NUR201 Exam 1 Review

Vulnerable Populations

• African American
• Hispanic population
• Homeless

Health Disparities

• A particular type of health difference that is closed linked with social economic, and or environmental disadvantage.

Health Equity

Health Disparity

Social Determinants of Health

Diversity

Inclusion

Equity

QSEN Competencies

• Quality and Safety Education for Nurses (QSEN) assists nursing programs in preparing nurses to provide safe, high-quality care in response to concerns about the safety and quality of client care in the USA.
• There are 6 QSEN competencies.
  1. Safety:
     • The minimization of risk factors that could cause injury or harm while promoting high-quality care and maintaining a secure environment for clients, self, and others.
     • Example: Bed alarm
  2. Patient-centered care:
     • The provision of caring and compassionate, culturally sensitive care that addresses clients' psychosocial, sociological, spiritual, and cultural needs.
     • Focuses on the decision-making process.
  3. Evidence-based practice (research):
     • The use of current knowledge from research and other credible sources on which to base clinical judgment and client care.
  4. Informatics:
     • The use of information technology as a communication and information gathering tool that supports clinical decision-making, scientifically based nursing practice.
     • Example: ER charts
  5. Quality improvement:
     • Care related and organizational process that involve the development and Implementation of a plan to improve health care services and better meet patient needs.
     • If something is wrong, we go back to the research.
  6. Teamwork and collaboration:
     • The delivery of client care in partnership with interprofessional members of the health care team to achieve continuity of care and positive outcomes.

Nursing Process and Development

• 1872 - First school of nursing
• Nurse Practice Act:
  • A legal and regulatory body created and applicable in each state.
  • Promotes care and safety by caring for a patient or client.
• Code of Ethics for Nurses:
  • Developed by ANA in 1896.
  • Rules for nurses about clients, behaviors to protect clients, and the profession.

Maslow's Hierarchy of Needs

• Physiologic: food, water, etc.
• Safety and Security: housing
• Love and belonging: friends, family, couple
• Self-esteem: patient values, setting goals
• Self-actualization: sense of direction and hope and maximize patient potential

Roles of the Modern Nurse

• Derived from Latin "nutrix," meaning a person who nourishes, fosters and protects and who is prepared to take care of sick, injured, older and dying people.
• APN: Advanced nurse practice, master's in nursing or a related field
• CNS: Clinical Nurse Specialist
• CRNA: Certified Registered Nurse Anesthesiologist
• CNM: Certified Nurse Midwife, maternal newborn
• Caregiver: Administering medication to clients recovering from surgery, ensuring they are comfortable, and monitoring their vital signs.
• Communicator: Explaining a new diagnosis to clients and their families, answering their questions, and providing emotional support.
• Teacher/Educator: Creating a diabetes management plan for patients, teaching them how to monitor their blood sugar levels, and advising on dietary changes.
• Counselor: Helping clients cope with a chronic illness by discussing their feelings, providing information about support groups, and guiding them through decision-making.
• Leader: Leading a team of nurses during a busy shift, prioritizing and efficiently managing client care.
• Researcher: Conducting a study on the effectiveness of a new wound care technique and presenting the findings to improve nursing practices.
• Advocate: Speaking up for a patient’s right to receive pain management treatment, ensuring their needs and preferences are respected.
• Collaborator: Coordinating with doctors, physical therapists, and social workers to create comprehensive discharge plan for a patient transitioning from hospital to home care.

Nursing Pioneers

• Jean Watson: Care/Caring Module Nursing
• Clara Barton: Started the American Red Cross in 1882
• Dorothea Dix: Mental health
• Idaura Murillo Rohde: Doctorate 1970, NAHA National Association of Hispanic Nurses
• Eddie Bernice Johnson: RN nurse congress, STEM 2012
• Isabel Hampton Robb: Leader in nursing
• Mary Mahoney: 1st African American nurse in 1879
• 1955: Nursing process term used by Hall
• 1973: ANA congress for nursing standard of practice
• 1982: State board examination for professional nursing using nursing process as organizing process
• Margaret Sanger: NY, Birth control, planned parenthood
• Virginia Henderson (1897-1996): Shaped nursing education through the application of her Need Theory.
• Anna Caroline Maxwell (1851–1929): Known for making field hospitals much more conducive to the health of wounded patients during battle
• Linda Richards (1841-1930): As the first professionally trained nurse in the United States, established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients
• Goldie D. Brangman (1917-2020): Was a nurse anesthetist, the cofounder of the School of Nurse Anesthesia at Harlem Hospital in 1951, first black woman
• Lillian Holland Harvey: An African American nurse leader who transformed nursing education, as Dean of Tuskegee
• Mary Breckinridge (1881-1965): Dedicated her life to improving the health of women and children.
• Lillian Wald: Founder of public health nursing
• Mary Elizabeth Mahoney: Became the 1st African American nurse in 1879
• Dorothea Dix: Army nurse during the Civil War, Crusader for reforming the treatment of the mentally ill.
• Linda Richards: 1873 graduated as the 1st trained nurse in the US. Began the practice of record keeping and order writing.
• Mary Adelaide Nutting: 1st professor of nursing in the world
• Mary Breckenridge: Established the Frontier Nursing Service and one of the first Midwifery schools in the US
• Dame Cicely Saunders: Founder of the modern hospice movement

Where Care Occurs

• Hospitals:
  • Rapid care, treat, stabilize, discharge
  • Centers of research and education
• Long-term care facilities, Nursing homes – ADL deficits
  • Skilled nursing facilities – PT, OT, Skilled Nurse Facilities
  • LTC Hospital
  • Assisted-living – ADL deficits
• Ambulatory care Settings
  • Healthcare providers office
  • Walk-in clinics
• Community agencies
  • Public health
  • Home care
  • Hospice
  • Community mental health centers
  • Dialysis centers

Basic Principles of Ethics

• Advocacy: supporting and defending clients' health, wellness, safety, wishes, and personal rights, including privacy.
• Responsibility: Willingness to respect obligations and follow promises
• Accountability: the ability to answer for one’s actions.
• Confidentiality: Protection of privacy without diminishing access to high-quality care.

