Download What Is Growth And Development ?

JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 10
Life Span: Older Adults
Copyright © 2016 F.A. Davis Company
Demographics
• Fastest growing age group
• By 2050 will be 21% of the population
• Population pyramid (fewer young, more old)
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Stages of Development
Older adulthood
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Begins at age 65
Young-old (65–74 years)
Middle-old (75–84 years)
Oldest-old (above 85 years)
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Stages of Development (cont’d)
Older adulthood
• Fastest-growing age group
• Most health problems are chronic
• Chronic disorders affect independent living
• Frail (fragile) elderly
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Theories of Aging
• Genetic theories
• Cellular malfunction
• Wear-and-tear
• Autoimmune reaction
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Age-Related Physical Changes
• Musculoskeletal
• Cardiovascular
• Respiratory
• Gastrointestinal
• Integumentary
• Genitourinary
• Neurological
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Age-Related Physical Changes (cont’d)
• Endocrine
• Sensory
• Cognitive
• Personality
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Leading Causes of Death
1.
2.
3.
4.
5.
6.
7.
Heart disease
Cancer
Chronic lower respiratory diseases
Stroke
Alzheimer disease
Diabetes mellitus
Influenza and pneumonia
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Cognitive Development
• Normally, memory declines; intelligence does not.
• Dementia.
– Common in 85+ group (about 50%)
– Not “normal” aging
– Alzheimer disease the primary form
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Housing for Older Adults
• Aging in place
• Elder-friendly residences
• Elder-friendly communities
• Naturally occurring retirement communities
• Retirement communities
• Continuing care retirement communities (CCRC)
• Assisted-living facilities
• Nursing homes
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
How elder-friendly is the community in which
you live?
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 11:
Experiencing Health & Illness
Copyright © 2016 F.A. Davis Company
Defining Health and Illness
Health
• Perfect body
• Not having illness
• Something you can buy
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Defining Health and Illness (cont’d)
Health (cont’d)
• Ideal state of physical wellness and mental well-being
• A positive concept emphasizing social and personal
resources, as well as physical capacities
• Power of the soul to cope with varying conditions of the
body
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Defining Health and Illness (cont’d)
Illness
• Pathology affecting an organ or body system
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Nurses’ Understanding of Health and Illness
• Experiences unique to each individual
• Illness usually described in terms of how it makes a
person feel
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Nurses’ Understanding of Health
and Illness (cont’d)
• An illness is a disruption of health.
• Health and illness are influenced by the client’s
attitude and lifestyle choices.
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Use of Conceptual Models to Understand
Health and Illness
• Health-illness continuum
• Dunn’s health grid
• Neuman’s continuum
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Dimensions of Health Along Health and
Illness Continuum
• Biological factors
• Nutrition
• Physical activity
• Sleep and rest
• Meaningful work
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Dimensions of Health Along Health and
Illness Continuum (cont’d)
• Lifestyle choices
• Family relationships
• Culture
• Religion and spirituality
• Environmental factors
• Finances
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What Factors Disrupt Health?
• Physical disease
• Injury
• Mental illness
• Loss
• Impending death
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Dunn’s Health Grid
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What Factors Disrupt Health? (cont’d)
• Competing demands
• The unknown
• Imbalance
• Isolation
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Five Stages of Illness Behavior
• Experiencing symptoms
• Sick role behavior
• Seeking professional care
• Dependence on others
• Recovery
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Factors That Influence Illness Behavior
• Age
• Family patterns
• Culture
• Nature of the illness
• Hardiness
• Intensity, duration, and multiplicity of the disruption
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Nature of the Illness
• Acute illness
• Chronic illness
• Remission
• Exacerbation
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Using the Nursing Process to
Promote Health
Assessment: Facilitate communication
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Attuning
Accepting
Respecting
Enjoying
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Using the Nursing Process to
Promote Health (cont’d)
Diagnosis
• Use NANDA diagnoses relating to health issues.
Planning outcomes/evaluation
• Envision acceptable outcomes.
• Set smaller, realistic goals.
