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epidemic
disease affecting a large number of people living in a community
pandemic
illness that spreads over several countries or continents is referred to as
endemic
disease affects only a particular people or country
healthy people
scientific base for a 10 year projection that addresses national health care goals and objectives
life expectancy
avg number of years person is expected to live
STAT**
“Life expectancy has increased from 47.3 years at the beginning of the 20th century to nearly 79 years today. ”
goals of healthy people
increase quality and years of ahealthy life
eliminate health disparities among persons that exist according to sex, race, ethnicity, education, income, disability, location and sexual orientation
five categories of obj for healthy people 2030
health conditions objectives focus on quality of life for individuals with certain conditions
health behaviors focuses on topics that can be taught to patqients such as nutrition and healthy eating, not using drugs and increase physical activity
populations objectives cover issues that affect segments of the population such as adolescents, LGBTQ+, men, women and people w/disabilities
setting and systems obj focused on role of health care organization in decreasing health disparities by providing a framework that cna make health care accessible to all individuals
social determinants of health focus on condition in the environment affecting people’s health, functioning and quality of life
WHO has discussed what social determinants of health
1) social and community context
2) economic stability
3) education access and quality
4) health care access and quality
5) neighborhood and built environment
social security act (1935)
provide unemployement insurance for people who lost their incomes due to old age
Medicare part A (1972)
hospital insurance - expanded to include low income, pregnant women, individuals needing long term care or people w/disabilities
Medicare part b (1972)
medical insurance - expanded to 65+
medicare part D (2006)
prescription drug coverage
PCP
primary care provider assigned to provide basic health care services
HMO
provides a plan that has the health care provider assume some of the financial risks and uses PCPs as gatekeepers
PPO
HCP’s deliver services to private sector for a discounted fee, PCP will have to give referrals to other doctors however
POS
point of service, HCPs are paid a preset payment based on membership or risk based system
COBRA (1996)
consolidated omnibus budget reconciliation act → health insurance protection for people who have to leave their jobs
HIPPA (1996)
health insurance portability and accountability → holds health care facilities and workers responsible for protecting sensitive patient’s data
CHIP (1997)
children’s health insurance program, providing coverage to millions of children in low-income families that do not qualify for Medicaid
ACA (2010)
offer health insurance to millions of americans who are uninsured and to improve coverage of those who have insurance
how many americans are uninsured so far?
48 million
WHO
strives to improve access to health care in some local communities because a lack of access affects all aspects of a person’s physical, mental, and social health
CDC
federal agency under department of health that promotes disease prevention primarily in the US but also globally
NIH
research is used to promote health, reduce occurrence of disease and disability and lengthen life span
health
state of complete physical, mental and social well being, not merely the absence of disease or infirmity
physical health
includes all characteristics that people inherit from their parents
psychological health
how person feels and expresses emotions
social health
deals w everyday issues of economics, religion, culture and interactions of people living tg
cognitive health
encompasses a person’s ability to learn and develop
disease
imbalance between internal and external forces
health promotion
health care directed toward the goal of increasing an optimum leve of wellness
how many americans spend greater part of day in workplace
85%
empowerment
form of self-responsibility that encourages peope, to take charge of their own decision-making
primary prevention
occurs before their is any disease or dysfunction
MAJOR NATIONAL GOAL → deliver vaccines to at least 90% of preschool population
secondary prevention
dx of a disease or infectious process, need for early dx and treatment of disease to prevent permanent disability
tertiary prevention
begins with a permanent disability, health restoration, regain lost function and develop new compensatory skills possibly w the use of an assistive device such as a cane or hearing aid
nutrition
science that studies the body’s need for foods, how foods are digested and how food choices relate to health and disease
malnutrition
poor dietary state that results from lack of essential nutrients or failure to use available foods
exercise stats
