Unit I: Concepts in Health Care

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Unit I Concepts in Health Care

• Health and Wellness
• Legal Principles in Nursing

Dr. Belal Hijji, RN, PhD January 4, 2012
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Learning Outcomes

• By the end of this lecture, students will be able
  to
• Define key terms
• Discuss models of health and illness
• Discuss variables influencing health beliefs and
  health practices
• Describe health promotion and illness prevention
  activities
• Discuss the preventive levels of health care
• Discuss four types of risk factors and the
  process of risk factor modification
• Describe the impact of illness on the client and
  family
• Discuss some of the legal principles and
  relationships in nursing practice
• Discuss some of the legal issues in nursing
  practice

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Definition of Key Terms

• Health
• State of complete physical, mental and social
  wellbeing, not only the absence of disease or
  infirmity. (WHO, 1947).
• Is a state of being that people define in
  relation to their own values, personality and
  lifestyle.
• Health status
• Is a description of health that can be measured
  by birth rates and death rates, life expectancy,
  quality of life, morbidity from specific
  diseases, risk factors, and other factors.

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Models of Health and Illness

• A model is a theoretical way of understanding a
  concept.
• Models provide various ways of approaching
  complex concepts such as health and illness.
• Models are used to understand the relationship
  between these concepts and the clients attitudes
  toward health and health practices.

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Health-Illness Continuum Model

• According to this model, health is a dynamic
  state that fluctuates as a person adapts to
  changes in the internal or external environments
  to maintain a state of well-being.
• Illness is a process in which the functioning of
  a client is diminished or impaired when compared
  with his/ her previous condition.
• In this model, high-level wellness and severe
  illness are at opposite ends of the continuum.
• Risk factors, including genetic and
  physiological, environmental age, and lifestyle,
  are at the centre of the model.

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Health Belief Model

• Was developed in the 1950s to examine why people
  did not participate in health-screening
  programmes
• Was later modified to address compliance to
  therapeutic regimen
• Is built on the premise that disease prevention
  and curing regimens will eventually be successful
  and the belief that health is highly valued. Both
  premises need to be present in the model to be
  relevant in explaining health behaviour

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Revised Health Promotion Model

• Has been primarily used in nursing
• Describes major components and variables that
  influence health promoting behaviours
• Emphasises actualisation of health potential and
  an increase in the level of wellbeing rather than
  avoidance of disease
• Has three major components of individual
  characteristics and experiences,
  behaviour-specific cognition and affect, and
  behavioural outcome

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Variables Influencing Health Beliefs and Health
Practices

• Internal variables
• Developmental stage The persons concept of
  illness depends on his developmental stage. For
  example, different techniques of teaching are
  used about contraception to an adolescent and to
  an adult
• Intellectual background Cognitive abilities
  shape the way a person thinks, including the
  ability to understand factors involved in illness
  and to apply knowledge of health and illness to
  personal health practices
• Emotional factors A persons degree of calm or
  stress can influence health beliefs and
  practices. A very calm person may have little
  emotional response during illness, whereas a
  person unable to cope with stress may either
  overreact to illness or deny the presence of
  symptoms.

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• Spiritual factors Religious practices are one
  way people exercise spirituality. Nurses must
  understand clients spiritual dimensions to
  involve them in nursing care
• External variables
• Family practices A person raised in a family
  that values the importance of preventive care,
  e.g periodic dental checkups, is more likely to
  continue those health practices during adulthood.
  
• Socioeconomic factors These factors can increase
  the risk for illness and influence the way a
  person defines and reacts to illness. A person
  with low income tend to focus on food for the
  family than to costly drugs or special diets.

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• Cultural background Cultural backgrounds
  influence beliefs, values, and customs. It
  influences the approach to the health care
  system, personal health practices, and the
  nurse-client relationship.

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Health Promotion and Illness Prevention Activities

• Health promotion strategies can be
• Passive Clients gain from activities of others
  without acting themselves, (e.g flouridation,
  fortification of milk with vitamin D)
• Active Clients are motivated to adopt specific
  health programmes (e.g weight reduction, smoking
  cessation)

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Levels of Preventive Care

• Health activities and nursing care occur at the
  following levels of prevention
• Primary True prevention preceding disease or
  dysfunction and is targeting physically and
  emotionally healthy people (immunisation,
  personal hygiene)
• Secondary Focuses on clients who experience
  health problems or illnesses and who are at risk
  of developing complications or worsening
  conditions (e.g early treatment, screening)
• Tertiary Disability is permanent and
  irreversible. The aim is to minimise the effects
  of long-term disease or disability by
  intervention directed at preventing complications
  and deterioration (bed sore development).

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Types of Risk Factors

• A risk factor is a situation, habit,
  environmental condition, physiological condition,
  that increases the vulnerability of an individual
  to an illness or accident.
• Risk factors can be grouped into
• Genetic and physiological factors Diabetes,
  Pregnancy, or overweight
• Age Increases risk of heart disease, birth
  defects when a woman is gt 45 yrs.
• Environment Unclean, crowded dwellings increase
  the risk of infection and other disease.
• Lifestyle Overeating, poor nutrition,
  insufficient rest or sleep, alcohol or smoking

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• The goal of risk factor identification is to
  assist clients in understanding those areas in
  the lives that can be modified or eliminated to
  promote wellness and prevent illness.
• Risk factor identification is the first step in
  health promotion, wellness education, and illness
  prevention.
• Once risk factors are identified, health
  education programmes can be implemented and this
  may lead a person to change a risky health
  behaviour, such as smoking cessation, alcohol
  misuse, lack of exercise, unhealthy food.

