Roles of a Registered Nurse (RN)
1. Nursing tasks for patients
2. Assessments
3. Medication tasks
4. Physician orders
5. Urgency of Tasks:
a. ABC's
b. Pain
c. Elimination
6. Status change
7. Off-unit procedures
8. Helping co-workers
Timeline of Events During a 12-Hour Shift
a. 0700- Report- "getting familiar w/ patient (labs) and preparing for the day" "tests".
b. 0800-1000- A.M. Assessments, setting up patient for breakfast, charting, giving
meds, calling doctors, following out MD orders, assisting patient's with ADL's. (Activities
of Daily Living: brushing teeth, showering, etc.) Physicians did rounds.
c. 1100-1300- Giving meds "insulin," setting up patient's for lunch, discharging patient's
due to morning rounds, charting, trying to grab lunch for yourself.
d. 1400-1600- Busy time for admissions and discharges, giving meds, charting, trying to
catch up from tasks "dressing changes, starting new IVs, wound care, ambulating
patients (getting them up and moving) etc, following new MD orders.
e. 1700-1800- setting up patient's for dinner, giving meds.. major med pass time,
"crossing your T's and dotting your i's" b/c next shift is coming in.
f. 1845-1900- giving report to oncoming shift & leaving.
Descriptions of Typical Interactions with Patients and Their Families
a. Meals
b. Meds
c. Anything they call for
d. Answer any questions patient or family members might have
Name Members of the Interdisciplinary Team:
a. Community Health Worker
b. Dentist
c. Health Educators
d. Interpreters
e. Mental Health Provider
f. RN
g. Vocational or Practical Nurses
h. Nutritionist
i. Pharmacists
j. MD
k. PA
l. Social Worker
m. Volunteers
n. Other Team Members
Differentiate b/w Science and Theory:
Theory functions in a parallel manner to scientific process, although theory generally
applies to a more specific area of the larger scientific process.
Science
a method of bringing together facts and giving them coherence and integrity
Ex: Scientific Process
Theory
A compilation of data that defines, describes, and logically relates info explaining past
phenomena and future trends. An abstract generalization that presents a systematic
explanation about how phenomena are interrelated; must include at least two related
concepts.
(ex: Freud's theories about psychology of man, Einstein's theory of relativity).
a. An idea that had been supported by research
b. Explains relationships b/w symptoms and interventions.
Criteria for Theory Acceptance (6 Factors)
1. Inclusiveness
2. consistency
3. Accuracy
4. Relevance
5. Fruitfulness
6. Simplicity
Nursing Science
a collection of data related to nursing that may be applied to the practice of nursing.
Spans all of nursing and its diversity. Guides the practice of nursing to better serve
patients through healing prevention, education, and health maintenance.
Steps in the Scientific Process
1. Hypothesis
2. Method
3. Data Collection
4. Results
5. Evaluation
Hypothesis
Ask the question that is to be the main focus. It usually includes independent and
dependent variables.
Method
Decide what data will be collected to answer the question. Decide on and identify the
step-by-step procedure that will be used to collect this data. Make sure this process can
be easily replicated.
00:02
01:42
Data Collection
Implement the step-by-step procedure that has been determined to answer the
question.
Results
Statistically identify the outcomes. Establish parameters (e.g., level of significance) that
will determine whether that data is relevant.
Evaluation
Examine the results to determine the relevance of outcome data in answering the
hypothesis. Determine the significance and identify the potential for future research.
Conceptual Models
a description of the link b/w concepts such as nursing, person, health and environment.
A structure to organize concepts (ideas).
a. More loosely structured than theories, nursing conceptual models offer broader
explanations of a process.
b. Provides conceptual perspectives regarding interrelated phenomena.
4 Concepts Basic to Nursing That Are Included in Models
1. Nursing
2. Person
3. Health
4. Environment
Schematic Models
is something that demonstrates concepts, usually with a picture. It is a visual
representation of ideas.
a. Clarify and show relationships b/w complex concepts
b. Illustrate the layouts and features specific to a theory—----similar to the blueprint of a
building.