adults shud get at least 30 min of moderate physical exercise per day, children shud get at least 60 min
proteins
broken down in body into amino acids, which are building blocks needed for repairing body’s cells and tissues
carbohydrates
starches and dietary fiber that provide fuel and energy for the body
fats
lipids, cushion and provide insulation for the vital organs in the body
SATURATED → oils that are solid at room temperature
UNSATURATED → oils that are liquid at room temperature
vitamins
organic compounds that assist in building body tissues and are important in all chem rx
minerals
inorganic substance that come from the earth and are important in body fx
water
aids in regulation of body temp, lubricates and cushions joints, protects spinal cord and eliminates waste from body
mental health
fluctuating state in which individual attempts to adjust to new situations, handle personal problems without undue stress and still contribute to society in a meaningful manner
emotions
best defined as a feeling state, produce both physiological and psychological changes
limbic system
comprises interconnected nuclei that affect memory and emotions
stress
defined as anything that upset our psychological or physiological equilibrium or balance
GAS
alarm stage → fight or flight response
state of resistance → attempt to adapt to stressors
state of exhaustion → prolonged exposure to stress, body’s energy may become depleted
separation anxiety stages
protest → loud crying, restlessness and dissatisfaction w substitute caregivers
despair → sense of hopelessness and is seen during a quieter period
detachment → state of withdrawal and apathy, lack of interest in one’s surroundings
regression
return to earlier stage of development, may be another childhood adaption to stress
SRRS
social readjustement rating scale (death of spouse, divorce and separation)
PTSD
affect anyone who has experienced a traumatic incident. last 6 months or become chronic
maladaptive responses to stress
denial, withdrawal or acting out
substance abuse
refers to abuse of drugs, such as alcohol, nicotine, caffeine, and legal or illegal pharmaceutical preparations
stats for smoking
every day 1600 young people start smoking
studies show that _% of youth ages 12-20 report drinking alcohol
29%, ½ caused by MVA, 1/3 of all homocides, drowning and boating deaths
anxiety (four levels)
mild anxiety → part of normal, everyday life, sharpens one’s perceptions and prepares them to act
moderate anxiety → increasing discomfort, perceptions decrease
severe anxiety → decreases one’s perceptions even further, focus only on small detail of an event
panic → most EXTREME form of anxiety, unable to think clearly, reality is distorted, communication may be ineffective and behavior is not purposeful
communication
interaction between two or more persons - exchange of information, ideas, feelings or emotions
five parts of communication
message → expression of your thoughts and feelings in words, symbols or body language
sender → delivers the message by initiating the conversation
method → convey message determined by sender and can be words, symbols, gestures or a combination of all three
receiver → person to whom message is sent
feedback → response to the message, serves to verify that msg was received as intended
intrapersonal communication
occurs when individuals are thinking to themselves, helps to control emotional responses
interpersonal communication
two or more individuals and includes both verbal and nonverbal communication
verbal communication
transmits attitudes, thoughts and feelings using spoken or written words
nonverbal communication
body language, may choose to use body language to emphasize their thoughts or feelings and may use gestures without being aware of doing so
eight modes of nonverbal comm
physical appearance and dress
body movement and posture (open, closed)
facial expression
gestures
eye contact
tone and volume of voice
touch
silence
personality types
passive/unassertive → have difficulty asking for help, often feel hurt or angry that others are taking advantage of them
aggressive → destructive, angry vocalization to dominate and harm other people
assertive → express confidence and are comfortable sharing their feelings, take responsibility for their action
social communication
use of language in social contexts, may not have a specific purpose or direction
therapeutic communication
used between HCP and pt and among nurse, pt and or family members
cognitive domain
expressed in words
affective domain
expresses feelings thru TONE of words
six components of therapeutic comm
listening and observing (active or passive)
warmth
genuineness
attentiveness
empathy
positive regard
three phases of therapeutic relationship
orientation phase → both nurse and pt will initially experience some anxiety
working phase → nurse determines the type of coping mech that the patient is using and what support systems exist
termination phase → end of relationship
factors affect comm.