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Impact of Illness on Client and family

• Emotional and behavioural changes Depend on the
  nature of illness, the clients attitude, and the
  reactions of others, to it.
• Short-term, non-life threatening illness produce
  few behavioural changes in the clients and
  family functions (e.g cold)
• Severe life-threatening illness can lead to more
  extensive emotional and behavioural changes such
  as shock, anxiety, denial, and withdrawal.

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• Some illnesses result in changes in physical
  appearance, and clients and families react
  differently to these changes.
• Changes in body image depend on the type of
  changes (loss of a limb or an organ).
• Illness may change the roles of the family and
  client.
• Such changes may be subtle slight and short
  term that an individual or family can easily
  adjust to, or drastic severe and long term that
  require an adjustment process similar to grief
  ????? process. In this latter case, the client
  and family need specific counselling and guidance
  to assist them in coping with the role changes.

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Legal Principles in Nursing

• Legal limits of nursing
• An understanding of the law coupled with sound
  judgment helps to ensure safe and appropriate
  nursing care.
• Nurses must understand the legal limits that
  affect nursing practice to know their
  responsibilities and to protect clients from
  harm.
• Sources of law Nursing practice is subject to
  statutory law, regulatory law, and common law
• Statutory law is created by the US congress and
  state legislatures. Examples include Americans
  With Disabilities Act and the Nurse Practice Acts
  respectively

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• State Boards of nursing create regulatory law
  when they pass rules and regulation. An example
  of regulatory law is the duty to report
  incompetent or unethical nursing behaviour
• Courts create the common law when individual
  legal cases are decided. Examples include
  informed consent and the clients right to refuse
  treatment
• Statutes ????????? ?? ???????? are either
  criminal or civil
• Criminal law is classified as a felony crime
  which is a serious offense, or a misdemeanor
  ???? which is a less serious crime.
• Civil law protects individual rights. Violation
  of a civil law results in the payment of money to
  the injured party. A tort ??? is a civil wrong
  or injury. Torts are classified as intentional or
  unintentional. Intentional torts are willful acts
  such as assault ??????. Unintentional torts
  include negligence which is a conduct that falls
  below the standards of care.

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Legal Relationships in Nursing Practice

• Student nurses Students are responsible for all
  of their actions (USA) that cause harm to
  clients. When an injury occurs as a direct
  consequence to students action, the liability
  for the incorrect action may be shared by the
  student, the instructor, staff nurses, and the
  hospital.
• Physicians prescriptions Nurses are responsible
  for carrying out medical treatment unless the
  prescription is in error, violates hospital
  policy, or would be harmful to the patient. If
  the nurse determines that the prescription is
  wrong or harmful, s(h)e needs to obtain further
  clarification.

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• If after clarification the physician confirms an
  order that a nurse still believes that it is
  inappropriate, the nursing supervisor needs to be
  informed.
• The nurse should not carry out an order if there
  is a risk of harm. Otherwise, the nurse may be
  legally responsible for the harm suffered by the
  patient . All physicians prescriptions should be
  well-written, dated, and timed appropriately.
• Consent A general signed consent is necessary
  for all routine treatments, surgery,
  chemotherapy, and participation in research. A
  special consent form is signed before specialised
  procedures may be performed.

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• Death and dying Nurses must know their legal
  responsibilities concerning death and dying. A
  nurse must document all events that occur when
  the dying client is in his care.
• There are two standards for the determination of
  death
• Cardiopulmonary standard requires irreversible
  cessation of a clients circulatory and
  respiratory functions
• Whole brain standard requires irreversible
  cessation of all functions of the entire brain.
• An autopsy requires consent by the client before
  his death, or a close family member at the time
  of death.
• Nurses encounter legal issues with caring for
  terminally ill, severely debilitated, or
  persistently vegetative clients.

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• A competent client has the right to refuse
  medication and food.
• A dead client has the right to be treated with
  dignity and care. Wrong handling can cause
  emotional harm to family members.
• Organ and tissue donation A signed consent is
  required before a clients body, tissues, or
  organs can be donated for medical use.
• At the time of death, a qualified health care
  provider can ask the clients family members to
  consider organ donation.

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Legal Issues in Nursing Practice

• Nurses need to be aware of changes in the laws
  that affect nursing practice and patient care.
• Laws pertinent to narcotics administration are
  constant, while those of other issues such as
  abortion and care for clients with HIV are
  changing
• Controlled substances May be administered by
  nurses under the direction of a licensed
  physician. These agents should be kept securely
  locked, and only authorised personnel should have
  access to them. Precise records must be kept.
  There are criminal penalties for the misuse of
  controlled substances.

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• HIV Nurses care for patients with HIV. Nurses
  must use the standard precautions for the control
  of transmission of the HIV. Nurses need to
  safeguard themselves and others from exposure to
  infectious material.
• Abortion issues In the USA, the woman can decide
  to have an abortion as a fundamental right to
  privacy. This is true during the first trimester
  without state regulation. In the second
  trimester, the state may enforce regulations
  regarding the person who performs abortion and
  the facility. By the 3rd trimester, when the
  fetus becomes viable, the states interest is to
  protect the fetus by prohibiting abortion unless
  necessary.