Levels of Theory
range from a broad scope to a smaller/more specific scope.
a. Grand Theory: broad scope
b. Middle-Range Theory: smaller in scope
Grand Theory
often broad in scope and may describe and explain large segments of human
experience.
Middle-Range Theory
smaller in scope and may refer to a specific population. (ex: theory of unpleasant
symptoms, which examines symptoms that are influenced by physiological,
psychological, and situational factors as they relate to performance.)
Theory-to-Practice
1. Stimuli Frame: accidentally misinterpretation
2. Nursing Intervention: listen carefully and caringly
3. Appraisal Stage: results of experimental interpretations
4. Nursing Intervention: follow-up
5. Initiation of Coping Mechanisms:
6. Nursing Interventions: check with patient and observe verbal and nonverbal cues.
7. Adaptation: dependent on steps 1, 2, 3.
8. Nursing Intervention: as patient accepts idea of new info, new schema will follow.
9. Summary
Florence Nightingale
a. 1st to put nursing concepts in a form of which relationships are described and
predictions are made.
b. Influence Toward Nursing Theory:
i. Classic education
ii. Upper class life
iii. Religion and spirituality
iv. Era of reform throughout England
c. Nursing is an art- it requires an organized practice and scientific training.
d. Nursing is putting us in the best possible conditions for nature to preserve health- to
prevent or restore or to cure disease and injury.
e. Nursing is to help patients live.
f. Theory of Practice: developed the "Canons of Nursing" which include:
i. Ventilation and warming
ii. Variety: different view or routines or nurses
iii. Noise
iv. Diet
v. Sunlight
vi. No chattering of hopes and advice
vii. Cleanliness.
Hildegard Peplau
Theory of Interpersonal Relations as a Nursing Process: Man as an Organism That
Exist in an Unstable Equilibrium. Explores the interpersonal relationship of the nurse
and the client and identifies the client's feelings as a predictor of positive outcomes
related to health and wellness.
a. Nursing interventions focus on reducing the related incapacitating stressors through
therapeutic interpersonal interaction. Intervention involves the nurse assisting the client
with mutual goal setting.
b. Nursing interpersonal process is present and interactive, using associated and
appropriate nursing intervention skills, which incorporate the roles of the nurse as
resource person, educator, mentor, transfer agent, and counselor.
c. Requires that the nurse have a self-awareness and insight regarding her/his own
behaviors; maybe applied in identifying and working through those behaviors unique to
the client's schema.
Martha E. Rogers
Theory of Science of Unitary Human Beings: Humans as Energy Fields That Interact
Constantly with the Environment. The synchronicity b/w human beings and their
universe or environment: energy field, openness, pattern, and organization.
a. When the client-human unit incurs an insult that renders him/her out of balance with
the universe, nursing interventions must be geared toward helping the client-human unit
attain an increasing complex balance and synchronicity with the universe.
b. Each being is unique and consists of more than the collective sum of parts and that
each being is constantly evolving in a forward momentum as he/she interacts
continually with their surroundings.
c. States: that a brain integration is necessary to support the notion of
human-environmental synergy, using the right side of the brain to recognize every
human unit's capacity for imagery, sensation, and emotion and the left side of the brain
for language, abstraction, and thought.
Dorothea Orem
Theory of Self-Care Deficit Model: Self-Care, Self-Care Deficits, and Nursing Systems.
Nursing facilitates client self-care by implementing measures to assist the client in
meeting self-care needs.
a. Purpose is to restore the client's self-care capability to enable him/her to sustain
structural reliability, performance, and growth through purposeful nursing intervention.
b. Aim: is to help the client cope with the unmet care needs by acquiring the max level
of function: either to regain previous function or maximize available function present
after the insult, hence restoring a sense of well-being. To help patient become more
independent and maintain independence.
c. Self-Care model: Nursing facilitates client self-care by measuring the client's deficit
relative to self-care needs; the nurse implements appropriate measures to assist the
client in meeting these needs by matching them with an appropriate supportive
intervention.
