Nursing 108 Welcome back to School.

1
Nursing 108Welcome back to School.

• Lola Oyedele RN MSN CTN

2
Today's Topics

• Trends
• Community health nursing
• Middle aged adult
• Client education standards
• Teaching and learning
• Culture and ethnicity

3
Definition

• The general direction in which things are
  changing
• Greater focus is on keeping individuals healthy
  and well, providing illness care in the clients
  home environment and containing cost.

4
Age Trend

• In general, clients who receive home care tend to
  be in the elderly population
• This trend is likely to continue as the baby
  boomers get old

5
Disease Trend

• Have diverse needs
• Circulatory disease
• Diabetes
• cancer

6
Community Health

• Definitions

7
Community

• It is a group of people who live in the same area
  or who have something in common with each other.
  E.g., student community, community of nurses
• Community health nursing is a nursing approach
  that merges with professional nursing theories to
  safeguard and improve the health of population in
  the community.

8
Community Health Settings

• Hospital based health agencies
• Private or corporate owned agencies
• Others include public health agencies
• Nursing centers
• Schools

• Occupational health programs
• Parish nursing
• Clinics for the homeless
• Case management
• Wellness centers

9
Reasons for Home Healthcare and Community Focused
Services

• Consumer demand
• Advent of Medicare reimbursement for home health
  services
• The aging population
• The rise of managed care

• Federal legislation that encouraged expansion of
  home care
• Escalating health care cost

10
Components of a Community

• Structure or locale
• Structure includes name of community
• Geographical boundaries
• Environment
• Water and sanitation
• Housing and economy
• Population
• Age distribution, sex, growth trends, density,
  education level, predominant cultural groups and
  predominant religious groups

11
Components contd

• Social systems
• Includes education system, government,
  communication system, transportation, welfare,
  volunteer program and health systems

12
Vulnerable Populations

• Principle client for community health nurse
• Defined as those clients who are more likely to
  develop health problems as a result of excess
  risks, who have limits in access to health care
  services or who are dependent on others for care
• Example are individuals living in poverty, older
  adults, homeless persons individuals in abusive
  relationships, drug abusers, mentally ill
  clients, new immigrants

13
Middle Aged Adults

• Adults between the age of 30s to late 60s.
• Levinson described this age as the age of
  settling down and pay off years.

14
This age is characterized by

• Personal and career achievements
• Joy in assisting children and young people
• Helping aging parents

15
Physical Changes

• Major physical changes occur between 40 to 65
  years of age
• Graying of the hair
• Wrinkling of the skin
• Thickening of the waist Pot belly
• Balding
• Decreased hearing and visual acuity increased
  rate of glaucoma

16
Physical Changes Contd

• Most significant change is
• Menopause in the female
• Climacteric in the male

17
Psychosocial Changes

• It may be due to expected events e.g. children
  moving away from home
• Unexpected events e.g. marital separation or
  death of a close friend
• Family enters the post parental family stage
• Erickson primary developmental task is to
  achieve generativity

18
Psychosocial Changes continues

• Carrier transition
• Sexuality Increased marital and sexual
  satisfaction
• Family types e.g. single hood, marital changes
  family transition.
• Care of aging parents A sandwich generation
• Health concerns and risk

19
Health Concerns and Risk Factors continued

• Health risk
• Health patterns of concern
• Obesity
• Cancer risk
• Osteoporosis
• Cardiovascular disease

20
Risk Factors for Depression

• Being female
• Disappointment or losses
• Departure of last child
• Family history

21
Applying the Nursing Process

• Assessment
• Planning
• Implementation
• Evaluation

22
Client Education Standard

• There are four standards of client education
• Standard 1 Assess the clients learning needs,
  abilities, readiness and preferences
• Safe and effective use of medication
• Safe and effective use of medical equipment
• Potential food-drug interaction, counseling on
  nutrition and modified diet
• Rehabilitation techniques to help the patient
  adapt

23
Client Education Standard

• Access to additional resources in the community
• How to obtain any further treatment
• Explain family and patient responsibilities
• Health maintenance with regards to hygiene

24
Client Education Standard

• Standard 2 client education is interactive
• Standard 3 Discharge instruction given to
  client and family and organization caring for the
  client
• Standard 4 The hospital plans, supports and
  coordinates activities and resources for client
  and family

25
Purpose and Significance of Health Education

• Maintenance and promotion of health and illness
  prevention
• Restoration of health
• Coping with impaired functioning

26
Teaching and Learning

• Definition Teaching is an interactive process
  that promotes learning. It consists of a
  conscious deliberate set of actions that help
  individuals gain new knowledge, change attitudes,
  adopt new behaviors or perform new skills.
• Learning is the purposeful acquisition of new
  knowledge, attitudes, behaviors and skills.

