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1. In comparing the old health care paradigm with the new paradigm, what are the issues that relate to nursing care of patients/clients?
- Old Paradigm -----------New Health care Paradigm
- Hospital-based, acute care------Short-term hospital
- Specialty Units-------Cross-training
- Hierarchical Management-------- Decentralization
- Physician “Captain of Ship”; others are followers Inter/multidisciplinary team, collaboration
- Nurse as employee: job-focused, “refrigerator nurse”---------- Nurse as professional
- Medical condition, Focus on segment--------Holistic person in family/community
- “sick care,” focus on cure-------- Health care, health promotion, prevention programs
- Cost containment, focus on billing------- focus on patient and accountability of caregivers/agency
- Written medical record--------Integrated electronic records
- Fee for service-------------Managed competition
- Physician as employer--------Physician as employee
- One insurance plan----------Variety of insurance options
- 80-100% insurance ----------Greater deductible, lower percentage coverage, or copayment
2. Some of the strategies used by nurses in the attempt to control costs and maintain quality include resource management, the development of critical pathways, and the utilization of assistive personnel.
- a. What resources must be managed? What are the issues related to resource management?
- i. Resource management is an important skill for successful, clinically competent nurses. Resource management uses cost-effective approaches to high-quality health care. The basic resources include financial, physical, and human, but others are organizational systems, information systems, and technical capabilities.
- b. What are critical pathways? What concerns have been expressed about critical pathways? What solution to these concerns has been developed?
- i. Critical Pathways – are interdisciplinary plans for managing the care of clients that specify interdisciplinary assessments, interventions, treatments, and outcomes for specific health-related conditions across a timeline. Critical pathways are also called critical paths, interdisciplinary plans, anticipated recovery plans, interdisciplinary action plans and action plans
- c. What staffing titles are considered assistive personnel? What are the issues related to the use of assistive personnel?
3. What is the central objective of Nursing’s Agenda for Healthcare Reform? What are some strategies to improve patient/client access to quality health care? What are some strategies that are unique to nursing to improve patient/client access to quality health care?
- a. The central objective of this agenda was to provide a basic “core: of essential health care services for everyone. The statement called for a restructuring of the health care system to focus on consumers and their health needs. Some strategies that are unique to nursing to improve patient/client access to quality health care are:
- i. Encourage consumer partnerships so that consumers can take an active role in their health and their care and in decisions about their care.
- ii. Allow all U.S. citizens and residents access to basic health care services
- iii. Increase health care access through the use of physician and nonphysician providers
- iv. Create incentives that promote health, wellness, and preventions; individuals with chronic illnesses will not be penalized
- v. Promote affordable, safe, and effective health care
- vi. Make provision for skilled and long-term care
- vii. Make provisions for catastrophic care, with some limitation on extraordinary procedures
- viii. Finance health care through a combination of public- and private-sector funding
4. Is health a state or a process? Explain your choice. Compare the definitions of “health” from the World Health Organization, the President’s Commission on Health Needs of the Nation and Dubos (1968, 1978)? How do they differ?
- a. Health is a state because a person who has a terminal illness may have a sense of well-being; conversely, another person may lack a sense of well-being yet be in a state of good health.
- b. The definitions of “health”
- i. World Health Organization –
- 1. Reflects concern for individual as a total person functioning physically, psychologically, and socially.
- 2. Places health in the context of environment
- 3. Equates health with productive and creative living
- ii. The President’s Commission on Health Needs of the Nation
- 1. Health is not a condition; it is an adjustment. It is not a state but a process. The process adapts the individual not only to our physical, but also our social environments
5. In more recent years, the understanding of health has taken a more holistic approach. What are the dimensions of a person that must be considered when defining health with and for that person?
6. What is sick role behavior?
- a. The person is not held responsible for illness
- b. The person is exempt from the usual social tasks
- c. The person has an obligation to get well
- d. The person has an obligation to seek competent help to treat the illness
7. What are the differences in the terms health and well-being or wellness?
- a. Wellness – is a continual balancing of the different dimensions of human needs – spiritual, social, emotional, intellectual, physical, occupational, and environmental.
- b. Well-being – is a subjective perception of balance harmony, and vitality. It is a state that can be described objectively, occurs at levels, and can be plotted on a continuum.
8. Define the following terms:
- a. Illness – is a highly personal state in which the person feels unhealthy or ill. Illness may or may not be related to disease. An individual could have a disease, for example, a growth in the stomach, and not feel ill. By the same token, a person can feel ill, that is feel uncomfortable, yet have no discernible disease. Illness is highly subjective; only the individual person can say he/she is ill.
