Fundes Exam 4

What is Watson’s Theory of Human Caring?

• nurse must care for self-first, attempt to achieve inner balance and spirituality

  • they should establish presence w/ pts, practice the act of “being” and work on developing trusting relationships

Which theory is the Ten caring processes aka Caritas Processes associated with?

Watson’s theory

Name all ten caring processes

1. Embrace: Practicing loving-kindness

2. Inspire: Being authentically present (faith/hope)

3. Trust: Interpersonal self—Cultivating one’s own spiritual practices

4. Nurture: Developing trust

5. Forgive: Being sensitive to self and others

6. Deepen: Helping meet human needs

7. Balance: Engaging in a supportive environment

8. Co-create: Creating healing environments

9. Minister: Assisting with the subjective experience of another

10. Open: Co-creating a healing relationship

1st process of the Caritas Processes

Embrace: Practicing loving-kindness towards oneself and others.

2nd process of the Caritas Processes

Inspire: Being authentically present with faith and hope.

3rd process of the Caritas Processes

Trust: being sensitive to self and others=cultivating one’s own spiritual practices and moving beyond ego

4th process of the Caritas Processes

Nurture: developing and sustaining a loving, trusting, caring relationship

5th process of the Caritas Processes

Forgive: allowing for expression of pos and neg feelings, and listening to another’s story

6th process of the Caritas Processes

deepen: creative problem solving

7th process of the Caritas Processes

Balance: teaching and learning, and staying with other’s frame of reference

8th process of the Caritas Processes

Co-Create: creating a healing environment at all levels— wholeness, beauty, dignity, comfort

9th process of the Caritas Processes

Minister: assisting w/ basic needs like sacred arts, touching mind/body/spirit

10th process of the Caritas Processes

Open: opening to spiritual, mysterious, unknowns, allowing for miracles

What are 8 questions exemplifying Caritas process?

1. tell me abt ur health.

2. what’s it like to b in ur situation?

3. tell me how u perceive urself?

4. what are ur health priorities?

5. how do u envision ur life?

6. whats the meaning of healing for u?

7. whats the most important thing i could do for u?

8. whats the most important thing u need rn?

What are the seven therapeutic techniques?

1. active listening

2. being present

3. touch

4. showing compassion

5. sharing info

6. promote understanding

7. pt preferences

What are conditions that can impact a pt’s culture?

• socioeconomic factors

• health literacy

• racism

• sexual orientation

Whats the 5 key elements to Culturally Competent care?

1. Cultural Awareness: self-awareness of their own culture and biases abt other cultures

2. Cultural Knowledge: willing to learn abt other cultural values and beliefs

3. Cultural Skill: ability to accurately assess pts cultural beliefs, values, and lifestyles

4. Cultural Encounters: interactions w/ pts from other cultures

5. Cultural Desire: commitment to become connected w pt cultures

What are four questions u can ask during a cultural assessment?

1. “Do u have any ethic, spiritual or racial affiliation w/ which u identify?”

2. “Do u have any beliefs and practices related to health or illness?”

3. “What current spiritual beliefs or practices do u want to observe?”

4. “Do u follow any food preferences/ prohibitions as part of ur culture?”

How to care for the Silent Generation (1928-1945)

• face-to-face, formal, and written comm.

• value loyalty and expect it in return

  • avoid looking at comp. screen= disrespectful

How to care for Baby Boomers (1945-1964

• informal in-person comm.

• idealistic

  • avoid looking at comp. screen= disrespectful

How to care for Gen. X? (1965-1980)

• comfortable w/ tech; independent

• cynical and pragmatic

• prefer quick, direct, to-the-point comm. and instruction

  • WILL question u as a nurse! and expect timely answers

How to care for Gen. Y/Z (1981-2012)

• digital natives

  • prefer text/ email

• frequent feedback

What do u assess for in a Spiritual Assessment?

• source of spiritual support and strength

• existential concerns:

  • lack of meaning, questions abt own existence

• Concerns abt relationship w/ God thats made them feel abandoned

• struggles related to loss of faith

• cultural norms/ preferences

What are some spiritual assessment questions?

1. where do u find spiritual strength?

2. do u have concerns abt meaning of ur life?

3. do u have questions abt ur relationship w God?

