limitation
• Screenings (MRI, BP measurement, Dental Examinations, mammographs, diagnostic tests, HIV testing)
Tertiary Prevention:
• Restoration= highest level of functioning possible despite the limitation caused by injury.
• Rehabilitation
o Rehabilitative care, hospice, outreach programs, palliative care
• Goal: prevent further disabilities or deduced functioning when possible
Define these terms and give an example related to nursing for each:
Fidelity
• Agreement to keep a promise
• Nurses need to follow through actions and interventions
• Unwilling to abandon patients regardless of circumstances
o Even though you promised and cannot make it send someone else
to do it
Non-maleficence
• Avoiding of harm
• Healthcare professionals try to balance risks and benefits of care while striving at the same time to do the least harm
o Ex: stopping a medication that would not benefit the patient
Autonomy
• The right of independence- making decisions for themselves
• Right to say no
• Include patients in decisions
• Providers need to inform patients about risks and benefits of treatment plans
• Ensure that patient understands and agree to treatment
• Always take the time to explain to patient what you are doing
o Ex: Letting the patient go home even though it is against orders.
Justice
• Fairness
• Often used in discussing about healthcare resources, including distribution of scarce resources
o Examples: health insurance, hospital locations and services be fair with all of the patients, have no favorites
Veracity
• Devotion to the truth
• People whose health is in question are to various degrees reliant on the person who possesses the knowledge and skills to bring these to bear on their behalf.
o Ex: Always being straight up with the patient and telling the truth.
Beneficence
• Best interest for the patient and NOT self interest
• Positive actions for others
Understand the difference between these three types of insurance and how people gain access to these health insurances in the Private Sector:
HMO
• Deliver comprehensive health maintenance and treatment services to a group of enrolled individuals who prepay a fixed fee.
• The employer pays a monthly or annual rate directly to the HMO.
• The individual may also have out-of-pocket expenses such as copayments.
• Go to primary doctor and get a referral for a specialty doctor
• Can’t go to doctors outside HMO physicians
PPO
• Contracted providers provide services for discounted price
• Additional costs if a provider outside the PPO is used.
• To control costs, the provider must receive preauthorization from the PPO for a member to be hospitalized or for some procedures or tests, and second opinions are usually required before major procedures or surgical operations are performed.
POS
• POS plans allow members, for an additional fee and higher copayment, to use providers outside the individual HMO network.
IPA
• Independent physicians in solo or group practices who provide health care services to members of an HMO
• Group practice model: HMO contracts with all physicians and specialists needed by the HMO enrollees, but physicians remain independent.
• Some contracts are exclusive, requiring physicians to restrict care to members of an individual HMO,
• Other variations allow physicians to care for members outside the HMO.
• Network model: HMOs contract with individual physicians and with physician groups for both primary and specialty services.
Understand the difference between Medicare and Medicaid: Who gains access?
Medicare:
-Federal Program
-Paid through taxes
-For people over 65
-Disabilities
-End stage renal failure
- Hospice
• Part A
o Inpatient care in hospitals, skilled nursing facilities home health care, hospice
• Part B
o Supplementary voluntary coverage
o Pays doctor’s visits
o Should not have a co-pay
• Part D
o Pharmaceutical costs
▪ Multiple plans available
▪ Medication is not covered
▪ Need supplemental plans (extra insurance etc. anta Blue cross blue shield) to cover meds.
▪ This company will not move medicate pays for something first
• Challenged
o Growth in elderly population
o Depletion of Medicare resources (trust fund)
o Uncovered services (glasses, hearing aids)
Medicaid:
• Federal +State funds
• Cost up to 50% of state budgets
• Available
o Certain low-income individuals
o No age requirements
o Families with children: 5-year lifetime limit
• Services
o Inpatient and outpatient hospital care
o Prenatal care
o Physicians’ services
o Nursing facility services for persons >2
o Family planning services
o Rural health clinic services
o Laboratory and radiologic tests
o Pediatric, FNP, and nurse midwife services
o Certain federally qualified ambulatory & health center services
o Home health services Definition of the Individual
How do you correctly write a nursing diagnosis? What are the three main parts?
1. Problem statement
1. What is the issue/problem with this client (always prioritize. Remember ABCs). Ex. Pain or SOB
2. Based on assessment of client
b. Etiology
1. what’s causing/contributing to the client’s problem? Ex. What is causing this problem
2. Determine what the problem is caused by or related to
b. Defining Characteristics (AEB)
1. what’s the evidence of the problem? Ex. Patient report or nurses’ assessment.
2. Then state as evidenced by(AEB) the specific facts the evidence is based on
b. Risk for as evidenced by (Risk Factors).
What makes a goal a SMART goal?