27
Behaviors Involved in Learning

• Cognitive refers to understanding e.g. disease
  process
• Affective refers to attitude e.g.
  acceptance/denial
• Psychomotor refers to motor skills. E.g.
  learning to test sugar levels and give insulin

28
Cognitive Learning

• Includes all intellectual behavior and requires
  thinking
• Six behaviors are needed for cognitive learning
• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• evaluation

29
Affective Learning

• Deals with expression of feelings and acceptance
  of attitudes, opinions or values.
• Five behaviors are needed to facilitate affective
  learning
• Receiving
• Responding
• Valuing
• Organizing
• characterizing

30
Psychomotor Learning

• Involves the acquisition of skills that require
  integration of mental and muscular activity such
  as the ability to walk or to use an eating
  utensil. The simplest is perception, the most
  complex is origination

31
Behaviors Associated with Psychomotor Learning

• Perception
• Set
• Guided response
• Mechanism
• Complex overt response
• Adaptation
• origination

32
Three Basic Learning Principles

• Motivation to learn
• The ability to learn
• The environment

33
Developing a Teaching Plan

• Assessment
• Nursing diagnosis
• Planning
• Implementation
• Evaluation

34
In Organizing a Teaching Plan

• Set priorities
• Timing
• Organize teaching material
• Maintain learning attention and participation
• Build on existing knowledge
• Select a teaching method

35
Types of Teaching Method

• Instructional method
• One on one discussion
• Group instruction
• Preparatory instruction
• Demonstration
• Analysis
• Role playing
• Discovery

36
Evaluation of Teaching

• Noting barriers
• Measuring objectives
• Identify need for clarification
• Identify ineffective interventions
• Noting areas that need clarification
• Success is measured by performance of expected
  behavior

37
Documentation of Client Teaching

• Assessment of learning need
• Specific content
• Method of teaching
• Reinforced information
• Evaluation of learning

38
Culture and Ethnicity

• USA Multicultural society
• Population projection for 2020
• 53 white as compared to 70.9 in 1998
• 2021, of Asians and Hispanics will triple
• African American population will be doubled

39
Culture and Ethnicity

• Variations exists across cultures and
  subcultures. It is essential to remember that
  regardless of race, ethnicity, culture or
  cultural heritage, every human being is
  culturally unique

40
Definition of Terms

• Culture refers to patterned life ways, values,
  beliefs, norms, symbols, and practices of
  individuals, groups or institutions that are
  learned, shared, and usually transmitted from
  generation to the next over time.

41
Definition of Terms

• Ethnicity refers to groups whose members share a
  common social and cultural heritage that is
  passed on to successive generations.
• Ethnicity confers a sense of identity.
• Emic is the local, indigenous or insiders views
  and values about a phenomenon.
• Etic is the outsiders or more universal views and
  values about a phenomenon.

42
Definitions

• Transcultural nursing is a humanistic and
  scientific care discipline and profession with
  the central purpose to serve individuals, groups,
  communities, societies and institutions
• Acculturation refers to the process by which an
  individual or group from another culture learns
  how to take on many values, behaviors, norms, and
  life ways of another culture.

43
Definition

• Religion is a system of organized beliefs and
  worship that a person practices to outwardly
  express their spirituality.

44
There are Six Cultural Phenomenon

• Communication
• Space
• Social organization
• Time
• Environmental control
• Biologic variation

45
Communication

• Communication means to make common, share,
  participate or import
• All behavior verbal or non verbal in the presence
  of another individual.
• It establishes a sense of commonality and permits
  sharing of information, signals, or messages in
  the form of ideas and feelings
• Culture influences how feelings are expressed and
  what verbal and non verbal expressions are
  appropriate

46
Space

• Personal space is the area that surrounds a
  persons body including the space and objects
  within the space.
• Western culture there are 3 primary dimensions
  of space
• Intimate zone 0-18 inches
• Personal zone 18 inches 3ft. Used with friends
• Social or public space 3ft 6ft, used for
  impersonal and business purposes

47
Social Organization

• Refers to how cultures organize itself around
  particular units such as families, racial or
  ethnic groups, religious groups and community or
  social groups
• In some culture, the family is the most important
  unit of organization e.g. Mexico, Chinese
• In some cultures, religion is the second most
  important social organization

48
Time

• Cultural groups construct system of time that
  measure social events and agricultural
  activities.
• Many cultures use time to schedule future
  activities
• Americans are future time oriented
• Chinese use past events
• Native Americans/Mexicans are present time
  oriented

49
Environmental Control

• Refers to the ability of an individual from a
  particular cultural group to plan activities to
  coordinate with nature. It refers to the
  individuals perception of their ability to
  control factors in the environment e.g. what a
  person believes about the cause of illness will
  affect their behavior in preventing and treating
  the illness.

50
Biologic Variations

• People differ culturally.
• Differences that are biologic in nature exist
  among the different races.
• Some illnesses and diseases are more prevalent in
  some groups than others.

51
Practice Assignment

• Explain what the following means in your culture.
  Give examples
• Space, time orientation, respect, caring
  behavior, healing practices, food and meaning of
  food, age, illness beliefs and practices, healing
  practices, what causes illness.

52
Case Study Middle Aged Adult

• J. D, age 48, married and the father of 13 and 16
  year old sons has recently had to assume
  responsibility of caring for his 78 year old
  mother after she suffered a stroke. Describe the
  nurses role in assisting J.D. in caring for his
  mother.

53
Case Study Client Teaching

• Kay is a 50 year old nurse who recently had a
  heart attack. Her medical history reflects that
  she has a family history of heart disease and has
  had HTN and high Cholesterol for 15 years. She
  reports eating a high fat diet and does not
  exercise regularly. She complained of chest pain
  x 2 days that worsened with activity before she
  went to the hospital. Kay blames her husband for
  her diet because he wont eat a low fat diet,
  and I had a heart attack because I have been
  worried about my husbands health. List your
  teaching priorities.