CHN Midterm Study Guide

Chapters 1, 5, 10, 11, 21, 22, and 25

patient/client centered care

• cultural traditions

• personal preferences → consider literacy skills and how the client prefers to learn

• values → what is important to the client?

• families

• lifestyles

health information technology (HIT)

comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner

telehealth

use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

personal responsibility for health

active participation in one’s own health through education and lifestyle changes

social determinants of care

social conditions in which people live, their income, their social status, their education, their literacy level, their home and work environment, their support networks, their gender, their culture, and the availability of health services

principles of public health nursing

1. client or unit of care is the population

2. primary obligation = greatest good for the greatest number of people

3. collaborate with the client as an equal partner

4. primary prevention

5. focusing on strategies that create healthy conditions in which populations may thrive

6. actively identify and reach out to all who might benefit from a specific service

7. optimal use of available resources and creation of new evidence-based strategies

8. collaboration with other professions, populations, organizations, and stakeholder groups

equity

providing equal care without discriminating against gender, race, sexual orientation, socioeconomic status

primary prevention

maximizing health and wellness through strategies that are set in place BEFORE illness or injury is present

secondary prevention

maximizing health and wellness through strategies that are set in place at the early and active chronic stages of the pathogenesis of illness and injury

tertiary prevention

maximizing health and wellness through strategies that are set in place at the palliation and end stage of disease and injury trajectories

culture

knowledge, values, practices, customs, and beliefs of a group

properties of culture

• dynamic

• shared

• learned

cultural competence

a skill the nurse develops in learning to respect individual dignity and preferences, as well as acknowledging cultural differences

an attitude of openness to, respect for, and curiosity about different cultural values and traditions, and ideally includes a broader critical analysis of power relations affecting health disparities

cross-cultural / transcultural nursing

any nursing encounter in which the client and nurse are from different cultures

For community and public health agencies to be culturally competent, they must…

• have a defined set of values and principles

• demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally

• have the capacity to

  • value diversity

  • conduct self-assessment

  • manage the dynamics of difference

  • acquire institutionalize cultural knowledge

  • adapt to diversity and the cultural contexts of the communities they serve

cultural humility

an acknowledgment that…

• everyone’s views are culturally influenced,

• that our own are NOT inherently better than those of our clients, and

• that our clients can teach us

ethnocentrism

an assumption that everyone shares your cultural values or an opinion that your culture is superior to others

What is the first step to being culturally competent?

to be competent in one’s own cultural heritage

Aspects of culture DIRECTLY affecting health and health care are…

• attribution of illness

• diet

• verbal communication

• nonverbal communication

  • eye contact

  • personal space

• style of communication

• time orientation

• roles

• religion

• folk medicine

A cultural assessment provides…

information to the healthcare provider about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors

Why should the nurse perform a self-assessment PRIOR to collecting information about a client’s culture?

to prevent personal bias

Question Examples

• Am I aware of my culture and views about other cultures?

• Am I able to perform a culturally sensitive assessment?

• Do I have the knowledge necessary to develop culturally appropriate nursing interventions?

• What is my goal in learning about diverse populations?

cultural sensitivity

awareness and appreciation of the values, norms, and beliefs characteristic of a cultural, ethnic, racial, or other group that is NOT one’s own, accompanied by a willingness to adapt one’s behavior

Conveying Cultural Sensitivity

• Address clients by their last names, unless the client gives the nurse permission to use other names.

• Introduce yourself by name and explain your position.

• Be authentic and honest about what is known or not known about a client’s culture.

• Use culturally sensitive language.

• Find out what clients know about their health problems and treatments, and determine the client’s intent to adhere to the prescribed treatment plan.

• Incorporate clients’ preferences and practices into care when possible.

• Do not make assumptions about clients.

• Encourage clients to ask about anything that they might not understand.

• Respect clients’ values, beliefs, and practices.

• Show respect for clients’ support systems.

• Provide health teaching materials in the client’s primary language and at the recommended readability level.

Using an Interpreter

• The nurse should use an interpreter when it is difficult for a nurse or client to understand the other’s language.

• Interpreters should have knowledge of health-related terminology.

• The use of family members as interpreters is not advisable because clients might need privacy in discussing sensitive matters. Family members can lack objectivity when relaying information to or from the client, and the family member can have difficulty understanding medical terminology.

• The nurse should consider client preferences when selecting the age and gender of an interpreter.

A community assessment includes…

examination of biological, psychological, and sociocultural influences of the environment that surrounds a specific group of people.

Windshield Survey

observation of a community while driving a car or riding public transit to collect data for a community assessment

Community Assessment Asset-Based Approach

identifies community resources and strengths along with community needs

Collaborative Model

an assessment by an interdisciplinary team and members of the community

Risk Factors for Suicide (SAD PERSONS scale)

• Sex

  • females have more attempts

  • males are more lethal

• Age

  • increases with age

  • adolescents and the elderly are the highest-risk groups

• Depression

• Previous attempts

• Excessive alcohol and/or drug use

• Rational thinking loss

• Social support lacking

• Organized plan

• NO spouse

• Sickness

  • chronic or debilitating

Symptoms of Bipolar Disorder

Depression Symptoms

• LOW self-esteem and energy

• slow movement and speech

• suicidal ideation

• poor hygiene

• anergia

• anhedonia

Mania Symptoms

• HIGH self-esteem and energy

• euphoric

• delusions of grandeur

• rapid speech

• risk for violence

• risky behavior

• outlandish clothing

Autism Interventions

• early identification and treatment

• screening tools mostly used in toddlers

• screening for prodromal symptoms in infancy

  • some of the more debilitating features of the disorder might be mitigated with early intervention and treatment

Long-term outcomes of children with autism are improved with…

early identification and treatment.

3 main symptoms of attention-deficit/hyperactivity disorders (ADHD)

• inattention

• hyperactivity

• impulsivity

What is the diagnostic criteria for ADHD?

symptoms occur in 2 settings (e.g., home and school for children or home and work for adults

What medications are given to children with ADHD?

psychostimulants

• methylphenidate (Ritalin)

• methylphenidate hydrochloride extended-release tablet (Concerta)

Nursing Considerations for ADHD Medication (children)

• DO NOT administer after 6 PM

• may cause insomnia

• affects growth and development

  • keep a growth chart

• monitor BP

• obtain bloodwork

Role of the School Nurse

• health assessment

  • individual

  • population-based

  • health promotion

  • school health needs

• health educator

• emergency preparedness

School nursing encompasses many roles:

• case manager

• community outreach

• consultant

• counselor

• direct caregiver

• health educator

• researcher

Common Health Concerns (school nursing)

• drugs and alcohol

• smoking

• sexual behavior and teenage pregnancy

• sexually transmitted infections

• nutrition

• violence

The school nurse as a child advocate…

• provides education and communication necessary to ensure that the student’s health and educational needs are met

• implements strategies to reduce disruptions in the student’s school activities

• communicates with families and healthcare providers as authorized

• ensures the student receives prescribed medications and treatments and that staff who interact with the student on a regular basis are knowledgeable about these needs

• provides a safe and healthy school environment to promote learning

site walk-through

a part of a workplace assessment focused on the following:

• observation of work processes and materials

• job requirements

• actual and potential hazards

• employee work practices (hygiene, water disposal, housekeeping)

• incidence/prevalence of work-related illness/injuries

• control strategies to eliminate exposures