Intro Nursing Midterm

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  1. Roles & Functions of Nurses
    Caregiver - #1 role - physical, psychosocial, developmental, cultural, and spiritual

    Communicator - with other members of health team

    Teacher - assess clients learning needs and readiness to learn, set learning goals

    Patient advocate - protect the client - help client exercise their rights and speak up for themselves

    Counselor - provide emotional, intellectual, and psychologic support

    Change agent - help bring about change both in patients and clinical settings

    Leader - influences others to work together to accomplish a specific goal

    Manager -manages nursing care of individuals, families, and communities - delegates nursing activities to ancillary workers and other nurses

    Case Manager -works with entire health care team to measure effectiveness of case management plan and monitor outcomes

    Research consumer - use research to find posible solutions - be a discriminating consumer of research findings
  2. Nurse Practice Acts
    Purpose: to protect the public

    Nurse Practive Acts are laws that govern professional nursing practice. Each state has it's own nurse practice act that sets rules for receivng and maintaining licensure and for educational facilities.

    Nurses are responsible for knowing the Act that governs their practice.
  3. ANA Standards of Practice for the RN
    Standards of Practice describe a competent level of behavior in the professional role. "What a reasonable and prudent nurse would do in a given situation"

    1. Assessment - Collects comprehensice data pertinent to the patient's health or the situation.

    2. Diagnosis - Analyzed the assessment data to determine the diagnoses or issues

    3. Outcomes Identification - Identifies expected outcomes for a plan individualized to the patient or the situation.

    4. Planning - Develops a plan that prescribes strategies and alternatives to attain expected outcomes

    • 5. Implementation - put the plan into action
    • -A. Coordination of care
    • - B. Heath teaching and health promotion
    • - C. Consultation
    • - D. Prescriptive authority and treatment
    • - E. Treatment and evaluation

    6. Evaluation - Evaluates progress towards attainment of outcomes.

    7. Quality of practice - systematically enhances the quality and effectiveness of nursing practice

    8. Education - Attains knowledge and competency that reflects current nursing practice

    9. Professional practice evaluation - Evaluates one's own nursing practice in relation to professional practice standards and guidelines, relevant statutues, rules, and regulations.

    10. Collegiality - Interacts with and contributes to the professional development of peers and colleagues

    11. Collaboration - Collaborates with patient, family, and others in the conduct of nursing practice

    12. Ethics - Integrates ethical procisions in all areas of practice

    13. Research - Integrated research findings into practice

    14. Resource utilization - Considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.

    15. Leadership - Provides leadership in the professional practice setting and the profession.
  4. IOM recommendations for heath insurance
    Institute of Medicine reommendations:

    • 1. Heath coverage should be for everyone
    • 2. Health coverage should be ongoing/ uninterruptible
    • 3. Individuals and families need to have coverage they can afford
    • 4. A national approach nust be cost effective and able to be maintained by the society
    • 5. The care provided under this coverage must ensure care that is "effective, safe, timely, patient centered, and equitable"
  5. RN scope of Practice
    • Promotion of Health and Wellness
    • Prevention of illness
    • Restoration of health
    • Care for the dying
  6. LPN scope of practice
    • Provide basic direct technical care to clients
    • practive inder the supervision of an RN

    RN is responsible for assessing the client's condition. planning care, and evaluating the effect of the care provided.
  7. Evidence-based practive EBP
    the use of some form of substantiation in making clinical decisions

    evidence can arise from tradition, authority, esperience, trial and error, logic and reason, or research

  8. ANA Standard of Performance pertaining to research
    • Standard 13: Research
    • RN integreates research findings into practice

    Utilizes best available evidence, including research findings to guide practice decisions

    • Actively participated in research activities at variuos levels appropriate to the nurse's level of education and position.
    • -identify clinical problems specific to nursing research (patient care and nursing practice)
    • -participating in data collection
    • -participating in a formal committee or program
    • -sharing research activities and/or findings with peers and others
    • -conducting research
    • -critically analyzing and interpreting research for application to practice
    • -using research findings in the development of policies, procedures, and standards of practice in patient care
    • -Incorporating research as a basis for learning
  9. Nightingale
    Nightingale's Environmental Theory

    Definition of Nursing - the act of utilizing the environment of the patient to assist him in his recovery

