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Nursing 108 Welcome back to School. Lola Oyedele RN MSN CTN. Today's Topics. Trends Community health nursing Middle aged adult Client education standards Teaching and learning Culture and ethnicity. Definition. The general direction in which things are changing

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nursing 108 welcome back to school

Nursing 108Welcome back to School.

Lola Oyedele RN MSN CTN

today s topics
Today's Topics
  • Trends
  • Community health nursing
  • Middle aged adult
  • Client education standards
  • Teaching and learning
  • Culture and ethnicity
  • 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.
age trend
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
disease trend
Disease Trend
  • Have diverse needs
  • Circulatory disease
  • Diabetes
  • cancer
community health

Community Health


  • 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.
community health settings
Hospital – based health agencies

Private or corporate owned agencies

Others include public health agencies

Nursing centers


Occupational health programs

Parish nursing

Clinics for the homeless

Case management

Wellness centers

Community Health Settings
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

Reasons for Home Healthcare and Community Focused Services
components of a community
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
components cont d
Components cont’d
  • Social systems
    • Includes education system, government, communication system, transportation, welfare, volunteer program and health systems
vulnerable populations
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
middle aged adults
Middle Aged Adults
  • Adults between the age of 30’s to late 60’s.
  • Levinson described this age as the age of settling down and pay off years.
this age is characterized by
This age is characterized by
  • Personal and career achievements
  • Joy in assisting children and young people
  • Helping aging parents
physical changes
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
physical changes cont d
Physical Changes Cont’d
  • Most significant change is
    • Menopause in the female
    • Climacteric in the male
psychosocial changes
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
psychosocial changes continues
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
health concerns and risk factors continued
Health Concerns and Risk Factors continued
  • Health risk
  • Health patterns of concern
    • Obesity
    • Cancer risk
    • Osteoporosis
    • Cardiovascular disease
risk factors for depression
Risk Factors for Depression
  • Being female
  • Disappointment or losses
  • Departure of last child
  • Family history
applying the nursing process

Applying the Nursing Process





client education standard
Client Education Standard
  • There are four standards of client education
    • Standard 1 – Assess the client’s 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
client education standard1
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
client education standard2
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
purpose and significance of health education
Purpose and Significance of Health Education
  • Maintenance and promotion of health and illness prevention
  • Restoration of health
  • Coping with impaired functioning
teaching and learning
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.
behaviors involved in learning
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
cognitive learning
Cognitive Learning
  • Includes all intellectual behavior and requires thinking
  • Six behaviors are needed for cognitive learning
    • Knowledge
    • Comprehension
    • Application
    • Analysis
    • Synthesis
    • evaluation
affective learning
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
psychomotor learning
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
behaviors associated with psychomotor learning
Behaviors Associated with Psychomotor Learning
  • Perception
  • Set
  • Guided response
  • Mechanism
  • Complex overt response
  • Adaptation
  • origination
three basic learning principles
Three Basic Learning Principles
  • Motivation to learn
  • The ability to learn
  • The environment
developing a teaching plan
Developing a Teaching Plan
  • Assessment
  • Nursing diagnosis
  • Planning
  • Implementation
  • Evaluation
in organizing a teaching plan
In Organizing a Teaching Plan
  • Set priorities
  • Timing
  • Organize teaching material
  • Maintain learning attention and participation
  • Build on existing knowledge
  • Select a teaching method
types of teaching method
Types of Teaching Method
  • Instructional method
  • One on one discussion
  • Group instruction
  • Preparatory instruction
  • Demonstration
  • Analysis
  • Role playing
  • Discovery
evaluation of teaching
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
documentation of client teaching
Documentation of Client Teaching
  • Assessment of learning need
  • Specific content
  • Method of teaching
  • Reinforced information
  • Evaluation of learning
culture and ethnicity
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
culture and ethnicity1
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
definition of terms
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.
definition of terms1
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.
  • 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.
  • Religion is a system of organized beliefs and worship that a person practices to outwardly express their spirituality.
there are six cultural phenomenon
There are Six Cultural Phenomenon
  • Communication
  • Space
  • Social organization
  • Time
  • Environmental control
  • Biologic variation
  • 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
  • Personal space is the area that surrounds a person’s 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
social organization
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
  • 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
environmental control
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.
biologic variations
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.
practice assignment
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.
case study middle aged adult
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 nurse’s role in assisting J.D. in caring for his mother.
case study client teaching
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 won’t eat a low fat diet, and I had a heart attack because I have been worried about my husband’s health”. List your teaching priorities.