Sister Callista Roy
Roy's Adaptation Model: Assistance with the Adaptation to Stressors to Facilitate the
Integration Process of the Client. Client's adaptation to condition using environmental
stimuli to adjust perception.
a. When the client incurs an insult that renders him/her in need of environmental
modification, the nurse is the charge agent in assisting the individual with this
adaptation.
b. The outcome is a diminished or absent integration of the constantly changing setting
known as the illness environment with the constantly changing human, who is
interacting with the existing outside surroundings.
c. The nurses' role is to promote this adaptation by modifying and regulating peripheral
stimuli to enable the client's adaptation and integration with a supportive healing
environment.
Jean Watson
Theory of Human Caring: Transpersonal Caring as the Fulcrum; Philosophy and
Science as the Core of Nursing. Philosophy and science of caring and humanistic
nursing; there are 10 "carative" factors that are core to nursing; this holistic outlook
addresses the impact and importance of altruism, sensitivity, trust, and interpersonal
skills.
a. Everyone requires human caring to quell need: the caring among nurse, environment,
and client, is essential to healing. Caring promotes the notion that every human being
strives for interconnectedness with other people and nature.
b. The nurse is the facilitator in the goal of restoring congruence b/w the client's
perceived self and the existent self through the promotion of health and equilibrium
c. The expectation is that the client will experience in harmony and mind, body, and
soul. Harmony/wellness will prevail.
Margaret Newman
Theory of Health as Expanding Consciousness/Increasing Complexity. Central
components of this model are health and consciousness followed by concepts of
movement, time, and space; all components are summative units, described in
relationship to health and to each other.
a. Stimulated by concern for those of whom health as the absence of disease or
disability isn't possible.
b. Theory as progressed to include the health of all persons regardless of the presence
or absence of disease.
c. The theory asserts that every person in every situation, no matter how disordered and
hopeless it may seem, is part of the universal process of expanding consciousness- a
process of becoming more of oneself, of finding greater meaning of life, and of reaching
new dimensions of connectedness with other people and the world.
Merle Mishel
Theory of Uncertainty of Illness.
a. Uncertainty in illness is frequently a stress-producing incident that us capable of
contributing to negative physical and/or psychological outcomes. Uncertainty exists
when the client is unsure about diagnosed illness.
b. Uncertainty renders the client either incapable of assigning a concrete value to the
illness itself or to a predictable outcome. It can occur with a client misperceiving a
diagnosed illness b/c of the inadequate info received, the health care provider
incorrectly presuming client knowledge, or the health care informant failing to recognize
the client's individual unique filtering of provided illness info.
c. Establishes a framework that guides nursing practice by assisting nurses to work with
clients in establishing interventions that promote positive outcomes.
d. Theory is used in chronic illness and outlines a 4 step approach:
i. Stimuli Frame:
ii. Appraisal Stage:
iii. Initiation of Coping Mechanisms:
iv. Adaptation:
Stimuli Frame (of theory of chronic illness)
antecedents generating client uncertainty.
Appraisal Stage (of theory of chronic illness)
client assignment of a value, positive or negative, to the uncertainty
Initiation of Coping Mechanisms (of theory of chronic illness)
client ability to develop, improvise, and implement skills to cope with uncertainty
Adaptation (of theory of chronic illness)
positive client assimilation and accommodation to uncertainty, resulting from effective
coping.
Future of Nursing Theories
a. New questions are being asked in the 21st century about how health care is being
conducted and managed.
b. Establish nursing theories will be reevaluated and modified accordingly.
c. Nursing theories will embrace complex environmental changes that incorporate new
technologies, such as genetics, computers, noninvasive surgery, robotics, decreasing
energy sources, increasing pollutants under a thinning ozone layer, environmental
hazards, new diseases, and antibiotic-resistant illness.
