What are the four goals of the Healthy People
2020?
1). Attain high- quality, longer lives free of
preventable disease, disability, injury, and
premature death
2). Achieve health equity, eliminate disparities,
and improve the health of all grps.
3). Create social & physical environments that
promote good health for all
4). Promote quality of life, healthy
development, and healthy behaviors across all
life stages
What are the two overarching goals for Healthy
People 2020?
1)To increase quality and years of healthy life.
2) to eliminate health disparities.
What is the WHO's definition of health?
"A state of complete physical, mental, and
social well-being, not merely the absence of
disease or infirmity."
Health Beliefs Model
addresses the relationship between a person's
beliefs and behaviors.
3 Components of health beliefs model
1) individual's perception of susceptibility to an
illness.
2) Individual's perception of the seriousness of
the illness.
3) The likelihood that a person will take
preventive action—results from a person's
perception of the benefits of and barriers to
taking action
Health promotion model
defines health as a positive, dynamic state, not
merely the absence of disease
3 focuses of the Health Promotion Model
1) Individual characteristics and experiences, (2)
behavior-specific knowledge and affect, and (3)
behavioral outcomes
Basic Human Needs
are elements that are necessary for human
survival and health (e.g., food, water, safety,
and love).
Maslow's hierarchy of needs
1) physiological needs such as air, water, and
food.
2) safety and security needs, which involve
physical and psychological security.
3) love and belonging needs, including
friendship, social relationships, and sexual love.
4) esteem and self-esteem needs, which involve
self-confidence, usefulness, achievement, and
self-worth.
5) self-actualization, the state of fully achieving
potential and having the ability to solve
problems and cope realistically with situations
of life.
Holistic Health Model
nurses consider patients to be the ultimate
experts concerning their own health and
respect patients' subjective experience as
relevant in maintaining health or assisting in
healing.
Internal variables influencing health beliefs &
practice
Developmental stage
Intellectual stage
Perception of functioning
Emotional factors
Spiritual factors
Developmental Stage
(person's thought and behavior patterns change
throughout life); nurse considers the patient's
level of growth and development when using
his or her health beliefs and practices as a basis
for planning care
Intellectual stage
person's beliefs about health are shaped in part
by the person's knowledge, lack of knowledge,
or incorrect information about body functions
and illnesses, educational background, and past
experiences
Perception Stage
subjective data about the way the patient
perceives physical functioning such as level of
fatigue, shortness of breath, or pain.
Emotional factors
patient's degree of stress, depression, or fear
can influence health beliefs and practices.
Spiritual factors
how a person lives his or her life, including the
values and beliefs exercised, the relationships
established with family and friends, and the
ability to find hope and meaning in life
External variables influencing health beliefs &
practice
Family practices
Socioeconomic factors
Cultural background
Family practices
the way that patients' families use health care
services generally affects their health practices.
Socioeconomic factors
Psychosocial variables include the stability of
the person's marital or intimate relationship,
lifestyle habits, and occupational environment
Cultural background
influences beliefs, values, and customs. It
influences the approach to the health care
system, personal health practices, and the
nurse-patient relationship.
Health Promotion
activities such as routine exercise and good
nutrition help patients maintain or enhance
their present levels of health.
Wellness
strategies help people achieve new
understanding and control of their lives
Illness Prevention
activities (such as immunization programs)
motivate people to avoid declines in health or
functional levels
Levels of Preventive care
Primary Prevention
Secondary Prevention
Tertiary Prevention
Primary Prevention
is true prevention; it precedes disease or
dysfunction and is applied to patients
considered physically and emotionally healthy.
• Immunization, health education programs,
physical & nutritional fitness activities
Secondary Prevention
focuses on individuals who are experiencing
health problems or illnesses and are at risk for
developing complications or worsening
conditions.
• Dx and prompt intervention, thereby reducing
the severity and enabling the pt. to return to
normal level health as early as poss.