- b. Disease – is a term that can be described as an alternation in body functions resulting in a reduction of capacities or a shortening of the normal life span.
- c. Deviance – is behavior that goes against social norms. Some deviant behaviors may be considered diseases according to the earlier definition of disease.
9. Differentiate between Primary prevention, Secondary prevention, and Tertiary prevention. Give an example of each.
- a. Primary prevention – is directed toward avoiding health problems before they begin and include such activities as getting immunized and practicing safe sex.
- b. Secondary prevention – occurs with the recognition of risk and taking action to reduce risk before disease gets a foothold. An example would be stopping smoking.
- c. Tertiary prevention – refers to treatment or rehabilitation, such as physical therapy following an injury to restore function.
10. Describe Leavell and Clark’s Agent-Host-Environment Model. It is considered a predictive model. What is meant by that? Give an example of how it could be used to predict illness? Wellness?
- a. The three dynamic interactive elements in this model are described as follows:
- i. Agent. Any environmental factor or stressor (biologic, chemical, Mechanical, Physical, or Psychological) that by its presence or absence can lead to illness or disease
- ii. Host. Person who may or may not be at risk or acquiring a disease. Family history, age, and lifestyle habits influence the host’s reaction
- iii. Environment. All factors external to the host that may or may not predispose the person to the development of disease. Physical environmental includes climate, living conditions, noise levels, and economic levels. Social environment includes interactions with others and life events, such as the death of a spouse
11. How does Dunn’s Health Grid differ from the Health and Wellness Continuum?
- a. Dunn’s Health Grid
- i. High-level wellness in a favorable environment. An example of this is a person who implements healthy lifestyle behaviors and had the biopsycholosocial, spiritual, and economic resources to support this lifestyle.
- ii. Emergent high-level wellness in an unfavorable environment. An example of this is a woman who has the knowledge to implement healthy lifestyle practice because of family responsibilities, job demands, or other factors
- iii. Protected poor health in a favorable environment. An example of this is an ill person whose needs are met by the health care system and who had access to appropriate medications, diet, and health care instructions
- iv. Poor health in an unfavorable environment. An example of this is a young child who is starving in a drought-stricken country
- b. Health and Wellness Continuum
- i. Physical Health – Body size, sensory acuity, susceptibility to disease, body functioning, physical fitness, and recuperative abilities.
- ii. Intellectual Health – Ability to think clearly and analyze critically to meet life’s challenges
- iii. Social Health – Ability to have satisfying interpersonal relationships and interactions with others
- iv. Emotional Health – Appropriate expressions of and control of emotions; self-esteem, trust, and love.
- v. Environmental Health – Appreciation of the external environment and the role one plays in preserving, protecting, and improving environmental conditions.
- vi. Spiritual Health – Belief in a supreme being or a way of living prescribed by religion; a guiding sense of meaning or value in life
12. List and discuss at least five predisposing factors, 5 enabling factors, and 5 reinforcing factors for influencing health behavior change.
- a. Predisposing Factors
- i. Knowledge
- ii. Beliefs
- iii. Values
- iv. Attitudes
- v. Culture
- b. Enabling Factors
- i. Adequate support, resources
- ii. Skill and abilities
- iii. Availability of health resources
- iv. Community/government priority and commitment to health
- v. Health related skills
- c. Reinforcing Factors
- i. Incentives/rewards
- ii. Family support
- iii. Peer support
- iv. Teacher support/ encouragement
- v. Employer actions/ policies
13. Differentiate between internal and external locus of control as it relates to one’s health.
- a. Locus of control – is a concept from social learning theory that nurses may consider when determining who is most likely to take action regarding health, that is, whether clients believe that their health status is under their own or others’ control.
- i. Internally – more likely than others to take the initiative in their own health care, be more knowledgeable about their health, and adhere to prescribed health care regiments
- ii. External – people who believe their health is largely controlled outside forces (luck) and is beyond their control
14. Described how the perceptions of susceptibility, seriousness, and threat may affect one’s response to a health problem. Describe modifying factors that may modify a person’s perception regarding a health problem. What factors influence the likelihood of a person taking recommended preventive health action?
15. Review the documents The world health report 2007 - A safer future: global public health security in the 21st century and WHO – Working toward the millennium at http://www.who.int/whr/2007/en/index.html
How have they changed since the WHO 2000 document Health for all in the twenty-first century (see text, p. 314)?
16. Review the goals of Health People 2010 at http://www.healthypeople.gov/About/goals.htm What are the goals of Healthy People 2010? What are the leading health indicators identified by Healthy People 2010?
17. Review the document Nursing Shortage Fact Sheet at http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm What are the factors/issues related to the nursing shortage? What strategies do you propose to ease the nursing shortage?