Nursing Research
A systematic inquiry or study conducted to generate new knowledge or to refine existing
knowledge.
a. Application of results demonstrates professional accountability to insurers and health
care consumers.
b. Generates knowledge in areas that indirectly affect nursing care process.
c. Results provide support for the quality and cost effectiveness of interventions.
d. Results provide scientific base for nursing.
e. Results provide foundation for practice decisions and behaviors.
Influences on the Selection of Nursing Research
1. NINP (National Institute of Nursing Research)
2. AHRQ (Agency for Healthcare Research and Quality)
3. Private Foundations:
a. Helene Fund Trust
b. Robert Wood Johnson Foundation
c. W. K. Kellogg Foundation
4. Nursing Organizations: Fund Research Studies:
a. Sigma Theta Tau International (STTI)
b. American Nurses Association (ANA)
c. The Oncology Society (ONS)
NINR (National Institute of Nursing Research)
Focus is designed to advance the "science of health" by encompassing health
promotion and disease prevention; improving quality of life through symptom
management, palliative care/health disparities, and end-of-life care.
i. Potential Funding Areas:
1. Discovering approaches that encourage people to effectively take responsibility for
symptom management and health promotion.
2. Determining effective health-promotion strategies for individuals, families, and
communities.
3. Determining disease risk and treatment through using genetic info.
4. Assisting in identification and effective management of symptoms related to acute
and chronic disease.
5. Improving clinical settings in which care is provided
6. Improving quality of caregiving in long-term care facilities, the home, and the
community
7. Understanding predispositions to disease socioeconomic factors that influence
health, and cultural health practices that protect from or expose to risk of health
problems.
8. Improving symptom management for those at end of life.
AHRQ (Agency for Healthcare Research and Quality)
i. Mission: improving "the quality, safety, efficiency, and effectiveness of health care for
all Americans."
ii. Aims: to reduce risk of harm by promoting delivery of the best possible health care,
improve health care outcomes by encouraging use of evidence to make informed health
care decisions, transform research into practice to facilitate wider access to effective
health care services, and reduce unnecessary costs.
1. Improve quality of health care through scientific inquiry, dissemination of findings, and
facilitation of public access to info.
2. Promote patient safety and reduce medical errors through scientific inquiry, building
partnerships with health care providers, and establishing centers for education and
research on therapeutics (CERTs).
3. Advance use of info technology for coordinating patient care and conducting quality
and outcomes research.
4. Establish an office on priority populations to ensure that the needs of low-income
groups, minorities, women, children, elderly, and individuals with special needs are
addressed by the agency's research efforts.
Sigma Theta Tau International (STTI)
1. Makes research awards to increase scientific knowledge related to nursing practice.
2. Supports creative interdisciplinary research and places importance on identifying
"best practices" and benchmark innovations.
The American Nurses Association (ANA)
Awards small grants through the American Nurses Foundation
The Oncology Nurses Society (ONS)
Awards grants for research that focuses on oncology
Components of the Research Process
a. Formulating research questions or problems
b. Defining purpose of study
c. Reviewing related literature
d. Formulating hypotheses and defining variables
e. Selecting research design
f. Selecting the population, sample, and setting
g. Conducting a pilot study: a way to test something in a small environment
h. Collecting data
i. Analyzing data
j. Communicating conclusions and let people now by publishing results.
Study Designs/Methodologies
Plans that tells a researcher how data should be collected, and how data will be
analyzed to answer specific research questions.
a. Quantitative Designs
b. Qualitative Designs
Quantitative Study
i. Case Study
ii. Survey
iii. Needs Assessment
iv. Methodologic
v. Meta-analysis
vi. Experimental
vii. Quasi-Experimental
viii. Secondary Analysis
ix. Triangulation
x. Pilot Studies
Case Study
A quantitative study that provides an in-depth analysis of a single subject, group,
institution or social unit.
Survey
A quantitative study that is used to collect large amounts of info with little expenditure of
time and money.
Needs Assessment
A quantitative study that determines what is most beneficial to an aggregate group.