Tertiary Prevention
occurs when a defect or disability is permanent
and irreversible. It involves minimizing the
effects of long-term disease or disability by
interventions directed at preventing
complications and deterioration
• Rehabilitation
Illness
a state in which a person's physical, emotional,
intellectual, social, developmental, or spiritual
functioning is diminished or impaired
Impact of illness on patient & family
Behavioral & emotional changes
body image
self- concept
family roles (dynamic)
Behavioral & emotional reactions (to illness)
depend on the nature of the illness, the
patient's attitude toward it, the reaction of
others to it, and the variables of illness behavior
Body image (impact to illness)
depend on the type of changes (e.g., loss of a
limb or an organ), their adaptive capacity, the
rate at which changes takes place, and the
support services available.
Self- concept (impact to illness)
depends in part on body image and roles but
also includes other aspects of psychology and
spirituality.
Family roles (impact to illness)
role reversal- can lead to stress, conflicting
responsibilities for the adult child, or direct
conflict over decision making.
Risk factors (health hazards)
any situation, habit, social or environmental
condition, physiological or psychological
condition, developmental or intellectual
condition, spiritual condition, or other variable
that increases the vulnerability of an individual
or group to an illness or accident
Types of Risk Factors
Genetic & Physiological
Age
Environment
Lifestyle
Genetic & Physiological (risk factors)
pregnancy, obesity, diabetes, cancer, heart
disease, or mental illness
Age (risk factors)
premature infants; heart disease & cancer w/
increased age
Environment (risk factors)
industrial workers are exposed to certain
chemicals or when people live near toxic waste
disposal sites (cancer)
Lifestyle (risk factors)
habits are risk factors (sunbathing, smoking,
poor diet, obesity, stress)
The goal of risk factor identification
is to help patients visualize the areas in their life
that can be modified, controlled, or even
eliminated to promote wellness and prevent
illness
5 stages of Health Behavior change
Precontemplation
Contemplation
Preparation
Action
Maintenance stage
Precontemplation
not intending to make changes w/in the next 6
mths
Contemplation
considering a change w/in the next 6 mths
Preparation
making small changes in preparation for a
change in the next mth.
Action
actively engaged in strategies to change
behavior; lasts up to 6 mths
Maintenance stage
sustained change over time; begins 6 mths after
action
Nurses role in health and illness
Nurses emphasize health promotion activities,
wellness-enhancing strategies, and illness
prevention activities as important forms of
health care because they assist patients in
maintaining and improving health.
Illness behavior
how people monitor their bodies, define, and
interpret their symptoms, take remedial
actions, and use the resources in the health
system.
Illness behavior-- internal variables
pt perception of symptoms and the nature of
the illness, influence pt behavior. (Patient
experiencing chest pain in the middle of the
night seeks assistance)
Illness behavior -- External variables
visibility of symptoms, social grp, cultural
background, economic variables, accessibility of
the health care system, and social support.
Development of professional nursing
* continuing education
* It has a theoretical body of knowledge
* It provides a specific service.
* Autonomy and accountable
* Code of ethics
* Teaching, leadership, career development,
working in different areas (caregiver, manager,
educator, advocate, etc.)
Professional nursing organizations
Nat'l League for Nursing (NLN)
Am. Nurses Assoc. (ANA), Nat'l Student Nurse
Assoc. (NSNA),
Internat'l Council of Nursing (ICN)
Economic changes on nursing practice
NP instead of physicians; greater influx in
patients; preventive care; nurses are no longer
limited to just the hospital setting
Social influences on nursing practice
medication cost, demographic population
(65yrs and older), medically underinsured;
threat of bioterrorism; rising health care cost
Political influences on nursing practice
health care reform, raising health care costs,
medically underinsured, nursing shortage
Standards of Practice (ANA)
Assessment
Diagnosis
Planning
Outcome Identification
Implementation
Evaulation
Assessment
collecting comprehensive data about the
client's health
Diagnosis
analyze the assessment data to determine the
dx or issues.
Planning
develop a plan that prescribes strategies and
alternatives to attain expected outcomes
Implementation
implements the identified plan
Evaluation
evaluate progress
The objective of the ANA
is to promote national associations of nurses,
improve standards of nursing practice, seek a
higher status for nurses, and provide an
international power base for nurses
Primary/ Preventive Health care
focuses on improved health outcomes for an
entire population. It includes primary care and
health education, proper nutrition,
maternal/child health care, family planning,
(preventive care) immunizations, and control of
diseases
Primary/ Preventive Health care facilities:
school health, occupational health, physicians'
offices, nurse-managed clinics, block & parish
nursing, community health centers
Secondary & Tertiary care
the diagnosis and treatment of illnesses are
traditionally the most common services.