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Using the Nursing Process to
Promote Health (cont’d)
Planning interventions/implementation
• Envision strengths and potential in clients and families
who are too overwhelmed to identify their own.
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How Can I Honor Each Client’s Unique
Health/Illness Experience?
• Examine life’s uncertainties.
• Envision wellness for your clients and yourself.
• Establish trust at your first client contact and through
transfers and discharge.
• Provide a healing presence.
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
• What qualities are essential to your own personal
definition of health?
• How do you define illness?
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 12:
Stress & Adaptation
Copyright © 2016 F.A. Davis Company
What Is Stress?
• Any disturbance in a person’s normal balanced state
• Unique response by each person to a stressor
• Can be harmful or motivating
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Categories of Stress
Distress
• Can threaten health (e.g., continual financial worries)
Eustress
• Good stress (e.g., passionate kiss)
Developmental
• Associated with life stages (e.g., college graduation)
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Categories of Stress (cont’d)
Situational
• Random, unpredictable (e.g., hurricane, accident)
Physiological
• Affect body: structure/function (e.g., diseases,
mobility problems)
Psychological
• Arise from life events (e.g., work pressure, family arguments)
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Dealing With Stress: Coping Strategies
• There are three general approaches for coping,
depending on the situation
– Alter the stressor: change jobs
– Adapt to the stressor: change thoughts about
nursing clinicals
– Avoid the stressor: end a relationship
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Styles of Coping Strategies
Adaptive
• Healthy choices
• Directly reduce negative effects of stress
• Examples: change in lifestyle, problem solving
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Styles of Coping Strategies (cont’d)
Maladaptive
• Unhealthy style, temporary fix
• Possibly other harmful effects
• Examples: substance abuse, overeating
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Adaptation
• A possible/desired outcome of stress
• Involves adjusting to the stress/stressor
• Allows for
– Normal growth and development
– Effective responses to life’s challenges
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Adaptation (cont’d)
Ability to adapt depends on
• Intensity of the stressor
• Effectiveness of coping skills
• Personal factors
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Factors That Influence Adaptation
Personal perception of stressor
• Is understanding of stressor realistic?
• How successful have previous adaptation attempts been?
Overall health status
• The number of illnesses present and the chronicity of
illnesses may affect the ability to adapt to new stressor(s)
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Factors That Influence Adaptation (cont’d)
Support system (e.g., friends; family providing emotional,
financial, physical help)
• Strong support = better adaptation
Personal factors
• Age
• Developmental level
• Life experiences
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Physical Responses to Stressors
General Adaptation Syndrome (GAS)
• Selye’s theoretical model of physiological responses to
stress
• Nonspecific bodily responses shared by all people
• Response to distress as well as eustress
• Involves three stages
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General Adaptation Syndrome: Stages
Alarm Stage
• Fight or flight
• Involves involuntary body responses
– Endocrine system: CRH, ACTH, ADH
– Sympathetic nervous system: epinephrine, norepinephrine
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General Adaptation Syndrome: Stages (cont’d)
Alarm Stage (cont’d)
– Cardiovascular (CV) system: vasoconstriction, elevated BP
– Respiratory system: dilated bronchioles
– Metabolic: increased availability of glucose
– Urinary: sodium and water retention
– Gastrointestinal (GI): decreased peristalsis
– Musculoskeletal: increased blood flow to muscles
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General Adaptation Syndrome: Stages (cont’d)
Resistance Stage
• Goal: maintenance of homeostasis
• Involves use of coping mechanisms
• Psychological
• Physical  return of vital signs to normal
• Failure to adapt to or contain stress leads to third phase
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General Adaptation Syndrome: Stages (cont’d)
Exhaustion
• If adaptive mechanisms become ineffective/nonexistent
• Decrease in BP, elevated pulse, respiration
• Usually ends in disease or death
Recovery
• Third stage, if adaptation is successful
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Physical Response to Stressors
Local Adaptation Syndrome
• Response to stress involving specific body part, tissue, or
organ
• Short-term attempt to restore homeostasis
• Localized
• Types
– Reflex pain response
– Inflammatory response
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Psychological Responses to Stress
Include feelings, thoughts, and behaviors
• Anxiety and fear
• Ego defense mechanisms (e.g., denial,
rationalization, projection)
• Anger
• Depression
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Consequences of Failed Adaptation
Stress-Induced Organic Responses
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Continual stress
Repeated central nervous system (CNS) stimulation
Elevation of certain hormones
Results in long-term changes in body systems
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Consequences of Failed Adaptation (cont’d)
Somatoform Disorders
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Hypochondriasis
Somatization
Somatoform pain disorder
Malingering
Stress-Induced Psychological Responses
• Crisis
• Burnout
• Post-traumatic stress disorder (PTSD)
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Stress Reduction Interventions
Health Promotion Activities
• Promote adequate nutrition.