Methodologic
A quantitative study that focuses on development and testing instruments to improve
their reliability and validity.
Meta-Analysis
A quantitative study that is an advanced process by which research on a specific topic
is reviewed and findings of multiple studies are statistically analyzed and expressed
quantitatively.
Experimental Study
A quantitative study that include the manipulation of one or more independent variables,
random assignment to a control or a treatment group, and observation of the outcome
or effect that
Quasi Experimental
A quantitative study that lacks one of the components of experimental design (i.e.,
randomization, control group, or manipulation of one or more variables.)
Secondary Analysis
A quantitative study that involves asking new questions on data collected previously.
The data may have been generated from previous formal research or may've been
gathered through any previous systematic collection of data.
Triangulation
A quantitative study that uses various research methods or data collection techniques in
the same study.
Pilot Studies
A quantitative study that is a small-scale study referred to as feasibility studies; purpose
is to identify strength and limitations of a larger planned study.
Qualitative Studies
a method of research designed for discovery rather than verification:
a. Phenomenology
b. Ethnography
c. Grounded Theory
Phenomenology
a qualitative study that is used to study intangible experiences such as grief, hope, or
risk taking. It is designed to provide an understanding of the patient's "lived experience."
Ethnography
a qualitative study that is a method used to study phenomena from a cultural
perspective.
Grounded Theory
a qualitative study that is a method designed to explore a social process.
Research Utilization
a. There is extensive concern that nurses have failed to realize the potential for using
research findings as a basis for making decisions and developing interventions.
b. Locating published research: focuses on the usefulness of computerized databases
such as CINAHL and MEDLINE and the Annual Review of Nursing Research.
c. Critical Appraisal of Nursing Research:
i. Blind review
ii. Abstract and findings may be the easiest sections of a research report for the novices
to understand.
Emerging Roles of Nurses
Nurse Researcher Roles:
a. Clinical Nurse Specialist (CNS)
b. Clinical Nurse Researcher (CNR)
Clinical Nurse Specialist (CNS)
a. A Master's degree prepared nurse who is an expert clinician with additional
responsibility for education and research.
b. Assess agency's readiness for research utilization.
c. Works with staff to identify clinical problems.
d. Helps staff find, implements, and evaluates findings relevant to current practice.
Clinical Nurse Researcher (CNR)
Doctoraly prepared with clinical and research experience:
1. Focuses on the conduct of facilitation of research.
2. Works with staff to identify research questions.
3. Designs studies
4. Disseminates findings to staff, administrators, and legislators.
5. Emerging roles: DNP (Doctor Nursing Practice) and CNL (Clinical Nurse Leader)
Examples of Evidence Based Practice
a. Heparinized (blood thinner) saline for flushing peripheral intravenous catheters.
b. Interventions such as exercise for cancer-related fatigue
c. Prevention and treatment of pressure ulcers
d. Clinical practice guidelines: developed by AHCPR (Agency for Health Care Policy
and Research) in 1992:
i. Acute pain care management in infants, children, and adults
ii. Prediction and prevention of pressure ulcers in adults
iii. Identification and treatment of urinary incontinence in adults.
Types and Levels of Evidence
a. Journal article describing a single study
b. Systematic review methods (meta-analysis and meta-synthesis)
c. Intervention guidelines
d. Patient values and preferences
e. Expert opinion
f. Theory-based info
g. Compiled databases
...
...
Historical Examples of Unethical Research Based Practice:
a. Nazi experiments
b. Tuskegee Syphilis study
c. Jewish Chronic Disease Hospital in New York.
Ethical Issue in Research: IRB (Institutional Review Board)/Human Subjects Committee
Examines research proposals to make sure that the ethical rights of those individuals
participating in the research study are protected.
Influences on Health Care Agencies and Services provided
Policies, economics, patients, gov., education, providers, needs, research.
For-Profit Organization
Profit made is given to stockholders.
more profit= more customers or cut expenses
Not-For-Profit Organizations
Uses their own profits to pay personnel and improve and advertise their own services.