    • 5 environmental factors:
    • 1. pure or fresh air
    • 2. pure water
    • 3. efficient drainage
    • 4. cleanliness
    • 5. light -esp direct sunlight

    keep client warm, maintain a noise-free environment, attend to clients diet (assess intake, timeliness of food, and effects on the person)
  10. Peplau
    Peplau's Interpersonal Relations Model

    -use of therapeutic relationship between the nurse and the client

    • 4 phases:
    • 1. Orientation - client seeks help, nurse helps client understnd the problem and extent of need for help
    • 2. Indentification - client assumes posture of dependence, interdependence, or independence in relation to nurse
    • 3. Exploitation - client derives full value from what the nurse offers in the relationship - power shifts from nurse to client
    • 4. Resolution - old goals and needs are put aside and new ones adopted
  11. Henderson
    Henderson's Defision of Nursing

    Describes nursing in relation to the client and clients environment - emphasis on importance of nursing's independence from, and interdependence with, other health care disciplines

    • Nurse's role is to assist sick or healthy individuals to gain independence in meeting 14 fundamental needs
    • 1. Breathing normally
    • 2. Eating and drinking adequately
    • 3. Eliminating body wastes
    • 4. Moving and maintaining a desirable position
    • 5. Sleeping and resting
    • 6. Selecting suitable clothes
    • 7. Maintaining body temperature with normal range by adjusting clothing and modifying the environment
    • 8. Keeping the body clean and well groomed to protect the integument
    • 9. Avoid dangers in the environment and avoid injuring others
    • 10. Communicating with others in expressing emotions, needs , fears, or opinions
    • 11. Worshipping according to one's faith
    • 12. Working in such a way that one feels a sence of accomplishment
    • 13. Playing or participating in various forms of recreation
    • 14. Learning, discovering, or satisfying the curioisity that leads to normal development and health, and using abailable health facitities
  12. Leininger
    Leininger's Cultural Care Diversity and Universality Theory

    • -care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing
    • -human caring varies among cultures in its expressions, processes, and patterns -largely culturally derived

    • Three intervention modes:
    • 1. Culture care preservation and maintenance
    • 2. Culture care accommodation, negotiation, or both
    • 3. Cuture care restructuring and repatterning
  13. Watson
    • Watson's Human Caring Theory
    • -caring-healing health model

    The practice of caring in central the nursing - it is the unifying focus for practice

    • Nursing Process
    • 1. Formation of hamanistic-altruistic system of values
    • 2. Instillation of faith-hope
    • 3. Cultivation of sensitivity to one's self and to others
    • 4. Development of a help-trusting, human caring relationship
    • 5. Promotion and acceptance of the expression of positive and negative feelings
    • 6. Systematic use of a creative problem-solving caring process
    • 7. Promation of transpersonal teaching-learning
    • 8. Provision for a supportive, protective, and.or corrective mental, physical, societal, and spiritual environment
    • 9. Assistance with gratification of human needs
    • 10. Allowance for existential-phenomenological-spiritual forces
  14. Types of heath care agencies & services
    • 1. Public health - government agencies - health agencies at the state, county, or city level (local health dept)
    • PHS - public health service, National Institute of Health, NI on Drug Abuse, Alcohol abuse, Mental Health
    • CDC - center for disease control

    2. Physician's Offices - primary care setting

    3. Ambulatory Care Centers - outpatient care, diagnostic and treatment facilities providing medical, nursing, laboratory, and radiological services

    4. Occupational Health Clinic - industrial clinic - focuses on work safety and health education, employee health screening

    5. Hospitals - for acute illness

    6. Sub-acute care - inpatient care for person with acute ilness, injury, or exacerbation of a disease process

    7. Extended care facilities (nursing homes) - different levels of care for chronically ill patients or those who are unable to care for themselves

    8. Retirement and assisted-living centers - fhr those unable to reamin at home but do not require hospital or nursing home care

    9. Rehabilitation centers - help restore health and recuperate

    10. Home health care agencies -result of earlier discharge of clients from hospitals - large scope of services - educate clients & familits and are for acute, chronic, and terminally ill patents

    11. Rural care hospitals - manage a wide variety of clients and health care problems

    12. Day care centers - for infants or elderly

    13. Hospice services - services to terminally ill, their families, and support persons

    14. Crisis centers - phone hotlines - help people cope with immedicate crisis and provide guidance and support for long-term therapy