S- specific
M-measurable A-attainable R-relevant
T-time bound
Transtheoretical Model of Change
o Precontemplation
▪ Research stage, you are thinking about it
▪ Example: Looking for the right nursing schools, you are researching online for the top 5 best schools
▪ Nursing Example: Nurse talks to a patient that comes in with cholesterol
o Contemplation
▪ Thinking about it, and then taking the next step
▪ Talk to nursing schools
▪ Nursing Example: Looking at the discharge papers and do more research about the medications and thinking about taking the medication.
o Planning or Preparation
▪ Getting all the paperwork, documentation, you are on your ways
▪ Nursing Example: Taking the prescription to the pharmacy
o Action
▪ In class and navigating what needs to be done (in regards to school work)
▪ Nursing Example: Taking the prescription
o Maintenance
▪ Doing/turning in assignments on time
▪ Reading the book
▪ Nursing Example: Taking the prescription every night before bed and continuing to do so for couple days
Screening:
Significance
• Primary Objective: Detection of a disease in its early stages in order to treat it and deter its progression
• Secondary Objective: Reduce cost of disease management by avoiding costly interventions required at later stages
• The significance of a disease is the level of priority assigned to the disease or disorder as a public health concern
• Determinants of Significance
o Quality of Life
▪ Subjective; difficult to estimate
o Quantity of Life
▪ Disease-specific mortality rates
▪ Prevalence Rates: Existing Cases (chronic disease)
▪ Incidence Rates: New Cases (acute disease)
• Cost to treat Benefits vs. Risk
What is the Health Belief Model?
• Individual perceptions of readiness for change
• The value of health compared to other aspects of living
• Perceived susceptibility to a health problem
o Don’t understand what is going on and they will continue to do it
• Perceived seriousness of the disease level
• Risk factors to a disease
o What are some of the risk factors of the disease
• Perceived benefits of health action
• Perceived barriers to promotion action
• Example: A person needs to recognize a link for coronary artery disease, a person may not see this as serious and not really care or the opposite, the patients reaction to whether
or not he/she sees this disease to be serious will determine what changes they will make or not make to help them.
• This model focuses on the relation of perception and compliance with therapy
• Between the person belief and health behaviors HIPAA:
• Has the privacy rule to set standards for the protection of health information
• In practice you cannot share information about a patient's medical condition or personal information to anyone not involved in the care of the patient.
Roles of the Nurse:
Advocate
• Be the voice for the patience
• Know the patient’s rights
o Get what they are entitled to in health care
• Make sure system is responsible for patient and community needs
• Help people develop advocating skills
• Everyone receives high quality care, cost efficient appropriate care
Care manager
• Looking at all aspects and pulling it all together for the Pt.
• Safety and reduce cost
• Maintain quality
Consultant
• Provide knowledge for health promotions and disease preventions
• Providing more education to the PT
• Some nurses may specialize in areas
Deliverer of services
• Direct service such as
o Health education
o Influenza vaccinations
o Counselling in health promotions
• Home/Health nursing
Educator
• Teaching patient about diagnosis
• To teach effectively nurses must know facts about how people learn and teaching process
Healer
• Emotional support
• Help individuals integrate and balance the various parts of their lives
• Ability to look at the individuals inside to sense what is important to the patient and add specific care to help that patient
Researcher
• Evidence based practice
• Looking for a better way to do something.
Evidence based practice
Adult learning Principles. How do adults learn?
• Adults are internally motivated and self-directed
• Adults bring life experiences and knowledge to learning experiences
• Adults are goal oriented
• Adults are relevancy oriented
• Adults are practical
• Adult learners like to be respected
Three domains of learning
1. Cognitive
1. Development of new facts or concepts
b. Psychomotor
1. Developing physical skills from simple to complex actions
a. Affective
1. Recognition of values, religious and spiritual beliefs, family interaction patterns and
relationships
Code of Ethics Provisions 8.3: Obligations
• Nurses work with others to change unjust structures and processes that affect both the individuals and communities
• Nurses educate the public
o Facilitate informed choices
o Identify conditions and circumstances that contribute to the illness
o Injury and disease
o Foster healthy lifestyles
o Participate in institutional and legislative effort of protecting and promoting health
• Nurses address barriers to health
• Nurses must collaborate to create a moral milieu that is sensitive to diverse cultural values and practices
Standards of Practice Standard 8 Culturally Congruent Practice
Therapeutic Relationships Types of communication
• Verbal Communication
o Vocabulary
o Pacing
o Clarity/Brevity (length of time)
o Timing/Relevance
• Nonverbal Communication
o Personal appearance
o Posture
o Facial Expression
o Eye Contact
o Gestures
Mechanisms of Communication
• Intrapersonal
o Occurs within an individual
• Interpersonal
o One-to-one interaction between two people
• Public
o Interaction with an audience
• Electronic
o EMR (emails, social media)
• Small Group
o Interactions with a small number of people
• Transpersonal
o Interaction within a person’s spiritual domain
Barriers to communication
• Transference
o Client comparing you somehow to something from the past
• Countertransference
o “You remind me of my 16 year old daughter” [Show Less]