4. Do u have questions abt ur spiritual practice?

5. what kind of spiritual practice hold meaning for u?

6. do u have any concerns/fears abt dying?

7. do u have any concerns abt ur relationship?

8. is there anything rn making u feel sad/ inadequate?

Define Spiritual distress

uncomfy feeling related to questioning life’s meaning, belief system and anger toward higher power

• fear, anger, despair

How do u care for a pt w/ spiritual distress?

• listening/ being there for them

• praying w them

• reading spiritual texts

• calling pastoral care for consultation

Whats the role of Pastoral Care?

used for supporting pts/fam.:

• Ethical dilemmas

• terminal illness

• death of pt

• hardship

How do u define Palliative care?

giving treatment that provide pain relief/ enhance quality of life, BUT does not have cure

What’s it called when u give treatment, but the treatment WILL NOT provide cure OR extend life?

Medically Futile

What is Potentially inappropriate care?

giving treatment that DOES its job, BUT is not needed for pt in situation

What are five things needed for managing care?

1. Time management/ Prioritization!!

2. organization

3. goal creating/ planning

4. assignments based on pt acuity

5. delegate right tasks when needed

What are the five rights to delegating tasks? (should know)

1. Right task

2. right circumstance

3. Right person

4. Right direction/ communication

5. right supervision/ evaluation

Whats the definition of Culture?

• Based on ppl they’re around (not genetics!)

• informal part of a person (gestures)

Examples of what contributes to Culture

• human communication

• language

• actions

• beliefs

• values

• customs

• race

• religion

• social/ethnic groups

Define Ethnicity

• based on shared culture related to common ancestor and shared history

• genetics!!

Define race

• based on perceived shared physical traits!

  • ppl view themselves based on color of skin (appearance)

  • ASK pt their race

• ppl can identify as more than 1 race

Whats some factors related to Health Disparities?

• cognitive disabilities

• mental health

• race. ethnicity, gender. sexual orientation

• religion

• access to transportation

• health insurance

• accessibility to health care

• limited education

• socioeconomical status

Whats Implicit vs. Explicit bias?

Implicit

• when you have thoughts or feelings about people that happen automatically without you realizing it.

  • hidden/unintentional

Explicit bias

• you have certain beliefs or feelings about people and might even say them out loud. It’s more obvious and intentional.

  • clear/ on purpose

What is Health Equity?

making sure everyone has what they need to achieve the best health possible, even if it means giving more help to those who need it most.

• It focuses on fairness by addressing differences so that everyone can reach the same health outcomes.

*goes a step further than equality

Whats Health Equality?

giving everyone the same resources or opportunities when it comes to health, regardless of their needs.

• It's about treating everyone the same way, NO MATTER WHAT

Define Cultural awareness

self-assessment of own beliefs, traditions and values, and understanding individuals of other cultures

Whats is Cultural Competence?

acknowledging/accepting/respecting all ppl w/ other beliefs, values and customs

• pos comm. and open feedback b/w nurse and pt

What are cultural encounters?

nurse interacts w/ pt from other cultures

Whats Cultural Desire?

nurse’s commitment to becoming more connected w/ pts from cultures other than their own!!

Whats the diff. b/w Emic and Etic Knowledge in Cultural Competence?

Emic knowledge contains info from an insider’s POV of a culture, whereas Etic knowledge is from an Outsider’s POV

Whats Cultural Diversity impacted by?

• age, sexual orientation, culture, ethnicity, socioeconomic status

How can Cultural Diversity increase chance of miscommunicating b/w pt and nurse?

language

• diff. cultures use diff. words for illness

According to CDC, how can us Nurses improve Health Literacy?

1. provide info/ services ppl can understand

2. collab w/ others to assist individuals w/ becoming familiar w/ personal health info.

3. share ur info by working w/ trusted messengers

4. use certified interpreters!

Why is it important for the nurse to ask for sex and gender pt identifies w?

bc imprtant to know when doing dosage calc and giving meds.

Whats the purpose of Leininger’s Sunrise Enabler?