• Help the client establish a routine that includes
regular exercise.
• Teach the client the importance of getting 7 to 8 hr of
sleep per day.
Copyright © 2016 F.A. Davis Company
Stress Reduction Interventions (cont’d)
Health Promotion Activities (cont’d)
• Encourage participation in leisure activities.
• Help clients to manage time, balance responsibilities, and
prioritize tasks.
• Advise clients to avoid maladaptive behaviors such as
excess alcohol, caffeine, sweets, smoking, and illicit drugs.
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Stress Reduction Interventions (cont’d)
• Use of specific interventions to relieve anxiety
• Anger management
• Stress management techniques
• Meditation, biofeedback, Reiki, humor, and so forth
• Change perception of self
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Stress Reduction Interventions (cont’d)
• Change perception of stressor.
• Identify and use support systems.
• Use spiritual support.
• Implement crisis intervention.
• Use proper referrals.
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
Review the scenario of Gloria and John (Meet Your Patients in Volume 1). How
much does it really tell you about the clients’ situation?
• Which aspect of stress do you have the most information about: their
stressors, their coping methods and adaptation, their responses to stress, or
their support systems?
• What facts do you have about the clients’ emotional and behavioral
responses to their stressors?
• What information do you have about how well they are coping with stress?
• What data do you have about their support systems? What information do
you need?
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 13:
Psychosocial Health & Illness
Copyright © 2016 F.A. Davis Company
Psychosocial Theory
Understanding people as a combination of
psychological and social events
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Psychosocial Theory (cont’d)
Patient responses to illness are influenced by the
relationship among
• Physical pathology
• Psychosocial health
• Overall wellness
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Psychosocial Influences on Health
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Self-Concept: Overall View of Oneself
Forms out of a person’s evaluation of her/his
• Physical appearance
• Sexual performance
• Intellectual abilities
• Success in the workplace
• Friendships
• Problem-solving and coping abilities
• Unique talents
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Factors Affecting Self-Concept
• Gender
• Developmental level
• Socioeconomic status
• Family
• Peer relationships
• Internal locus of control
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Components of Self-Concept
• Body image
• Role performance
• Personal identity
• Self-esteem
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Body Image: Mental Image of Physical Self
Influenced by
• Ideal versus perceived and actual body image
• Appearance and function of body
• Gradual versus sudden body changes
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Role Performance
The actions a person takes and the behaviors
demonstrated in fulfilling a role
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Personal Identity
• Your view of yourself as a unique human being,
different and separate from all
• Relatively constant and consistent
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Self-Esteem
• How well a person likes one’s self
• The difference between ideal self and actual self
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Psychosocial Assessment
• Biological, psychological, and social details
• Functional abilities
• Self-efficacy
• Family relationships
• Relationships with the wider social environment
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Psychosocial Assessment (cont’d)
• Interpersonal communication
• Social resources and networks
• Understanding current illness
• Usual coping mechanisms
• Health priorities
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Psychosocial Assessment Continuum
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Psychosocial Diagnoses
Must determine cause and effect
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Interrupted family processes
Family coping
Parental role conflict
Ineffective individual coping
Post-trauma syndrome
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Psychosocial Diagnoses (cont’d)
• Risk for loneliness
• Social isolation
• Risk for violence: directed at others
• Impaired social interaction
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Self-Concept Diagnoses
• Chronic low self-esteem
• Situational low self-esteem
• Disturbed personal identity
• Ineffective role performance
• Disturbed body image
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Psychosocial, Self-Concept, and
Self-Esteem Outcomes
Approximately 30 NOC standardized outcomes to
describe
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Psychological well-being
Psychological adaptation
Self-control
Social interaction
Found in psychosocial Health and Family Health
domains
Copyright © 2016 F.A. Davis Company
Psychosocial Illness: Anxiety
• Common emotional response to a
(usually unknown) stressor
• Results from psychological conflicts
• Accompanied by physical symptoms
• Can be mild, moderate, severe, disabling
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Psychosocial Interventions
NIC standardized psychosocial interventions found in
Behavioral and Family domains
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
Refer to the Meet Your Patient scenario in the
textbook.
