NRSG 111 midterm

Illness

A subjective experience of loss of health. Only the person experiencing it can say they are ill.

Disease

A objective state of health. Can be diagnosed and measured.

Health

Physical, mental, social, and spiritual. Objective, characterized by functional stability, balanced, integrity

Wellness

Subjective, determined by the person experiencing health

WHO definition of health

Physical, social, and mental well-being

Medical approach to health

Only looked at the medical aspect. “ You are obese and at risk for a stroke”

Behavioral approach to health

Focused on changing peoples lifestyles. “You eat poorly so lets focus on making smarter choices”

Socioenvironmental approach to health

Focused on what leads people to make the choices they do. “You eat poorly because you are trying to provide for your family”

Health Inequity

Health differences: social, economic, environmental, disadvantage, genetics, choices

Health equity

Access, health care for all

Impact of health and wellness on the individual

• behavior and emotional changes

• loss of autonomy

• self-concept and body image changes

• life style changes, financial adjustments

• denial, anger, guilt, hopelessness

Impact of health and wellness of the family

• depends which member is ill (mom, dad, baby)

• depends on seriousness and length of illness

• financial demands

• cultural and social customs the family follows

Individual

1 human being

Family

2 or more individuals who all depend on each other for emotional, physical, or finical support

Group

Groups within a population (youth with diabetes)

Community

People and relationships that emerge among them as they develop and commonly shared agencies, insituations, or physical space

Population

a large group of people who have at least 1 characteristic in commom and reside in a community

Society

The system that incorporates the social, political, economic, and cultural infrastructure to address issues of concern

What influences your lens

• previous experiences

• upbringing

• culture

• gender

• socioeconomic background

Why is public heath important?

The average lifespan of Canadians has increased by 30 years since 1900s, and 25 of those are attributable to advances in public health

12 achievements- Control of infectious diseases

Controlling the spread has been a fundamental goal of public health

12 achievements- safer workplaces

Rate of work related injury has been steadily declining

12 achievements- Motor vehicle safety

Invention of seatbelts and drinking and driving laws

12 achievements- Safer and healthier food

Canada has safe and high-quality food

12 achievements- Decline in death from cardiovascular disease

Canada is a world leader in treatment and control

12 achievements- recognition of tobacco use as a health hazard

Dramatic decline in tobacco consumption

12 achievements- healthier mother and babies

Health of mothers and children in Canada is among the best in the world

12 achievements- universal policies

The term “universal” applies benefits that are awarded based on age, citizenship, without recipients income. Universal programs, social welfare and healthcare help Canada maintain high standards of living. 

12 achievements- family planning

invention of birth control and abortion becoming legal

12 achievements- healthier environments

Policies have increased community health and reduced toxic admissions

12 achievements- vaccination

Because of vaccinations, diseases now cause less than 5% of all deaths

12 achievements- Acting on SDOH

Recognition that health is influenced by many factors outside the healthcare system

Social determinants of health

Conditions in which people are born, grow, work, live, and age, the wider set of forces and systems shaping the conditions of daily life

SDOH- income

• money impacts resources, housing, general health, and food security

• lack of money increases stress and increases risk of life threatening coping behaviors

SDOH- education and literacy

Literacy is often closely tied to income and enables increased understanding and ability to obtain and use info

Functional literacy

Reading and math ability

Interactive literacy

Apply new info to changing circumstances

Critical literacy

Advanced ability to analyze info for understanding

SDOH- employment

• unemployment, job security, working conditions

• nursing has the highest rate of calling in “sick” because of workload

SDOH- development

Ages 0-6 are most impactful, caring, environments, and supportive parenting will set your kids of for success

SDOH- health services

• physical environment: geography, housing, food security

• what do you have access to: safe drinking water, fresh air, location of healthcare

SDOH- gender

how does our understanding and feelings about gender influence our health, and everyone’s health

SDOH- culture, race, racism

BIPOC, minority groups, immigrants, refugees

Racism

individual

Systematic racism

Policy, laws, regulations- colonization

Racialazation

Seen as belonging to a particular race

Colonialism

European policy and intuition of domination

SDOH- social environment

• social safety net, social exclusion, disability

• family, friends, people you connect with

Primary Healthcare

• high level of health and wellbeing

• equitable distribution

• patients centered

• early access

• on a continuum

• accessible 

• intersectoral cooperation- everyone working together

Prerequisites for health

Peace, education, shelter, food, income, ecosystem, resources

• with a focus on social justice and equity

Health Equity

The absence of systemic disparities in health (everyone gets what they need)

• health inequity puts those disadvantaged at a further disadvantaged

• reflects social justice and is critical and necessary to achieve health for all, with the concept health is a human right

