NURS 441 - TEST II

what are the properties of culture? (SATA)

dynamic (not static)

shared (not private)

learned (not inherited)

what is culture competence?

an ATTITUDE of openness to, respect for, and CURIOSITY about different cultural values + traditions, + ideally includes a BROADER critical analysis of power relations affecting health disparities

- a CONTINUOUS process

what is the first imperative of cultural competence?

to be competent in one's own cultural heritage + then further familiarizing oneself w/ cultures that represented in the communities they serve

what is cultural humility?

an ACKNOWLEDGEMENT that everyone's views are culturally influenced, that our own are not inherently better than those of our client, + that our clients can teach us

what is the first imperative of cultural humility?

cont self-evaluation + critique their own cultural assumptions + advocate for their clients

ask open ended questions

avoid making assumptions

what is institutional cultural humility?

organizations must be aware of + seek to minimize structural hindrance to cultural openness + respect

aka where you work

to promote institutional cultural humility, nurses must do what?

be actively critical to best promote the wellness of all their clients

to achieve institutional cultural humility, institutions must do what? (SATA)

value diversity

conduct self-assessment

management the dynamics of difference

acquire + institutionalize cultural knowledge

adapt to diversity + the cultural contexts of the communities they serve

what is cultural safety?

providing culturally appropriate health services to MARGINALIZED GROUPS while stressing dignity + avoiding institutional racism, assimilation (forcing people to adopt to dominant culture) + repressive practices

what is ethnocentrism?

assumption that others believe + behave as the dominant culture does, or the belief that the dominant culture is superior to others

what is the ethnocentric statement?

"they are in the US now; you would think that they would act like us."

what are the aspects of culture directly affecting health + healthcare?

attribution of illness

diet

verbal communication

nonverbal communication (eye contact/personal space)

style of communication

time orientation

roles

religion

folk medicine

Mr Ali case study

this is a reminder that nursing is more than tasks - it's about honoring human dignity.

advocacy sometimes means standing w/ the patient, even when others around you want a different outcome.

active listening

clarify understanding

provide information, not persuasion!!

goal is informed choice not coercion

what is case management?

a CLIENT CENTERED, collaborative process focused on the individual + their family

person focused advocacy

involves assessment, planning, coordination, facilitation, + advocacy

what is the building block of care management?

case management

what is a case manager's role?

advocacy + education

clinical care coordination

continuity/transition management

utilization/financial management

performance + outcomes management

psychosocial management

research + practice development

what is a care manager's utilization review?

determines how much time the patient can be in the hospital before transfer

what is care management?

a broader, SYSTEMS FOCUSED process that coordinates health services to function as a cohesive whole

what is the biggest fear of the client concerning home healthcare?

fear of lack of cleanliness or judging from nurse

what is a hospital based agency?

developed in last 25 years to save money + maintain control of costs

the objective is to maintain levels of quality + increase collaboration as part of the care continuum

is home care only for old people?

no! for peds + pregnancy too

financing + regulation of home care with medicare criteria for eligibility? (SATA)

must be renewed every 60 days

homebound (only grocery + church)

plan of care

skilled needs

intermittent care needs

necessity

#1 places for falls

living room + bedroom

how must the nurse interact with/ family when doing home care?

caregivers are often family members + friends

they must be considered members of the home care team + offered support to be successful

home health case study takeaways

in hom health, safety isn't just about eliminating every risk - it's about helping people live safely on their terms.

our role is partner, not control.

acknowledge autonomy first then educate!

describe the concept of family

hard to define today, noted as a complex phenomenon

the concept of family is dynamic, as it is impacted by sociocultural + economic factors

how to do a family assessment?

Calgary Family Assessment Model - a multidimensional model comprised of 3 assessment categories: structure, function, + development

assessment tools for a family interview?

ecomaps + genograms

used during a family interview

acknowledging family strengths

what is the test that outlines the influence that other systems or groups have on families + helps to identify social supports + available resources?

ecomap

what is the diagram of family relationships between blood relatives that can span 2 or more generations includes life events (marriages, divorces, births, + deaths) + identifies relationships as well as possible patterns of disease?

genogram

education of caregiver burden

major problem for families - can lead to intrafamily strain

majority of caregivers are female

vulnerable population

perform a wide range of care tasks

CARE act

family medical leave act (FMLA)

types of disasters

pandemic

natural human-made (accidental) - social/technological/environmental

terrorists attack

disaster management continuum

preparedness: identify all hazards, proactive planning, evaluate possible damage

mitigation: take measure to limit damage, disability, + loss of life

response: implementation of disaster plan, provide care, restore communication + transportation

recovery: stabilization + return to normal status

evaluation: learn from past + prepare for future

which phase of disaster management continuum do nurses spend most of their time in?

mitigation

what is preparedness?

disaster preparedness plans are action plans developed in anticipation of a disaster, providing a framework for response to emergencies

ensure successful response, steps must be taken before any incident occurs

risk is assessed + impact is evaluated

involve data collection - risk assessment, vulnerability, + response networks

the identification of all existing + potential dangerous situations before disasters occur is the first step in planning for response

what are point of distribution plans or emergency dispensing sites for?

where to get resources after disaster

math for test: water

1 gallon per person per day x 3 days

what is mitigation?

take measures to limit damage, disability, + loss of life

effort to prevent identified risks from causing a disaster

what is a response?

implementation of a disaster plan + responders are deployed

NIMS - guides response to disaster + goal is to reduce loss of life, poverty, + harm

START model to assess pt injury

red

immediate - critical - airway issues, severe hemorrhage, requiring immediate intervention

yellow

delayed - serious/not immediate - can wait for care

green

minor - walking wounded, minor injuries

black

deceased/expectant - dead or w/ injuries incompatible w/ life given available resources

how many sec per patient in disaster?