Money goes back into hospital
Horizontal Organizational Structure
Decentralized and emphasis is placed on departments or divisions; decisions are made
closer to staff who do the work
Vertical Organizational Structure
Centralized.
Consists of:
1. Board of Directors/Trustees
2. Chief Executive Officer (CEO)
3. Medical Staff
4. Nursing Staff
Board of Directors/Trustees
Typically includes members of the community and community leaders who aren't
directly involved in health care.
Responsible for developing the overall direction of the hospital and ensuring that the
goals of the organization are met.
Chief Executive Officer (CEO)
1. Hired by board and reports to board.
2. Hires other major leaders for the hospital such as CFO and the nursing leader (CNO).
3. Responsible for overall operation on daily basis .
Medical Staff
Physicians who must be granted privileges by the board of trustees/directors to see
patients at a particular institution.
Nursing Staff
Consists of all RNs, LPNs, patient care techs, and clerical assistants employed by
department of nursing; the senior administrative nurse is know as the CNO or CEO.
Health Care Agencies
a. Governmental (Private) Agencies
b. Federal Agencies
c. State Agencies
d. Local Agencies
e. Voluntary (Private) Agencies
f. Not-For-Profit and For-Profit Agencies
Governmental (Private) Agencies
and Federal Agencies
Agency supported by taxes and focuses on health of all the US citizens
(Ex: OSHA)
State Agencies
Agency that oversees programs affecting health of citizens of an individual state.
(Ex: State Department of Health)
Local Agencies
Agency that serves on community, one country, or a few adjacent counties; Provides
services to paying AND non-paying citizens.
Voluntary (Private) Agencies
Agency that supports from funding and private donations
(Ex: AHA, Red Cross, March of Dimes)
Broad Classifications of Health Care Agencies
a. Ownership (faith-based, gov-owned)
b. Public access
c. # of Beds
d. Licensure (acute care, surgical center, long-term acute care, skilled nursing facility)
e. Teaching Hospital
f. Length of Stay
Health Care Team Members
a. Physicians
b. Nurses
c. Dieticians
d. Pharmacists
e. PTs, OTs, STs..
f. Respiratory Therapists
g. Social Workers
h. Administrative Support Personnel
Nursing Roles
The JOBS nurses take on while performing their jobs:
a. Care Provider
b. Educator and Counselor
c. Client Advocate
d. Change Agent
e. Researcher
Care Provider
Type of Nursing Role that:
a. Assesses patients
b. Plans patient care
c. Implements patient care
d. Evaluates therapeutic interventions.
Educator and Counselor
Type of Nursing Role that:
a. Teaches client about disease management.
b. Assists client to control health
c. Promotes health promotion activities.
Patient Advocate
Type of Nursing Role that:
a. Protects the patient' rights.
b. Promotes positive outcomes.
c. Ensures patient needs are met.
Change Agent
Type of Nursing Role that:
a. Identifies problems with safety and healthcare delivery.
b. Assesses desire for change, studies, and recommends alternatives.
c. Promotes cost-effectiveness.
Researcher
Type of Nursing Role that:
a. Monitors current studies.
b. Collects evidence/data.
c. Uses research findings to improve nursing practice.
Open System
Type of system that when the organization is affected by internal changes among it's
parts and external environmental forces that have a direct effect and can influence the
organization itself.
Close System
Views the system as being totally independent of outside influences, which is an
unrealistic view for health organizations.
Organizational Culture
In each institution there is an implicit, invisible, intrinsic, informal corporate culture.
Corporate Culture
Type of culture that embodies the organizational values that implicitly and explicitly
specify norms, shape attitudes, and guides the behaviors of the members of the
organization.
Dissonant Culture
When you don't like the culture and boss of the health care agency. You are always
getting yelled at and being told you did something wrong.
Consonant Culture
When you like the culture; it's a good culture. There are promotions, you get thanked for
what you do and get recognized.