congruence → implies an agreement btwn verbal and nonverbal language
incongruence → occurs when speaker’s works do not match nonverbal communication
time and setting → concerned w what precedes and follows and interaction
proxemics → refers to how close a person can get before they start to feel uncomfy
bias → word to describe a prejudice or a negative belief about someone or something
physical disabilities → such as problem w sight, hearing or illness can interfere w an individual ability to properly communicate
blocks to communication
belittling → using a statement that dismisses or mocks a person’s beliefs or fears
disagreeing → giving a response that indicates you believe the other person is incorrect
agreeing → statement to show that you believe what the person is saying is correct
defending → responding w a statement or justification or a counter reply to a verbal attack
giving false reassurance → offering a statement of reassurance without sincerity or justification
giving advice → telling another person what you think they should do
changing subject → minimizes significance of speaker’s feelings
asking closed-ended questions → shud be avoided in therapeutic communication bc they encourage a one-word answer of yes or no
asking why questions → increase a person’s uneasiness by demanding an immediate answer
probing → questioning that seeks information beyond what is necessary
techniques to enhance communication
giving information → helps patients know who you are, what you are doing and what you need from them
validating → making a statement or question that attempts to verify your perception of the person’s verbal and nonverbal message
clarifying → clear up possible misunderstanding or seeking info necessary for your understanding
reflecting → sitting your perception of another person’s message in the affective domain
flashback → reflecting on the past
paraphrasing or restating → similar words for what the other person said
asking broad questions → using open-ended questions
using general leads → short responses to encourage the person to continue talking
stating or making an observation → acknowledge and verbalize thoughts and feelings
offering self → accomplished by listening in silence
focusing → way of directing conversation to a specific topic when you are seeking more information on a poorly defined topic
humor → that does not demean can serve to decrease anxiety, help a person face stress, increase a person’s tolerance to pain
closed loop communication
depends on feedback to be sure that the sender’s words are heard and clearly understood
SBAR
situation → describes existing situation of the pt
background → information derived from pt’s history
assessment → information you obtain from physical exam of the pt
recommendation → how you, as nurse, think the problem can be corrected
culture
describes a social group within a society to which individuals belong and that gives meaning to their lives
subculture
culture within a dominant culture group that has its own common value, beliefs and interests
characteristics of culture
learned → when behaviors, values, beliefs and traditions are passed down from one generation to the next generation thru acquisition of language
enculturation → learning the culture thru observation and instruction
shared → most common practice is language
understood by all members of that group
integrated or patterned → based on economics, politics, social patterns, work ethics and individualism (understanding that all individuals are unique)
consists of a collection of cultural traits and behaviors
adaptive → response to environmental and biological demands
increased number of women in the workforce
47.1% in 2025 and taper off to 46.3% by 2060
diffusion → spread of cultural traits from another culture
acculturation → when values and beliefs are exchanged bc of continous direct interactions btwn cultures
globilization → change thru combo of diffusion + acculturation + migration and tourism
can be maladaptive if it fails to change to meet challenges of the grp
symbolic
ability to develop symbols that allow for communication
beliefs
truths held by culture’s people, determine and influence how they deal with and view social problems and concerns
values
deeply embedded characteristics and feelings that determine what is considered good or bad, sense of stability and security
norms
socially accepted rules and practices that guide an individual behaviors and interactions within the culture
folkways
customs within the culture that determine how we greet each other
laws
written policies supported and enforced by the govt
mores
moral beliefs that are strongly held by members of the culture
prejudice
negative feelings, attitude or judgement directed toward people bc of their race, gender or sexual orientation
ethnicity
ppl have a shared cultural heritage and are from same race and geographical area
transcultural nursing (madeleine leininger)
formal area of study and practice focused on comparative human care and understanding of diff and similarities in beliefs, values and practices among people
more than __ of all americans will belong to a minority ethnic group other than non-hispanic white
half
one in _ of the nation’s total population is projected to be foreign-born
1/5
how many ppl speak a language other than language
1/5 of US population
cultural relativism
means that professional must learn and seek understanding and apply the other person’s cultural standards to each situation
cultural competence
ongoing and continuous self-evaluation and development of cultural knowledge and skills which can only be acquired by interacting w or learning abt diverse cultural groups
cultural awareness
seeking understanding of another person’s culture and ethnicity
cultural sensitivity
recognizes that diversity exists and that you needs to respect each person’s uniqueness
cultural barriers
difficulties with the host language
lack of health insurance and access to health care
knowledge deficit
reluctance to question the health provider
adherence to traditional cultural practice
religion
specific system of beliefs and worship that is closely integrated w/ culture, ethnicity and spirituality