Karli perceives herself as unlovable “looking this way.”
You should not assume that you know exactly what
Karli means by this.
• Which of her words do you need to clarify with her?
• What might you say to her to get her to provide
more information about the psychosocial meaning of
her statement?
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 14:
The Family
Copyright © 2016 F.A. Davis Company
What Is a Family?
• Two or more people related by birth, marriage, or
adoption residing in the same household
• Two or more individuals who provide physical,
emotional, economic, or spiritual support while
maintaining involvement in each other’s lives
• May or may not be blood relatives
• Concept of nontraditional families
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Family Structures
• Traditional nuclear families
• Dual-earner families
• Single-parent families
• Stepfamilies
• Blended families
• Sandwich families
• Married couples with no children
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Family Structures (cont’d)
• Cohabitating adults
• Extended family sharing dwelling
• Grandparents raising grandchildren
• Single individuals sharing a household
• Gay or lesbian couples with or without children
• Individuals or couples who adopt children
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Approaches to Family Nursing
• Nursing care holistically directed toward the whole
family as well as to individual members
• Three perspectives
– Family as context
– Family as unit of care
– Family as system
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Theories
• General systems theory
• Structural-functional theories
• Family interactional theory
• Developmental theories
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Family Health Risk Factors
Childless and childbearing couples
• Adapting to new roles creates stress.
• This can led to maladaptive coping.
Families with young children
• Experience financial difficulties.
• Illness and injuries create risks to family health.
Copyright © 2016 F.A. Davis Company
Family Health Risk Factors (cont’d)
Families with adolescents and young adults
• Risk-taking behaviors
• Dealing with aging grandparents
• Life transitions between dependence and independence
Families with older adults
• Falls and trauma risks
• Risk for social isolation, depression, and malnutrition
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Challenges to Family Health
• Poverty and unemployment
• Infectious diseases
• Chronic illness and disability
• Homelessness
• Family violence and neglect
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Family Health Assessment
• Identifying data
• Family composition
• Family history and developmental stage
• Environmental data
• Family structure
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Family Health Assessment (cont’d)
• Family functions
• Health beliefs, values, and behaviors
• Family stressors and coping
• Abuse and violence within family
• Family communication patterns
• Caregiver role strain
• Social isolation
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Promoting Family Wellness
• Interventions when a family member is ill
• Interventions for caregiver strain
• Interventions when there is a death in the family
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Family Nursing Diagnosis
NANDA-I family diagnoses describe the health status
of the family as a whole.
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Think Like a Nurse
As a nurse, how can you promote overall wellness in
a family with a critically ill member?
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 15:
Culture & Ethnicity
Copyright © 2016 F.A. Davis Company
Importance
• The United States is a multicultural society.
• You will care for clients who are not from
your culture.