Healthy People 2020
National initiative to improve the nation's health by providing a comprehensive set of
disease preventions, health promotion goals and objectives with target dates.
a. Vision: a society in which all people live long, healthy lives
Overarching Goals of Healthy People 2020
1. Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature deaths.
2. Achieve health entity, eliminate disparities, and improve the health of all groups.
3. Create social and physical environments that promote good health for all.
4. Promote quality of life, healthy development, and healthy behaviors across all life
stages.
Missions of Healthy People 2020
1. Identify nationwide health
improvement priorities
2. Increase public awareness,
and understanding of the
determinants of health,
disease, and disability and the
opportunities for progress.
3. Provide measurable
objectives and goals that are
applicable at the national,
state, and local levels.
4. Engage multiple sectors to
take actions to strengthen
policies and improve practices
that are driven by the best
available evidence and
knowledge.
5. Identify critical research,
evaluation, and data collection
needs.
Topics of Healthy People 2020
1. Access to Care
2. Healthy Behaviors
3. Chronic Disease
4. Environmental Determinants
5. Social Determinants
6. Injury
7. Mental Health
8. Maternal and Infant Health
9. Responsible Sexual Behavior
10. Substance Abuse
11. Tobacco
12. Quality of Care
Access to Care
Indicators: Proportion of the population with access to healthcare services.
Objectives:
1. Increase proportion of persons with health insurance
2. Increase proportion of persons with a usual primary care provider
3. Developmental increase the proportion of persons who receive clinical preventative
services.
Healthy Behaviors
Indicators: Proportion of population engaged in healthy behaviors
Objectives:
1. Increase proportion of adults who meet current federal physical activity guidelines for
aerobic physical activity and for muscle-strengthening activity.
2. Reduce the proportion of children and adults who are obese
3. Reduce consumption of calories in the population of 2+yrs olds.
4. Increase proportion of adults who get sufficient sleep.
Chronic Disease
Indicators: Prevalence and mortality of chronic disease
Objectives:
1. Reduce coronary heart disease deaths
2. Reduce proportion of persons in the population with hypertension
3. Reduce overall cancer death rate
Environmental Determinants
Indicators: Proportion of population experiencing a healthy physical environment
Objectives:
1. Reduce # of days that air quality index exceeds 100.
Social Determinants
Indicators: Proportion of population experiencing healthy social environments.
Objectives:
1. Developmental improve the health literacy of the population
2. Developmental increase of the proportion of children who are ready for school in all 5
domains of healthy development:
a. physical development
b. social-emotional development
c. approaches to learning, language, and cognitive development
Injury
Indicators: Proportion of population that experiences injury
Objectives:
1. Reduce fatal and nonfatal injuries
Mental Health
Indicators: Proportion of population experiencing positive mental health
Objectives:
1. Reduce proportion of persons who experience major depressive episodes.
Maternal and Infant Health
Indicators: Proportion of healthy births
Objectives:
1. Reduce low/very low birth weights/premature births.
Responsible Sexual Behavior
Indicators: Proportion of population engaged in responsible sexual behavior.
Objectives:
1. Reduce pregnancy rated among adolescent families.
2. Increase proportion of sexually active persons who use protection.
Substance Abuse
Indicators: Proportion of population engaged in substance abuse.
Objectives:
1. Reduce past-month use of illicit substances.
2. Reduce proportion of persons engaging in binge drinking of alcohol.
Tobacco
Indicators: Proportion of population using tobacco.
Objectives:
1. Reduce tobacco use by adults
2. Reduce initiation of tobacco using among children, adults, and teens.
Quality of Care
Indicators: Proportion of population receiving quality healthcare services.
Objectives:
1. Reduce central line-associated bloodstream infections.
Community
People and relationships that emerge among them as they develop... some agencies
and institutions share a physical environment.
Healthy Community
a community that embraces belief that health is more than just the absence of disease;
includes elements that enable people to maintain a high quality of life and productivity.