Secondary & Tertiary care facilities
Hospital ER, Urgent care, Critical care units
(ICU), and Inpatient medical & surgical units
Restorative care
is to help individuals regain maximal functional
status and enhance quality of life through
promotion of independence and self-care
Restorative care facilities
Home health, Rehab facilities, & Extended care
facilities
Continuing Care
are for people who are disabled, who were
never functionally independent, or who suffer a
terminal disease
Continuing care facilities
Nursing homes, Assisted living, Respite care
(patient sitting service), Adult day care
Public health nursing
focus requires understanding the needs of a
population (high-risk infants, older adults, or a
cultural group) or a collection of individuals who
have one or more personal or environmental
charac. in common
Public Health nursing involves
population
Specific illnesses
Cultural/ ethnic
Nursing roles (epidemiologist, collaborator,
change agent)
Community health nursing
the primary focus on health care of individuals,
families, and groups in the community; goal is
to preserve, protect, promote, or maintain
health
Community Health Nursing involves
Individuals in the community
Hands-on/ personal
Direct patient care where patients live, work,
and play (different locations)
Nursing roles (educator, advocate, change
agent, epidemiologist, caregiver, collaborator,
counselor, case manager, must be competent,
expert on needs of population & resources,
critical thinker)
Vulnerable populations
patients who are limited in access to health care
services, or who depend on others for care.
Vulnerable populations include
Immigrant population
Poverty & homelessness
Substance abusers
Mentally ill
Older adults
Abused patients
Immigrant population
access to health care is limited because of
language barriers and lack of benefits,
resources, and transportation
Poverty & homelessness
live in hazardous environments, work at high-
risk jobs, eat less nutritious diets, have multiple
stressors in their lives, and be at risk for
homelessness
Substance abusers
socioeconomic problems result from the
financial strain of the cost of drugs, criminal
convictions from illegal activities used to obtain
drugs, communicable disease from sharing drug
paraphernalia, and family breakdown
Mental illness
many patients homeless or live in poverty;
others lack the ability to remain employed or
even to care for themselves on a daily basis
Older adults
suffering from chronic diseases, sensory loss,
and a greater demand for health care services
Abused patients
mental health problems, substance abuse,
socioeconomic stressors, and dysfunctional
family relationships
Nursing Theory
is a conceptualization of some aspect of nursing
that describes, explains, predicts, or prescribes
nursing care; theory helps to identify the focus, data/ info that comes from the patients
means, and goals of practice. assessment

Theory Output
contains a set of concepts, definitions, and end product of a system
assumptions or propositions that explain a
phenomenon Feedback
reflected patient responses to the outcome of a
4 concepts common in all nursing theories nurse intervention
Person (key element)
Health Content
Environment/ situation is the product and information obtained from
nursing the system.

Types of Nursing Theories Developmental theories

Grand Theories describe and predict behavior and development
Middle- range theories at various phases of the life continuum; as in
Descriptive theories the phase of older adulthood
Prescriptive theories
Psychosocial theories
Grand Theories Theoretical models to explain and/or predict
structural framework for broad, abstract ideas patient responses exist in each of these
about nursing domains (physiological, psychological,
sociocultural, developmental, and spiritual
Middle- range theories needs of patients)
address specific phenomena and reflect practice
Theoretical knowledge
Descriptive theories includes and "reflects on the basic values,
first level of theory development; describe guiding principles, elements, and phases of a
phenomena, speculate on why they occur, and conception of nursing
describe their consequences.