    15. Mutual support or self-help groups - AA
  15. Healthy People 2010
    Healthy People 2010 addresses the effect of lifestyle on health and created health improvment goals

    • 1. Physical Activity
    • 2. Overweight and Obesity
    • 3. Tobacco Use
    • 4. Substance Abuse
    • 5. Responsible sexual behavior
    • 6. Mental Health
    • 7. Injury and Violence
    • 8. Environmental Quality
    • 9. Immunization
    • 10. Access to Health Care
  16. Health Promotion
    • behavior motivated by the desire to increase well-being and actualize human health potential
    • - related to lifestyle choices
    • (exercise or diet to increase overall health)
    • Healthy People 2020

    • -not disease oriented
    • -motivated by personal, positive approach to well ness
    • -seeks to expand positive potential for health
  17. Health protection
    • behavior motivated byt a desire to actively avoid illness, detect it early, or maintain functioning with the constraints of illness
    • -exercise to decrease risk of cardiovascualr disease

    motivation for behavior is main difference between health promotion and health protection

    • -illness or injury specific
    • -motivated by avoidance of illness
    • -seeks to thwart the occurrence of insults to health and well-being
  18. Stages of Health Behavior Change
    cyclic phenomenon in which people progress through several stages

    1. Precontemplation - does not intend to take action in the next 6 month

    • 2. Contemplation - acknowledges having a problem
    • - intends to change in next 6 months
    • - not ready to commit to action

    • 3. Preparation - plans to take action in the immediate future
    • -has taken steps to begin the behavior change

    4. Action - makes observable modifications in lifestyle

    • 5. Maintenance - Strives to prevent relapse
    • - integrates new bahavior into lifestyle

    6. Termination - copes without fear of relapse

    -if person does not succeed in changing behavior, relapse occurs
  19. Seven Components of Wellness
    1. Physical - able to carry out tasks, achieve fitness, maintain adequate nutrition and proper body fat, generally practive positive lifestyle habits

    2. Social - able to interact successfully with people and their environment

    3. Emotional - able to manage struess and express emotions appropriately - able to recognize, accept, express feelings, and accept ones limitations

    4. Intellectual - able to learn and use info effectively for personal, family and career developemnt

    5. Spiritual - belief in some force that unites Humans and provides meaning and purpose to life - morals, values, ethics

    6. Occupational - able to achieve a balance between work and leisure time

    7. Environmental - able to promote health measures that improve the standard of living and quality of life in the community
  20. Health
    Health - state of complete physical, mental, and social well-being

    wellness - state of well-being

    well-being - subjective perception of vitality and feeling well - can be described objectively, exerienced, and measured
  21. Models of Health
    • 1. Clinical model
    • - health is the absence of signs and symptoms of disese and injury - the state of not being sick
    • -opposite of health is disease or injury

    • 2. Role Performance Model
    • - people who can fulfill their roles are healthy even if they have a clinical illness
    • -sickness is the inability to perform ones work role

    • 3. Adaptive Model
    • - health is a creative process
    • -disease is a failure to adapt
    • -aim of treatment is to restore persons ability to adapt (cope)
    • -extreme good health is felxible adaptaion to the environment and interation with the environment to maximum advantage

    • 4. Eudomonistic Model
    • -incorporates a comprehensive view of health
    • -Health is a conditon of realizing self-actualization accoring to Maslow hierarchy of needs
    • - Illness is a condtion that prevents self-actualization

    • 5. Agent-Host -Environment Model - ECOLOGIC model
    • - health is an ever-chaning state based on three interactive elements
    • - disease occurs when variable are not in balance
    • - - a. Agent - environmental factor or stressor that by is absence or presence cna lead to illness or disease
    • - - b. Host - person who may or may not be at risk of acquireing a disease
    • - - c. Environment - all factors external to the host (physical and social) that may or may no predispost the host to the development of disease