Characteristics of a Healthy Community
1. Safe
2. Treatment and Prevention
3. Parks; People Playing Outside
4. Clean Water Resource
5. Recycling
Continuum of Care
Matching a patient's ongoing needs with the appropriate level and type of medical,
psychological, health, or social care or service within an organization(s).
A view of health that describes a range of services and care setting that a patient might
receive at different stages of health. Goal is to decrease fragmented care and costs.
i. MD->ER->home->MD
ii. MD->ER->Hospital or rehab or home health-> home
Continuity of Care
the meeting of a patient's needs overtime, utilizing several different types of care.
Consistency. Focuses on care over time and in individual patients. b/c records are
available. Help reduce re-hospitalizations. Enables patient to get through medical
system to meet patient's needs.
Types of Care:
1. Informational
2. Management
3. Relational
Nurses are very involved b/c of their emphasis on the need to transfer and coordinate
care over time and their focus on consistency of care (Ex: discharge planning)
Informational Continuity
Focuses on info that is needed to link care from one provider and setting to another.
This info includes: medical info and the patient's preferences, values, and context.
Management Continuity
Requires sharing info and plans and flexibility to ensure quality, safe care.
Relational Continuity
Concerns the needs of patients to build relationships with providers, particularly a
primary care provider in the community. Emphasizes the need for providers to be
familiar with the patient and the patient's history, so that their is someone who has a
relationship with the patient and can easily access past medical info.
Factors That Influence Access to Care
1. Ability to pay
2. Language barriers
3. Transportation
4. Handicapped provisions
5. Hours of operation
6. Child care to attend
appointment
7. Appointment availability
8. No insurance
9. Waits in the MD office
10. Illiterate
11. Not enough doctors
12. Cultural barriers.
Care Across the Lifespan
federal government collects data about health and illness across the life span.
Leading Causes of Death in the US
i. Heart disease
ii. Cancer
iii. Chronic lower respiratory
diseases
iv. Accidents
v. Stroke
vi. Alzheimer's disease
vii. Diabetes
viii. Influenza and pneumonia
ix. Nephritis, nephrotic syndrome,
nephrosis
x. Suicide
Disease Prevention
Interventions to stop the development of the disease and treatments to prevent
diseases from progressing further.
Levels of Prevention:
a. Primary
b. Secondary
c. Tertiary
Primary Disease Prevention
Includes interventions that are used to maintain health before illness occurs
(Ex: teaching people about healthy diets before they become obese and encouraging
adequate exercise)
Secondary Disease Prevention
Occurs when a person is asymptomatic, but after disease has begun: focuses on
preventing further complications.
(Ex: early detection treatments: breast cancer screening, Blood pressure scanning)
Tertiary Disease Prevention
maintain or improve functions due to disease damage.
(Ex: teaching a person with diabetes how to administer insulin and manage the disease
or referring a stroke patient for rehabilitation or providing long-term home care.)
Health Promotion
Focuses on changing lifestyle to maximize health and is an important part of primary
prevention.
Aspects of Health Promotion
1. Prior Related Behavior
World Health Organization (WHO)
a. Focuses on public health.
b. Defines health as "a state of complete well-being, physical, social, and mental, and
not merely the absence of disease or infirmity."
c. Addresses health and illness from the global perspective.
Patient is considered to be
i. The FOCUS of care
ii. A member of the healthcare team
iii. A part of all healthcare team decisions
iv. Defined as:
1. Individual
2. Family
3. Population
4. Community
Vulnerable Populations
i. Individuals, families, communities
ii. At risk for developing health problems
iii. Complex factors increase their risk:
1. Economic, ethic, social,
communication
2. Ex: children, elderly, rural,
homeless, illegals, abuse,
chronic disease
iv. Need careful assessments and monitoring to identify problems early so that
complications can be prevented.
Health/Wellness
Structurally and functionally whole
Disease/Illness
Is the absence of wellness. Indication of a physiological dysfunction
Components of a System Theory
i. Input: hospital want input, it is an
open system
ii. Throughput
iii. Output
iv. Evaluation
v. Feedback