The goals of theoretical knowledge
Prescriptive theories stimulate thinking and create a broad
are action oriented and test the validity and understanding of the "science" and practices of
predictability of nursing interventions the nursing discipline

Interdisciplinary Theories Florence Nightingale's

explains the systematic view of a phenomenon The environment was the focus of nursing care
specific to the discipline of inquiry
Peplau
System Theory Nurse- patient relationship
Input
Output Henederson
Feedback 14 basic needs
Content
Orem
Input self- care
Leininger Searchable Scientific Literature Databases and
Transcultural care theory Sources
1). AHRQ- clinical guidelines & evidence
Roy summaries
adaption model 2). CINAHL- Include studies in nursing, allied
health, and biomedicine
Watson 3). MEDLINE- Include studies in medicine,
Transpersonal care nursing, dentistry, psychiatry, veterinary
medicine, and allied health
Neuman 4). EMBASE- Biomedical and pharmaceutical
Stress reduction is the goal of the system theory studies
5). PubMed- Offers free access to journal
Benner & Wrubel articles
focuses on patient needs (Caring)
Quantitative nursing research
Evidence-based practice study of phenomena that offers precise
is a problem- solving approach that integrates measurement and quantification (describes
best current evidence w/ clinical practice data in a numerical form)

Benefits of evidence-based practice Qualitative nursing research

* Lead to changes in practice
* Education
* New fields of research
5 steps of evidence-based practice
* Ask a clinical question
* Collect the best evidence
* Critically appraise the evidence
* Integrate the evidence
* Evaluate the practice decision or change
* Share the outcomes w/ others
Evidence is integrated in a variety of ways
through
teaching tools, clinical practice guidelines,
policies and procedures, and new assessment or
documentation tools
Developing a PICOT Question
P = Patient population of interest
I = Intervention
C = Comparison
O = Outcome
T = Time
I, C, T are not used in every situation.
study of phenomena that are difficult to
quantify or categorize such as patient's
perception to illness. (data in the form of
written transcripts from a series of interviews);
Offers answers when trying to understand
patient's experiences w/ health problems and
the context in which the experiences occur
Informed consent
means that research subjects (1) are given full
and complete information about the purpose of
a study, procedures, data collection, potential
harm and benefits, and alternative methods of
treatment; (2) are capable of fully
understanding the research and the
implications of participation; (3) have the power
of free choice to voluntarily consent or decline
participation in the research; and (4)
understand how the researcher maintains
confidentiality or anonymity
Confidentiality
guarantees that any information a subject
provides will not be reported in any manner
that identifies the subject and will not be
accessible to people outside the research team
Systematic review
is the most reliable evidence when reviewing
literature.
Quality improvement
improvement of any healthcare related
processes
Quality improvement (QI) Model
Plan: review available data
Do: select an intervention
Study: evaluate the results
Act: act on the practices
Scientific Method
foundation of all research
Caring
is a universal phenomenon influencing the ways
in which people think, feel, and behave in
relation to one another
Caring determines
what matters to a person; care helps protect,
develop, nurture, and provide survival to
people.
Patients continue to value nurses'
effectiveness in performing tasks; affective
dimension of nursing care
The Challenge of Caring
Nurses are torn between the human caring
model and the task-oriented bio-medical model
and institutional demands that consume their
practice (technology, etc..)
Providing presence
is a person-to-person encounter conveying a
closeness and sense of caring
Types of Touch
Task- oriented
Caring
Protective
Task-oriented touch
when performing a task or procedure. The
skillful and gentle performance of a nursing
procedure conveys security and a sense of
competence
Caring touch
is a form of nonverbal communication, which
successfully influences a patient's comfort and
security, enhances self-esteem, increases
confidence of the caregivers, and improves
mental well-being
Protective touch
is a form of touch that protects the nurse
and/or patient; can be viewed either positively
or negatively
Listening
includes "taking in" what a pt. says and
interpreting & understanding what the pt. is
saying and then giving back that understanding
to the pt
True listening
leads to truly knowing and responding to what
really matters to the patient and family.
active listening you begin to truly know your
patients and what is important to them
By observing the expressions and body
language of the patient, you find cues to help
the patient explore ways to achieve greater
peace.