    • Health-Illness Continua -
    • -continua (grids or graduated scales) can be used to measure a person's perceived level of wellness
    • - helath & illness on opposide ends of continua- people move back & forth on continua
    • -no distinct boundry between health and illness
  22. Culture
    nonphysical traits, such as values, beliefs, attitudes, and customs, that are shared by a group of people and passed from one generation to the next
  23. Subculture
    • people who have adistinct identity and yet are related to a larger cultural group - a subculture generally shares ethnic origin or physical characteristics with the larger cultural group
    • -occupational groups - nurses
    • -societal groups - feminists
    • -ethnic groups- cajuns
  24. bicultural
    • person who has dual patterns of identification and crosses two cultures, lifestyles, and sets of values
    • (canadians where both british & french influences are strong)
  25. diversity
    • state of being different
    • race, genderm sexual orientation, culture, ethnicity, socioeconomic status, educatinal attainment, religious affiliation, and so on
  26. prejudice
    negative belief or preference that is generalized about a group and that leads to prejedgement
  27. Cultural Nursing Care
    Leiningers Transcultural nursing - focuses on providing care within the differences and similarities of the beliefs, values, and patterns of culture

    • Professional nursing care should be :
    • 1. Culturally sensitive - nurses should posses basic knowledge of health traditions of the diverse cultural groups found in the area where they are practicing

    2. Culturally appropriate - nurse should apply that basic knowledge to give the client the best possible health care

    3. Culturally competent - nurse understands and attents to the total context of clients situation
  28. complementary medicine
    the use of rigorously tested therapies to complement those of convenrtional medicine

    ex. chiropractic, use of suppliments
  29. alternative medicine
    therapies used instead of conventional medicine and whose reliabilitly has not been validated through clinical testing in the US

    ex. iridology, aromatherapy, magnet therapy
  30. CAM
    complementary and alternative modalities
  31. Naturpathic medicine
    way of life that emphasis client responsibility, client education, health maintenance, and disease prevention

    • Naturopathic doctors have extensive training (similar to medical degree)
    • Use different CAMs to customize treatment for each patient - deitetics, therapeutic nutrition, herbs, physical theraly, spinal manipulation, acupuncture, lifestyle counseling, stress management, exercise therapy, homepthaty, and hydrotherapy
  32. Homeopathic medicine
    • self-healing system, assisted by small doses of remedies or medicaitons
    • - dangerous substances used in very small amounts to stimulate a persons self-healing capacity (serial dilution)
  33. Aromatherapy
    • therapeutic use of essential oils of plants in which the odor or fragrance plays an important part
    • -chemicals found in the essential oils are absorbed into the body, resulting in physiologic or psycholigic benefit
  34. Chiropractic
    third largest health profession in western world

    • Chiropractic practicioners believe that health is a state of balance, especially of nervous and musculoskeletal system.
    • three primary goals:
    • 1. reduce or eliminate pain
    • 2. correct spinal dysfunciton - restores biomechanical balance
    • 3. preventive maintenance to ensure the problem does not recur
  35. Music Therapy
    music is used in healing - quiet, soothing music is used to induce relaxation and distract clients - operative settings, ICU, birthing rooms, physical therapy, sleep induction units
  36. pilates
    method of physical movement and exercise designed to stretch, strengthen, and balance the body - particularly the core or center inclusing the abdominal region
  37. Biofeedback
    method for learned control of physiologic responses of the body - relaxation technique that uses electronic equipment to amplify the electrochemical energy produced by body responses
  38. animal-assisted therapy
    • specifically selected animals used as a treatment in health settings - help with physiologic & psychologic conditions -therapy, brush hair, throw object, walking dog
    • -emotional
  39. Family-centered nursing
    nursing that considers the health of the family as a unit in addition to the health of the individual family members
  40. intragenerational family
    more than two generations that live together - grandparents, or grandparents that care for granschildren
  41. Blended family
    • existing family units who join together to form new families are blended, step, or reconstituted
    • -one if every three americans is a member of a blended family
  42. family assessment
    purpose: determine the level of family functioning, clarify family interaction patterns, identify family strenghts and weaknesses, and describe the health status of the family and its members

    • 1. complete health history
    • 2. Genogram
    • 3. physical assessment
  43. family assessment guide
    • 1. Family structure - age, gender of members
    • 2. Family roles and functions - how work is shared
    • 3. Physical health status
    • 4. Interaciton patterns - openness & communication
    • 5. Family values -views on health, education, religion
    • 6. Coping resources - how the family copes
  44. signs of family violence
    burns, cuts, fractures, death, depression, alcohol and substance abuse, suicide attempts
  45. Communication Process
    The intent of comminication is to elicit a response- the process is ongoing - roles of sender and reciever change constantly