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Culture Characteristics
• Learned
• Taught
• Shared by its members
• Dynamic and adaptive
• Complex
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Culture Characteristics (cont’d)
• Are diverse
• Exist at many levels
• Have common beliefs and practices
• Are all-encompassing
• Provide identity
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Terminology
• Bicultural
• Multicultural
• Ethnocentrism
• Dominant culture
• Subcultures
• Minority groups
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Vulnerable Populations as Subcultures
• Homeless
• Poor
• Mentally ill
• People with physical disabilities
• Young
• Elderly
• Some ethnic and racial minority groups
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Concepts Related to Culture
• Ethnicity
• Race
• Religion
• Socialization
• Acculturation
• Cultural assimilation
• Cultural conflict
• Cultural shock
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Culture Universals and Specifics
• Culture universals are values, beliefs, and practices
that people from all cultures share.
• Culture specifics are values, beliefs, and practices
that are special or unique to a culture.
• Archetypes are something recurrent, based on facts.
• Stereotypes are widely held but oversimplified
beliefs that have no basis in fact.
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Cultural Specifics That Affect Health
• Communication
• Space
• Time orientation
• Social organization
• Environmental control
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Cultural Specifics That Affect Health (cont’d)
• Biological variations
• Religion and philosophy
• Politics, law
• Economy
• Education
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Culture of Healthcare
• Indigenous healthcare system
• Professional healthcare system
• Biomedical healthcare system
• Alternative health care
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Health and Illness Beliefs and Practices
• Scientific
• Magico-religious
• Holistic
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Culture of North American
Healthcare System
• Biomedical system
• Value technology
• Desire to conquer disease
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Culture of North American
Healthcare System (cont’d)
• Definition of health as absence or minimization of
disease
• Adherence to a set of ethical standards for
minimization of disease
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Nursing as a Subculture
• Nursing is the largest subculture in healthcare culture.
• Nursing values
– Silent suffering as a response to pain
– Objective reporting and description of pain
– Use of nursing process
– Nursing autonomy
– Caring
– Knowledge
– Critical thinking
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Traditional and Alternative Healing
• Folk medicine
• Complementary medicine
• Alternative medicine
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Culturally Competent Care
• Purnell and Paulanka
• Leininger
• Campinha-Bacote
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Purnell’s Model
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Barriers to Culturally Competent Care
• Lack of knowledge
• Emotional responses
• Ethnocentrism
• Cultural stereotypes
• Prejudice
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Barriers to Culturally Competent Care
(cont’d)
• Discrimination
• Racism
• Sexism
• Language barrier
• Street talk, slang, jargon
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Nursing Strategies for Responding to a
Client’s Cultural Health Practices
• When the practice is efficacious
• When the practice is neutral
• When the effects of a practice are unknown
• When the practice is dysfunctional
Copyright © 2016 F.A. Davis Company
Becoming Culturally Competent: LIVE and
LEARN Model (Carballeira, 1997)
Like
Inquire
Visit
Experience
Listen
Evaluate
Acknowledge
Recommend
Negotiate
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
• What do you do to keep yourself healthy?
• What do you do to treat minor illnesses when you do not
want to see a physician?
• What aspects of the indigenous and professional systems have
you used for yourself or your family? Give examples.
Copyright © 2016 F.A. Davis Company
JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 16:
Spirituality
Copyright © 2016 F.A. Davis Company
History of Spirituality in Nursing
• Pre-Christian era
• Early Christian era
• Post-Reformation
• Mid-20th century
Copyright © 2016 F.A. Davis Company
What Is Religion?
• A “map” that outlines essential beliefs, values, and
codes of conduct into a manner of living.
• Many of the world’s religions hold common beliefs.
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What Is Spirituality?
• A “journey” that takes place over time and
involves the accumulation of life experiences
and understanding.
• An attempt to find meaning, value, and purpose in life.
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Core Issues of Spirituality
• Faith
• Hope
• Love
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Core Issues of Spirituality (cont’d)
Cures, Miracles, and Spiritual Healing
• A miracle is anything that allows for the presence of
the transcendent.
• A miracle does not necessarily involve cure.
• Miracles commonly proceed according to natural law.
• Miracles can have a profound impact on a
person’s expectancies.