Knowing the patient comprises
both the nurse's understanding of a specific
patient and his or her subsequent selection of
interventions
Two elements that facilitate knowing
continuity of care and clinical expertise
Knowing the patient
is at the core of the clinical decision-making
process
Clinical decision making
involves various aspects of knowing the patient:
responses to therapies, routines and habits,
coping resources, physical capacities and
endurance, and body typology and
characteristics.
improved patient outcomes result
Culture
Integrated patterns of human behavior that
include the language, thoughts,
communications, actions, customs, beliefs,
values, and institutions of racial, ethnic,
religious, or social groups
Ethnicity:
shared identity
Race:
limited to biological attributes
Assimilation:
To become absorbed into another culture and
adopt its characteristics
Acculturation:
adapting to and adopting a new culture
Enculturation:
socialization into one's own culture
Cultural conflicts
Ethnocentrism
Cultural imposition
Cultural pain
Ethnocentrism:
a tendency to hold one's own way of life as
superior to others
Cultural imposition:
Nurses and other health care providers who
have cultural ignorance or cultural blindness
about differences generally resort to use their
own values and lifestyles as the absolute guide
in dealing with patients and interpreting their
behaviors
Cultural pain:
when health care providers disregard values
and cultural beliefs
Cultural competence
(the gaining of knowledge) is the process of
acquiring specific knowledge, skills, and
attitudes to ensure delivery of culturally
congruent care
Culturally congruent care
integrating the knowledge gained from cultural
competence to give meaningful and beneficial
care that fits people's valued life patterns
5 interlocking components to cultural
competence
Cultural awareness
Cultural knowledge
Cultural skills
Cultural encounters
Cultural desires
Cultural assessment
is a systematic and comprehensive examination
of the cultural care values, beliefs, and practices
of individuals, families, and communities
The goal of cultural assessment
is to gather significant information from the
patient that enables the nurse to implement
culturally congruent and safe patient care
Major components of cultural assessment
• Asking Open- ended Questions
• Census Data (Socioeconomic status)
• Estab. Relationship
According to the Office of Minority Health and
Health Disparities, national standards regarding
language services include
1). Providing language assistance services free
of charge to all patients with limited English at
all points of contact.
2). Notifying patients, both verbally and in
writing, of their rights to receive language-
assistance services.
3). Using interpreters for patients with limited
English proficiency (unless the patient requests
that family or friends interpret for them)
Selected components of cultural assessment
* Ethnic Heritage & Ethno history
* Bicultural Effects on Health
* Social Organization
* Religious & Spiritual Beliefs
* Communication Patterns
Ethnic Heritage & Ethno history
Knowledge of a patient's country of origin and
its history and ecological contexts are significant
to health care
Bicultural Effects on Health
• Some distinct health risks are the result of the
ecological context of the culture
• Certain genetic disorders are also linked with
specific ethnic groups
Social Organization
• Cultural groups consist of units of organization
defined by kinship, status, and appropriate roles
for their members
• Although different configurations of a family
exist, the most common is the nuclear
household made up of parents and their young
children
• Collectivistic groups often regard members of
their ethnic group as closest kin (made up of
distant blood relatives across three generations
and fictive or nonblood kin) and want to consult
them; social hierarchy and roles are further
defined by the culture.
Religious & Spiritual Beliefs
• Religious and spiritual beliefs frequently
influence the patient's worldview about health
and illness, pain and suffering, and life and
death.
Communication Patterns
• Cultural groups have distinct linguistic and
communication patterns
Cultural Healers
Naturalistic practitioners
Personalistic practitioners
Naturalistic practitioners
attribute illness to natural, impersonal, and
biological forces that cause alteration in the
equilibrium of the human body. Healing
emphasizes use of naturalistic modalities,
including herbs, chemicals, heat, cold, massage,
and surgery
Personalistic practitioners
believe that an external agent, which can be
human (i.e., sorcerer) or nonhuman (e.g.,
ghosts, evil, or deity), causes health and illness
Cultural & Life Transitions
Rites of passage
Grief & Loss
Barriers to knowing the patient are often
related to the
organizational structure of the organization and
economic constraints.
Rites of passage:
Ceremonies that mark important transitional
periods in a person's life, such as birth, puberty,
marriage, having children, and death.
Grief & Loss:
bring traditions that are meaningful to groups
of people for most of their lives. When
traditional medical measures fail, cultural
beliefs and practices that are religious and
spiritual become the focus