    1. Sender - Encoder - wished to convey message & chooses words to use, symbols, voice tone & hand gestures

    2. Message - what is actually said or written, body language accomapning the words, & how message is transmitted

    3. Reviever - decoder - must listen, observe and attend. must percieve what the sender intended (interpretation) - decode -to sort out the meaning of the message

    • 4. Response - feedback - message that reciever sends back to the sender - can be verbal, nonverbal, or both
    • feedback allows sender to know if reciever received the message properly and if they need to correct or reword a message
  46. Modes of Communication
    • Verbal Communication - spoken or written words
    • largely conscious becuase people choose what they say

    • 1. Pace and intonation - how fast & tone can impact meaning of words
    • 2. Simplicity - use of commonly understood words
    • 3. Clarity and Brevity - direct and simple
    • 4. Timing and relevance - timing needs to be appropriate to be sure that words are heard
    • 5. Adaptability - if client is distressed, nurse should modify tone and facial expression to show concern for the client.
    • 6. Credibility - nurses foster by being consistant, dependable, and honest
    • 7. Humor - can be positve but must be used with care

    Nonverbal communication - body language

    • 1. Personal appearance - may convey social and financial status, culture, religion, group association, and self-concept
    • 2. Posture and Gait - can indicate self-concept, current mood, and health
    • 3. Facial expression - very expressive - nurse must control their facial expressions
    • 4. Gestures -may be used to clarity spoken words or to communicate needs
  47. Therapeutic Communication
    • Promotes understnading and can help establish a constructive relationship between the nurse and the client
    • -client and goal directed - nurse responds to clients verbal message and feelings expresses

    • Techniques:
    • 1. Using silence - dont fill the silence
    • 2. Providing general leads - make statements that encourage client to talk
    • 3. Being specific and tentative
    • - - tentative -general statement that allows open response (you seem....)
    • - - specific - statements that are looking for specific answer or answers (rate pain on 1-10)
    • 4. Using open-ended questions
    • 5. Using touch
    • 6. Restating or rephrasing - actively listen & repeat key thoughs or feelings
    • 7. Seeking clarification -
    • 8. Perception checking - clarify the meaning of a specifc word rather than the overall meaning (my husband never gives me presents)
    • 9. Offerring self - offering to stay or help
    • 10. Giving information - simple and direct
    • 11. Acknowledging - recognizing a change in behavior or an effort the client made
    • 12. Clarifying time or sequence - help clarify an event, situation or happeing in relation to time
    • 13. Presenting reality - help differentiate real form unreal
    • 14. Focusing - help client expand on and develop a topic of importance - idea or feeling - nurse should let client state main concerns before attempting to focus
    • 15. Reflecting - directing feelings, questions, and ideas back to client to help them explore their own ideas and feelings
    • 16. Summarizing and planning - state main points to clarify relevant points discussed
  48. Barriers to Communication
    • Too many questions
    • Close-ended questions
    • Asking “Why?”
    • Changing the subject abruptly
    • Failing to listen
    • Failing to explore issues in detail
    • Expressing approval or disapproval
    • Offering advice
    • Giving false reassurance
    • Stereotyping
    •  Using patronizing language
  49. Learning Theories
    • Behaviorism
    • Learning is based on the learners behavior
    • • Pavlov & Skinner-Conditioning, stimulus and response, and positive reinforcement
    • • Bandura-Observational learning and instruction (imitation and modeling)

    • Cognitivism
    • • Piaget, Lewin, & Blood -Learning is a complex cognitive activity
    • -Learner structures and processes information
    • -Perception chosen by learner
    • -Personal characteristics impact perceptions
    • -Social, emotional, and physical contexts

    • Humanism
    • • Maslow, Rogers -Learning is self-motivated, self-initiated, and self evaluated
    • -Focus on cognitive and affective qualities of learner -Learning best when relevant to the learner -Autonomy and self determination of learner important -Learner is an active participant and takes responsibility for meeting learning needs
  50. Domains of Learning (Blooms Taxonomy)
    • Cognitive Domain
    • • “Thinking” domain
    • • Knowledge
    • • Comprehension
    • • Application
    • • Analysis
    • • Synthesis
    • • Evaluation

    • Affective Domain
    • • ”Feeling” domain
    • • Feelings
    • • Emotions
    • • Interests
    • • Attitudes
    • • Apprehensions