Copyright © 2016 F.A. Davis Company
Relationship Between Religion
and Spirituality
• Separate and distinct concepts
• Completely enmeshed concepts
• Religion: an aspect of spirituality
• Vague or undefined concepts
Copyright © 2016 F.A. Davis Company
Spiritual Beliefs and Health
• Some research suggests religion has a positive
influence over physical and mental health.
• Other studies find that some religious values impede
positive health outcomes.
• Research does not always answer how or why religion
affects health.
Copyright © 2016 F.A. Davis Company
Major Religions
Judaism
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Orthodox
Conservative
Reform
Reconstructionist
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Major Religions (cont’d)
Christianity
• Roman Catholicism
• Christian Science
• Protestantism
– Lutheran
– Baptist
– United Methodist
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Major Religions (cont’d)
• Islam
• Hinduism
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Major Religions (cont’d)
• Buddhism
• American Indian
• Rastafarianism
• Atheism
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What Every Nurse Should Know
Gain self-knowledge
• Be open
• Welcome challenges
• Take time to reflect
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What Every Nurse Should Know (cont’d)
Spiritual care demands nonjudgmental attitudes and
open thinking.
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Barriers to Spiritual Care
• Lack of awareness of spirituality in general
• Lack of awareness of your own spiritual belief system
• Differences in spirituality between nurse and client
Copyright © 2016 F.A. Davis Company
Barriers to Spiritual Care (cont’d)
• Fear that your knowledge base is insufficient
• Fear of where spiritual discussions may lead
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Assessment of Spiritual Needs and Practices
• Tools
– JAREL Spiritual Well-Being Scale
– SPIRIT model
– HOPE
• Levels of spiritual assessment
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Assessment of Spiritual Needs and Practices
(cont’d)
• Sources of information about spirituality
– Client and family interviews
– Client environment
– Client questions
– Nonverbal communication
Copyright © 2016 F.A. Davis Company
NANDA Diagnoses Related to Spirituality
• Moral distress
• Spiritual distress
• Risk for spiritual distress
• Readiness for enhanced spiritual well-being
Copyright © 2016 F.A. Davis Company
NANDA Diagnoses Related to Spirituality
(cont’d)
• Impaired Religiosity
• Risk for Impaired Religiosity
• Readiness for Enhanced Religiosity
• Spiritual Pain (non-NANDA)
Copyright © 2016 F.A. Davis Company
Planning Outcomes and Interventions
• NOC standardized outcomes
• NIC standardized interventions
• Spiritual interventions used to treat and prevent spiritual
problems related to client’s illness
• May need to make referrals
Copyright © 2016 F.A. Davis Company
Prayer
• Determine whether client wishes you to pray for him
or her or with him or her.
• Ask what client would like you to address in prayer.
Copyright © 2016 F.A. Davis Company
Prayer Guidelines for Nurses
• Ask how the client prefers to address the Divine.
• Ask the client if any rituals or religious items are
needed before prayer.
• Always feel free to pray or not to pray.
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Prayer Guidelines for Nurses (cont’d)
• Do not be compulsive about praying or
avoiding prayer.
• Know there are appropriate times and places for
prayer.
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Prayer Guidelines for Nurses (cont’d)
• When a client asks for prayer, know how to reply.
• Focus the prayer around the client’s request.
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Prayer Guidelines for Nurses (cont’d)
• Know prayers that are realistic.
• If composing prayer is difficult, use existing prayers
from religious text.
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Prayer Guidelines for Nurses (cont’d)
• Include request for divine help involving
healthcare team.
• Thank the client for being asked to participate in
prayer.
Copyright © 2016 F.A. Davis Company
Think Like a Nurse
Refer to Charles Johnson (Meet Your Patient).
• What data do you have about Mr. Johnson’s spirituality?
• What speculations might you make about his spirituality based
on your past experiences and knowledge, and the limited data
you have?
• How does your religion or spirituality differ from Mr.
Johnson’s? How is it similar?
• Can you think of problems these differences and similarities
could cause you in caring for him?
Copyright © 2016 F.A. Davis Company