• to assist nurse in proving culturally congruent care that enhances health and well-being of all pts at all stages in life

Name the 5 Categories of The Sunrise enabler Model

1. upper level of sun rays

2. rays of sun w/in sunrise enabler

3. the central core

4. the focus on family, groups, individual, communities or institution in diverse health contexts

5. the three modes of care decisions and actions

What doe Cat 1, the upper level of the Sunrise mean?

• represents rising sunrays, showing how culture and society shape how people see the world.

What does Cat 2, the Rays of the sun w/in the enabler mean?

sun’s rays symbolize the key parts of the assessment

1. technological factors

   • whether a client has access to technology including a phone, internet, or computer

2. religious, spiritual, philosophical factors

   • can show why they act the way they do about their health.

3. kinship and social factors

   • knowing marital status allows the nurse to plan care related to family and support systems.

4. cultural values, beliefs, and way of living life

   • Learning about what the client values, believes in, and how they live help the nurse give better care by understanding what matters most to them

5. biological factors

   • The nurse looks at the pts personal and family history of illnesses, helps the nurse understand health problems the pt might face and risks for future issues.

6. political and legal factors

   • like being an undocumented immigrant, can affect health behaviors and access to care, often leading to delays in seeking treatment until emergencies arise.

7. economic factors

   • factors like education, employment, income, and community conditions help nurses assess a client’s health literacy, poverty level, access to care, and how employment and income impact their ability to afford health insurance.

8. educational factors

   • all health information be presented at an eighth grade or lower reading level.

What does Cat 3, the central core of the Enabler mean?

• shows how different factors work together to affect how pts, families, and communities respond to nursing care

• looks at what influences them, their care practices, and overall health, including things like illness and end-of-life.

Whats Cat 4, of the Enabler mean?

• focuses on families, individual, groups, and community

• 3 types of care:

  • 1. Folk Care: traditional care given by family or cultural healers, like using a healer for physical, mental, or spiritual needs.

  • 2. Integrative care: combines folk care and modern medicine

  • 3. Professional Care: modern, research-based care provided by doctors and nurses

Whats Cat 5 of the Sunrise Enabler?

• Three modes of Care Decisions & Actions:

  • 1. Culture Care Preservation and Maintenance: keeping or maintaining the client's cultural practices.

  • 2. Culture Care Accommodation/ negotiation: adjusting care to fit the client's cultural needs.

  • 3. Culture Care Repatterning/ Restructuring: helping the client change harmful cultural practices for better health.

Whats the inability to see, hear, smell, feel, or taste referred to as?

Sensory Alterations

What are the three common sensory alterations?

1. Sensory deficit

2. Sensory Deprivation

3. Sensory Overload

What’s a sensory deficit?

pt has difficulty w one or more of the main senses

• still have the senses, just not as good

Sensory Deprivation meaning?

• reduction/ absence of stimuli to one or more of senses.

  • no sense at all (blind)

Whats Sensory Overload?

• receiving an overload of stimuli, and brain can’t keep up w processing

  • busy environment…tv, ppl in/out of room constantly

  • causes anxiety and restlessness

What’s a Sensory Processing Disorder? SPD

• pt oversensitive to normal sensations!

• physically painful or feel overwhelming to the client

  • light touch of shirt against skin

  • in ADHD, Autism, OCD

Whats Myopia?

Nearsightedness

(can’t see far)

What’s Hyperopia?

farsightedness

(cant see close up)

Whats Astigmatism?

• eye cant focus light evenly—> blurred vision/ distortion

Whats Presbyopia?

decrease in ability to focus up-close or w/ small print

(age related farsightedness)

Which of the eye disorders is cloudy and blurry vision, making it hard to see at night?

cataracts

What are causes of cataracts? And what do pts see with this?

• old age, DM, smoking

• double vision, faded colors and yellowing, cloudy/ blurry vision

how do u diagnose a cataract?

dilated eye exam

• use a slit lamp and medicated eye drops to dilate pupils

How to prevent cataracts, diabetic retinopathy, and glaucoma?

• control glucose level, BP, cholesterol, smoking

• make lifestyle mods!!

What causes Diabetic Retionopathy?

Unstable blood glucose levels cause damage to blood vessels in the retina

What does Diabetic retinopathy lead to?

• vision loss and complete blindness (leading cause of blindness in adults)

• can advance and damage optic nerve causing Glaucoma

What are the symptoms of Diabetic Rentinopathy?