    • Psychomotor Domain
    • • ”Skill” domain
    • • motor skills
  51. Factors affecting learning
    • • Motivation
    • • Readiness
    • • Active involvement
    • • Relevance
    • • Feedback
    • • Nonjudgmental Support
    • • Organizing material from simple to complex Factors Affecting Learning
    • • Repetition
    • • Timing
    • • Environment
    • • Emotions
    • • Physiologic events
    • • Culture
    • • Psychomotor ability
  52. Assessment of Learning Needs
    • • Nursing History
    • 1. age
    • 2. Clients understanding of the health problem
    • 3. Health beliefs and practices
    • 4. Cultural Factors
    • 5. Economic factors - cant afford supplies
    • 6. Learning style -
    • 7. Client support system

    • • Physical Examination -
    • 1. mental status
    • 2. energy level
    • 3. mutritional status
    • 4. physical capacity

    • Readiness to Learn
    • 1. Physical readiness - is client able to focus
    • 2. Emotional readiness - anxious, depress = not ready
    • 3. Cognitive readiness - able to think clearly at this point

  53. Components of Self-concept
    • Personal Identity
    • • Conscious sense of individuality and uniqueness
    • • Constantly evolves throughout life
    • • Includes name, gender, age, race, culture, occupation, talents
    • • Includes beliefs, values, personality, character
    • • Distinguishes self from others

    • Body Image
    • • Image of physical self
    • • How a person perceives size, appearance, functioning of body and its parts
    • • Has cognitive aspects
    • • Has affective aspects
    • • Includes clothing, hairstyle, make-up, accessories, prostheses
    • • Develops from attitudes and responses of others and from self-exploration

    • Role Performance
    • • Relates what a person in a particular role does to the behaviors expected of a role
    • • Role mastery = person’s behaviors meet social expectations
    • • Failure to master role creates frustration, feelings of inadequacy and lowered self-esteem
    • • Self-concept also affected by role strain and role conflicts (role strain - they feel inadequate to fullfill role) (role conflict - differing role expections)

    • Self-Esteem
    • • One’s judgment of one’s own worth
    • • Global – How much one likes oneself as a whole
    • • Specific – How much one approves of a specific part of oneself
    • • Derived from self and others
    • • Foundation established during early life experiences • May change from day to day or moment to moment
  54. Self-concept
    Formation of Self- Concept
    Self-concept - one's mental inage of oneself

    • Formation of Self-concept (Erickson)
    • • Self concept develops through social interaction
    • • People face developmental tasks
    • • Success in coping with these tasks determine self concept
    • • Difficulty in coping results in problems with self concept
  55. Factors that Affect Self-Concept
    • 1. State of Development
    • 2. Family and culture
    • 3. Stressors -how a person handles stressor depends on personal resources
    • - coping = +self-concept
    • - inability to cope = maladaptive response (substance abuse, withdrawal, anxiety)
    • 4. Resources
    • internal = confidence and values
    • external = support network, sufficient finances, organizations
    • 5. History of Success and Failure
  56. Spiritual Needs
    • Self Needs:
    • need for meaning, purpose, ability to express creativity, hope, personal dignity, gratitude, vision

    • Other needs:
    • need to forgive others, cope with loss of loved one

    • God Needs
    • need to be certain there is a God or umtimate power in the universe, need to beleive that God is loving and personally present, need to worship

    • Group needs:
    • need to contribute or improve ones community, need to be respected and valued, need to know what and when to give and take
  57. Spiritual well-being (spiritual health)
    manifested by feeling of being generally alive, purposeful, and fulfilled
  58. Spiritual distress
    challence to the spiritual well-being or belief system that provides strength, hope, and meaning to life

    • -lack of hope, maining and purpoe in life
    • -unable to forgive self
    • -feels abondoned by God
    • -withdraws from family and friends
    • -sudden change in spiritual practice
  59. Key Concepts of Spirituality
    Religion - organized system of beliefs and practices

    Faith - to believe in or be commited to something or someone

    • Hope - process of anticipation that involves the interaction of thinking, acting, feeling, and relating, and is directed toward a future fulfillment that is personally meaningful
    • not hope = client gives up