30-60 sec

what is recovery?

begins as disaster ends

communities that have prepared fare better

timeline varies widely

stress debriefing + MH services are essential

rebuilding + relocation

communication is essential

several factors cont in recovery

what is evaluation?

foundation of evidence based disaster response

analyze specific aspects of the plan + assess effectiveness

every should take part in evaluation

'hot wash' session: should occur while everything is fresh in one's mind, usually during recovery

after action report - is a more formal report that provides a detailed list of strengths + weaknesses, successes + failures, + suggestions for improvement

bioterrorism category A

high priority

pose a high to national security

easily disseminated

result in high mortality

potential for major public health impact

cause public panic

require special action is taken

bioterrorism agents

anthrax

botulism

plague

smallpox

tularemia

viral hemorrhagic fevers

ebola precautions

which bioterrorism agent caused the largest public fear response in the US after 9/11?

anthrax letters

with blast injuries, what can be very difficult?

communication w/ victims may be difficult d/t sudden temporary deafness

it is an ethical imperative to address health as a ___________ ___________ to wellness.

proactive approach

perceptions to health are what?

subjective

what do subjective perceptions determine?

a person's willingness to participate in health promotion initiatives

what are the core activities to public health?

health promotion

disease prevention

risk reduction

what is health promotion?

an ART and SCIENCE of helping people discover synergies between THEIR core passions + optimal health, enhancing THEIR motivation to strive for optimal health, and supporting THEM in changing THEIR lifestyle to move towards optimal health

how is strategy used in health promotion?

partnerships w/ health professionals, individuals, + communities

what is unique about the road maps to health promotion?

there are NO all or nothing approaches

levels of prevention

primary = education

secondary = screening

tertiary = support

what is the term for a client-centered communication style for eliciting behavior change by helping clients + groups explore + resolve ambivalence (mixed feelings) to change?

motivational interviewing

behavioral change models

health belief model

transtheoretical model

social learning theory

theories of social support

the relapse prevention model

health belief model

people act when they believe they are @ risk + that the benefit of action outweighs the barriers

a person's health choice are shaped by their beliefs about seriousness, susceptibility, + whether they feel capable of making the change

--> answer on test will say 'belief'

transtheoretical model

a sequential approach to behavior change that involve the readiness of the learner (aka meeting pt where they're at)

social learning / social cognitive

a person must believe in his/her capability to perform the behavior - know as self-efficacy as well as perceive an incentive to do so

theories of social support

DR WOODY'S BIGGEST FAN MODEL

family members, friends, neighbors, + adjacent communities influencing change by offering instrumental assistance, informational support, emotional support, +/or appraising support

the relapse prevention model (SATA)

relapse often occurs bc of . . .

negative emotional states

lack of or limited coping skills

decreased motivation

stress

high-risk experiences

what is the 6th VS?

education

what is health literacy?

the degree to which individuals have the capacity to obtain, process, + UNDERSTAND basic health info + services to make appropriate decisions

what are the 3 levels of health literacy?

allows the community health nurse to intervene at the individual, provider, + community level

- functional = reading/writing

- interactive = cognitive

- critical = reflection

what is it critical for the CHN to understand health literacy + have skill in health communication?

so they can be understood

what is the cross cutting issue?

affects all genders, ages, races, ethnicities, + socioeconomic groups (SES)

influenced by age, income, education, race, language, + context

not fixed: health literacy can improve over a lifespan thru education, social support, + experience

what are the health literacy skills + tasks?

information literate

visually literate

communication literate

computationally literate

analytically literate

computer literate

who are the populations @ risk for low health literacy? (SATA)

> 65 y/o

individuals w/ limited education or low income

non-native speakers of English

racial/ethnic minorities

recent refugees + immigrants

adults w/ any type of disability, difficulty, or illness

who is responsible for expanding health literacy?

consumers

healthcare providers

healthcare systems

governments

what is the most effective teaching method?

teach back

effective questioning of health literacy

ask me 3 -->

what is my main problem?

what do I need to do?

why is it important to me to do this?

what is the health care providers job w/ providing health information?

to make it easier to understand, confirm everyone's understanding, + reduce the difficulty of health related risks

what do clinicians needs to be aware of when giving education?

consider your attitudes

top rated health literacy practices

partners w/ pts from the outset of the encounter negotiating a mutual agenda

what is the role of nurses concerning health literacy?

knowledge of health literacy is a core responsibility of nurses

why is research important in nursing?

NURSES USE RESEARCH EVERY DAY (whether you read it or do it)

decides what works + what doesn't

EBP

research = the big picture

research design types + strength

weak --> strong

descriptive = describes what's happening

analytical = compare groups

experimental = tests cause + effect

randomized controlled trial (RCT) = GOLD STANDARD

epidemiologic research

community level research!!

who? where? when? why?

used for identifying community health problems + understand how diseases start + spread

descriptive/analytical OR qualitative/quantitative

types of trials

preventive

clinical/therapeutic

preventive trials

goal = prevent disease before it starts

focus on primary prevention

example: vaccine studies

clinical/therapeutic trials

goal = treat disease or prevent complications

focus on primary + secondary prevention

example: new med to control BP