• both eyes are asymptomatic at first!!

• when pt sees spots (floaters) and has blurred vision=more severe!!

How do u diagnose Diabetic Retinopathy?

in a dilated eye exam, OR Fluorescein angiography (dye injected into PV, then photos are taken of vessels in eye as dye flows through them)

Hows visual acuity tested?

Snellen Chart/ Jeager

• measures how accurately pt reads lines of letters of various sizes

what’s Fluorescein angiography?

dye injected into PV, and photos taken to see the dye flow through veins

What happens to eyes with Glaucoma?

Increased ocular pressure due to buildup of fluid causing compression on the optic nerve

Whats the first symptom of glaucoma?

loss of peripheral vision!!, which can progress to blindness!

• can experience severe headaches, eye pain, blurred vision

How to diagnose Glaucoma?

with tonometry—measures the pressure inside your eye

What meds lowers BP and HR??

• metoprolol, which also lowers pressure in eye…

Whats the pt at risk for if they have diabetes?

pts who has diabetes are at risk for Diabetic retinopathy, and is 2-5x’s more at risk for cataracts, and has twice the risk of having open-angle glaucoma

What happens to vision with Macular Degeneration?

• central visions lost as pts age

• irreversible!!

• impacts driving, reading

How is Macular Degeneration diagnosed?

With Amsler Grid

• pt is shown a grid made of lines and asked if the lines look straight or wavy, or if any section of the grid is missing

How often should u complete an eye exam?

every 1-2 years for those 65 and younger

In what order/ How do u administer eye drops?

1. give pt tissue

2. clean their eyes

3. position pt supine/ head tilted back

4. have pt look up and expose conjunctival sac

5. drop med. into conjunctival sac

   1. Ointments can be applied to inner/outer canthus

   2. DONT rub eyes, hold pressure on inner canthus for 30-60 secs!!

What is Presbycusis?

Gradually occurring age-related hearing loss

Whats Sensorineural Hearing Loss caused by?

• by problems in inner ear/auditory nerve (VIII)

• genetic or birth abnormalities, or prolonged exposure to loud music, and ear buds

  • Down Syndrome…

• ototoxicity (damaged caused by some meds— NSAIDS etc)

What is Conductive Hearing Loss caused by?

• caused by trauma, inflammation (Otitis media), cerumen impaction, perforated eardrum or blocked by foreign body

How can conductive hearing loss be treated?

antibiotics, anti-inflammatory meds, or surgery

Where in the ear canal does conduction hearing loss affect? How should u communicate with them?

the middle ear, and communicate with writing instructions out (don’t assume they know sign language)

Which type of hearing loss is permanent and which is temporary?

Sensorineural hearing loss is permanent!!

Conductive is more temporary!!

What is Tinnitus?

Ringing sensation in ears, hearing sound when NONE is present!!!

What causes Tinnitus?

aging, injury, cerumen blockage, or problem w circulatory system

how does the Rinne test and Audiometry test work?

1. Rinne Test: tuning fork that is vibrated and placed against the mastoid bone and the pt is asked to identify when they are unable to hear the sound. (AC>BC)

2. Audiometry Test: pt wears headphones and sounds are played at various decibels

How do u assess hearing loss?

• typically questioned by family members after constantly being asked to repeat what they say!!

How is hearing loss defined as? And what accommodations should u get for ur pts?

slight, mild, moderate, severe, profound

• moderate: hearing aids

• severe/ profound: sign-language, lip-reading (permanent)

What can lead to withdrawal from social activities, isolation, and depression?

Hearing Impairments

Would u administer eye/ear drops before or after meals?

before meals bc they need to lay down, then have pt eat when sitting up

Administering ear drops steps…

1. Clean pinna and ear canal

2. position pt side-lying w/ ear facing up

3. pull ear up and back!!

4. use dominant hand to hold bottle ½ in. above ear and admin. drops

5. massage tragus 2-3 x’s

6. tell pt to keep ear up for 5-10 mins

Whats the difference b/w Dementia and Delirium?

Dementia is Irreversible and progressive damage in brain—> altered perception of surroundings

Delirium is Reversible w/ multiple causes resulting in agitation, disorientation, and hallucinations