Ethical Principles for Client Care

• Autonomy: Patient freedom of choice.
• Beneficence: an action that promotes good for others, without any self-interest.
• Fidelity: fulfillment of promises
• Justice: fairness in care delivery and use of resources
• Nonmaleficence: a commitment to not harm
• Veracity: commitment to tell the truth.

Levels of Care

• Preventive:
  • Focus on educating and equipping clients to reduce and control risk factors for disease.
  • Examples: programs for immunization, stress management, occupational health and seat belt use.
• Primary:
  • Common health problems, emphasizes health promotion and includes prenatal and well-baby care, family planning, nutrition counseling and disease control.
  • Examples: Diabetes, Dehydration, clinic visits, community health centers, screenings: vision, obesity.
• Secondary:
  • Problems that require more clinical expertise.
  • Include the diagnosis and treatment of acute illness and injury.
  • Examples: Hospital settings, emergency, urgent care, diagnostic centers, Referral for uncontrolled diabetes, DKA, and renal failure.
• Tertiary (acute care):
  • Involves the provision of specialized and highly technical care.
  • Examples: Oncology, intensive care, and Rare and complex disorders like Infectious disease, neurosurgery.
• Restorative health center: follow-up care and rehabilitation centers.
• Continuing center care: long-term or chronic health care like Hospice, palliative care…

Collaboration

• The multidisciplinary team that works together, various training roles and responsibilities.
• Multidisciplinary team members:
  • LPN: Licensed practical nurse or vocational nurse
  • APN: Advanced practice nurse consists of NP, CRN, CNS, CNM.
  • Physicians, PA, RPh
  • Pharmacist, RD-Dietician, Social workers, case managers,
  • ST - speech therapy, RT respiratory therapy, PT and OT occupational therapy, chaplain /pastoral care.

PPACA - Affordable Care Act

• Patient Protection and Affordable Care Act (PPACA) deals with the health insurance marketplace, the shortage of providers, legislation addressing healthcare access, and caring for persons who are undocumented.
  • Goals: expand coverage, control health care costs, and improve health care delivery.
  • Provide Medicaid or subsidized coverage to qualified people with income up to $400\%$ of poverty, beginning in 2014.
  • Provide a new way to get health insurance: the health insurance marketplace is designed to help people more easily find the health insurance that fits their budget.

Payer Systems

• Multi-payer system: include multiple entities including insurance companies and government programs such as Medicaid paying for healthcare systems.
• Single Payer system: A single government entity finances for a population.
• Diagnosis-related group (DRGs): patient classification system used in USA by Medicare to categorize hospital patients into groups based in their diagnosed procedure.
• Resource utilization group (RUGs): a system used to categorize and classify individuals in long term care facilities, particular SNF skilled nursing facilities based on their clinical and functional status.
• Bundled payments: a reimburse method where providers receive a fixed payment for specific episode of care, such as surgery or treatment.
• Rate setting: the process which an authority, usually a state agency or government establish the payment for healthcare services.
• Comparative effectiveness analysis (CEA): a process that evaluates and compares the benefits and harms of different treatments or interventions for the same condition.
• Increasing client cost sharing: adjusting how much clients contribute to overall cost of services or products.

Chronic vs. Acute

• Acute: Rapid onset of symptoms and lasts only a relative short time, examples: appendicitis, diarrhea, common cold, pneumonia.
• Chronic: Slow onset, sometimes with periods of remission and exacerbation, requires long period of support.

Illness vs. Disease; Health vs. Wellness; Morbidity vs. Mortality

• Public health is measured globally by:
  • Morbidity: how frequently a disease occurs
  • Mortality: Number of deaths from a disease.
• Exacerbation/remission

Stages of Illness Behavior

• Stage 1: Experiencing symptoms
• Stage 2: Assuming the sick role
• Stage 3: Assuming dependent role
• Stage 4: Achieving recovery and rehab.

Human Dimensions of Health

• Physical Dimension: Genetic inheritance, age, developmental level, race and gender.
• Emotional Dimension: how the mind affects the body function and responds to body conditions.
• Intellectual Dimension: Cognitive abilities, educational background and past experiences.
• Environmental Dimension: housing, sanitation, climate, pollution of air, food and water.
• Sociocultural Dimension: economic level/lifestyle, family culture, neighbors.
• Spiritual Dimension: spiritual beliefs/values.

Models of Health and Illness

• Risk factors for illness and injury
  • Modifiable: things a person can change.
  • Non-modifiable: they cannot be changed, like age, genetic.
• Models:
  • The health belief model
  • The health promotion model
  • The health illness continuum scale
  • The agent host-environmental model

Stages of Change Model