    Transcendence - recognize that there is something other or greater than the self

    Forgiveness - of self and others, seeking forgiveness from God
  60. Beliefs reated to Birth
    Beliefs Related to Death
    Muslim- call to prayer recited in infants ear, child is names and tuft of hair taken on 7th day

    Christian - baptism or christening

    • Jewish - circumcision & naming on eighth day
    • females names on Sabbath after birth

    • Death:
    • Roman Catholis - sacrament of the sick - last rites

    Muslins - body or head turned toward Mecca - ritual bath after death by family member or ritual burial society

    Jews - burial within 24 hrs (except on Sabbath) - ritual bath after death

    Tibetan Buddhists - read bood of the dead within 7 days to release soul

    Hindus - cremate body within 24 hours to realease soul
  61. Defense Mechanisms
    • unconcoius psycoligic adaptive mechanisms
    • -the unconsciuos mind working to protect the person form anxiety
    • -precursors to conscious cognitive coping mechanisms the will ultimately solve the problem

    1. Compensation - covering up weakness by overachievement in another area (allow person to overcome weakness & achieve success)

    2. Denial - refusing to ignore unacceptable realities

    3. Displacement - transferrance of emotional reactions from one object or person to another - mad at wife, hits doctor

    4. Identification - manage anxiety by imitating the behavior of someone feared or respected (help person avoid self-devaluation)

    5. Intellectualization - evade emotional response by use of rational explanations (protect person from pain of tramautic events)

    6. Introjection - acceptance of other's norms and values into oneself, even when contrary to ones prevuios beliefs (important for child development of Superego)

    7. Minimization - not acknowledging the significance of ones behavior

    8. Rationalization - justifcation of behavior by foualty logic or ascribing motives that are socially acceptable (helps person cope with inability to meet goals or standards)

    9. Projection - blaming others or the environment for shortcomings and mistakes (protects self-image)

    10. Reaction formation - causes people to act exactly opposite to the way they feel (allows feelings to be acted out in a more acceptable way))

    11. Regression - resorting to earlier level of functioning that is less demanding and responsible

    12. Repression - unconscious mechanism by which threatening thoughs, feelings, and desires are kept from becoming conscious - repressed material id denied entry into consciuosness (protects person from tramatic experiences until they have resources to cope)

    13. Sublimation - displacement of energy associated with more primitive sexual or aggressive drives into socially acceptable activities (protects person from behaving in irrational, impulsive ways)

    14. Substitution - replacement of a highly valued, unacceptable, or unavailable object by a less valuable, acceptable or available object

    15. Undoing - action or words designed to cancel some disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation
  62. Minimizing anxiety
    quick action may be necessary to avoid contagious anxiety

    • - encourage client to take deep breaths before injection
    • - explain procedures before they are implemented
    • - administer massage to help client relax
    • - offer support to families

    • -listen attentively
    • -provide warmth and trust
    • -stay with clients as needed
    • -control environment
    • -implement suicide precautions if needed
    • -communicate in short clear sentences

    • Help client:
    • -determine situatuions that cuase anxiety and signs of anxiety
    • -verbalize feelings and fears
    • -identify personal strenths
    • -recognize usual and postive coping patterns
    • -find new strategies for managing stress (exercise, message)
    • - identify support systems

    • Teach client:
    • -importance of exercise, diet, rest, sleep to enhance coping abilities
    • -support groups avialable - AA
    • - educational programs available - time management, assertiveness training, meditation groups
  63. Mediating Anger
    Anger from clients can elicit fear and anger in nurse- nurse may respond is manner that intensifies clients anger

    Nurses tend to respond in a way that reduces their own stress rather than the clients

    • 1. Know your own response to feelings and expressions of anger
    • 2. Accept clients right to be angry - feelings are real and cannot be discounted or ignored
    • 3. Try to understand the meaning of the clients anger
    • 4. Ask client what contributed to the anger
    • 5. Help client own anger - do not assume responsibility for their feelings
    • 6. Let client talk about anger
    • 7. Listen to client & act as calmly as possible
  64. self-awareness
    • relationship between one's perception of herself and others' perceptions of her
    • -a nurse who is very self-aware has perceptions that are very congruent
    • -becoming more self-aware require time and energy and it never complete,
    • -nurse uses introspection - nurse must consider her own beliefs, attitudes, motivations, strenghts, and limitations
Card Set:
Intro Nursing Midterm

Intro Nursing Midterm Review
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