Social Justice

• rooted in responsibility and fairness

• focus in on relative social advantage of individuals or groups over others

• examine roots causes of inequities and how to eliminate them

SDOH strategies: health promotion

is directed towards increasing the level of well-being and self actualization

SDOH strategies: disease promotion

is action to avoid or forestall illness/disease

Strategies outlines in Ottawa Charter

• build public health policy

• create supportive environments

• strengthen community action

• develop personal skills

• reorient health services

Primary disease prevention

Prevent disease/injury before it occurs

Secondary disease prevention

Reduce impact of disease/injury which has already occurred (early detection)

Tertiary disease prevention

Management of illness/injury with long term effects

Growth and Development

understanding human development informs nursing plans and promotes optimal health

• impacted by gender, culture, and sexuality

• not always orderly and predicable

• sociocultural, biological and psychological forces are interacting 

Genomics

the study of genes and how they can be altered during growth and development

Epigenetics

factors outside of genes that change cellular function

• intergenerational

• poverty

• stress

Physical growth

Quantitative and measurable - genetic

Delevoplemnt

• progressive, continuous

• increasing capacity and skills to function

• qualitative, difficult to measure

• move from simple to complex

Cephalocaudal

Head to toe (neck and head develops before extremities)

Proximodistal

Midline to periphery (central NS develops before peripheral NS)

Differentiation

Simple to complex (babies make noises before talking)

Screening

Helpful to determine growth and development areas of issues for early intervention

Erikson’s theory of psychosocial development

• 8 stages throughout life

• each stage = resolution of conflict

• recognizes environments but focuses on individual mastering the conflict

• conflicts are predominant at stages but exist at all times and may emerge over again

• consider nursing implications for the person that is struggling with successful resolution of a stage

Infancy- trust vs mistrust

• teach with anticipatory guidance - prevention with understanding the G&D stage

• focus is on the parents

Early childhood - autonomy vs shame and doubt

• learn about independence and self confidence (what they can do wrong)

• teach with empathetic guidance

Preschool - initiative vs guilt

• teach about cooperation and control, helping them learn independence

• stick with something from start to finish

School age - industry vs inferiority

• allow for opportunities, helping them learn about interests and challenges

• learn risk taking - pushed out of comfort zone

Adolesence - idenity vs role confusion

• who am I?

• what do you believe?

Young adulthood - intimacy vs isolation

learn to be part of society and learn their ow identity, and develop close relationships

Middle adulthood - generativity vs stagnation

• expanding within society and supporting the future

• nurses can support social interactions

Maturity - integrity vs despair

• nurses can practice without ageism, showing respect, value, involvement

• reflective- what is happening?-changing/aging

Piaget’s theory of cognitive development

• 4 periods of time, experience by all cultures

• children making means of the physical world

• through to adults learning to cope with health challenges

• maturation, dependent on opportunity, simulation and challenge

• spontaneous process where individuals play active role in development

Sensorimotor (0-2)

• infant explores the world through direct sensory and motor contact

• object permeance and separation anxiety develop

Preoperational (2-6)

• child uses symbols to represent objects (cant logically reason)

• ability to pretend

• child is ego centric

Concrete operational (7-12)

• think logically about concrete ideas (addition or subtraction)

• understands conversation

Formal operational (12-adult)

• adolescent can reason abstractly

• think in hypothetical terms

Theory 2: Premoral

Will not follow rules

Theory 2: Conventional

Will follow rules

Theory 2: Autonomous

Mutual respect for rules impacted by morals and consequences

Kohlberg’s moral development theory: Level 1

Pre-conventional

• obedience and punishment orientation

• self-interest orientation

Kohlberg’s moral development theory: Level 2

Conventional

• interpersonal accord and conformity

• authority and social-order maintaining orientation

Kohlberg’s moral development theory: Level 3

Post conventional

• social contract orientation

• universal ethical principals

Why is understanding G&D important for nurses?

• understanding risks

• implementing appropriate strategies

• knowing when to involve the patient vs parent

Who makes health care decsions?

• under 19 is a minor

• or if deemed as incompetent

Infants act

Under 19 can make health care decisions if its in their best interest and they are making an informed decision

Health risks or risk factors

Increase susceptibility to disease

What guides our choices?

• beliefs

• values

• attitudes

• knowledge

• demographics

• access/resources

TTMOC- Pre contemplation

No plans to take action

TTMOC- contemplation

Acknowledges need to change

TTMOC- preparation

intends to take action immediately

TTMOC- action

Actively implements the behavior

TTMOC- maintenance

strives to prevent relapse

TTMOC- termination

Problem is no longer a threat

Health belief model

• is it serious?

• am i susceptible?

• is it worth it to change?

• what barriers are there?

Cyclic

People move through the stages in order, however relapse to earlier stage is possible