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. 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 Community Health Settings

9. 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

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 cont’d • 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 30’s to late 60’s. • 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 Cont’d • 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 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

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 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

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.