Health Promotion: Primary Prevention
things we do to prevent disease & promote health
Health Promotion: Secondary Prevention
screening tests for disease
- Sensitivity: picks up a disease when disease is present (without too many false positives)
- Specificity: correctly identifies when disease is not present
Health Promotion: Tertiary Prevention
taking medicine/ disease management
Health Disparities
differences in the quality of care received by minorities and non-minorities who have equal access to care.
Based on conscious or unconscious thought process
ex. treating 2 patients with similar conditions differently based on types of insurance they have
Six Aims for Improvement of the Healthcare System (IOM):
- Safe: avoiding accidental injuries
- Effective: providing services based on scientific knowledge (evidence-based)
- Patient-Centered: providing care that is responsive to individual patient preferences, needs and values
- Timely: reducing waits and harmful delays
- Efficient: avoiding waste
- Equitable: care does not vary in quality because of personal characteristics
Attributes of Patient-Centered Care
Empathy: treating patients how you want to be treated
Communication: encouraging active communication between the healthcare team & patient
Holistic Care:
treating a patient based on complete physical, mental, and social well being, not merely absence of disease or infirmity
Steps of the Nursing Process
ADPIE
- Assessment: gathering patient care data through observation, interviews, and physical assessment
- Diagnosis: Analyze, validate, and cluster patient data to identify patient problems
- Planning: Prioritize the nursing diagnosis and identify short/long term goals that are realistic, measurable, and patient focused
- Implementation: Initiate specific nursing interventions and treatments designed to help the patient achieve established goals and outcomes
- Evaluation: Determine whether the patients goals are met, examine effectiveness, and decide whether the plan of care should be discontinued or revised
Assessment
Data collection:
Primary Data: patient interview
Secondary Data:
-Subjective Data: verbal communication, signs/symptoms told by patient
-Objective Data: signs observed/ measured/ tested
Nursing Diagnosis
Looks at patient problems, clusters to find a common problem
- Actual Nursing Diagnosis: a problem already exists, trying to prove the problem. Identified by signs/ symptoms
- Risk Nursing Diagnosis: a potential problem. Assessment findings suggest the patient is at risk
Actual Nursing Diagnosis
A problem already exists. Trying to prove the problem by identifying signs/ symptoms
3 parts: problem, etiology, symptoms
formula: PROBLEM related to PATHOPHYSIOLOGY as evidenced by SIGNS/ SYMPTOMS
Risk Nursing Diagnosis
a potential problem, identified by signs/ symptoms
2 parts: problem, risk factors
formula: PROBLEM due to RISK FACTORS
Planning
- prioritizes a patients various diagnosis
- create short & long term goals
- chooses outcome indicators & identifies interventions to address patient goals
Goals= things the patient will do to improve
Goals must be SMART
Specific Measurable Appropriate to patient Realistic Timeframe (have a timeframe specified)
Implementation
initiation of interventions to meet patient needs.
Clinical Pathways: multidisciplinary resources to guide patient care
Protocols: standard procedures
Standing Orders: to be carried out when certain criteria is met
Evaluation
Patients response to nursing interventions and goal or outcome attainment
- care plan evaluation
- continue or discontinue treatment
- revise/adapt treatment
Development
sequence of physical, psychosocial, and cognitive changes that take place over the human lifespan
- physical growth: measured in numerical changes
- differentiation: growth @ cellular level
- developmental tasks
- maturation
Order of Developmental Stages
Infant Toddler Preschool School Age Adolescent Young Adult Middle Adult Older Adult
Developmental Milestones
Specific skills most individuals achieve at a certain age
Used to identify developmental delay or regression
Principles of Intervention
#1 Early identification and early intervention are critical #2 Specific interventions are dependent on category, age & type of developmental delay #3 Management requires interdisciplinary collaboration
Sigmund Freud: Psychoanalytic/Psychosexual Development
Personality grows, develops, & changes during lifespan
ID: Unconscious, present @ birth, generates impulses that seed immediate satisfaction
EGO: view of self/ what one wants others to see
SUPEREGO: 3-5 yrs. delays immediate gratification for socially appropriate reasons, recognition of good and bad, moral guide/ conscience
*5 stages of psychosexual development
5 Stages of Psychosexual Development (Freud)
- Oral (0-1): Mouth/sucking
- Anal (Toddler): Self-control of bowels/ potty training
- Phallic (Preschool): self-centered, masturbation, identifies with parent of opposite sex
- Latency (School Age): focuses on industry, achievement & skills
- Genital (Puberty): seeks mutual pleasure with a partner, sexual urges
Oral Stage of Development
0-1 yr
focuses on mouth & need to suck
Anal Stage of Development
Toddler
learning self control of bowels
Phallic Stage of Development
Preschool
self-centered, masturbation, child identifies with parent of opposite sex
Latency Stage of Development
School Age
surprises sexual urges, focuses on achievement & skills
Genital Stage of Development
Puberty
sexual urges involving opposite sex, seeks mutual pleasure with partner
Defense Mechanisms for Coping
- Rationalization: excuse for behavior
- Repression: Forced forgetfulness
- Projection: onto another person
- Agression/Regression: going backward in developmental stages
Jean Piaget: Cognitive Theory of Development
4 stages of development related to learning to understand and relate logically to the world
cognitive milestones involving sensory & motor interactions with the world
Sensorimotor Stage of Cognitive Development
Piaget’s 1st stage:
0-2:
object permanence, cause & effect, time of day
Preoperational Stage of Cognitive Development
Piaget’s 2nd stage:
2-7:
pretend play, self-centered, language explosion
Concrete Operations Stage of Cognitive Development
Piaget’s 3rd stage:
7-11:
understands more than 1 piece of info, realistic understanding, present focused
Formal Operations Stage of Cognitive Development
Piaget’s 4th stage:
Adolescent:
abstract & logical thinking, future oriented, social & moral rules
4 Stages of Cognitive Development (Piaget)
- Sensorimotor (0-2): object permanence, cause/effect, time awareness
- Preoperational (2-7): pretend play, self-centered, language explosion, logic development
- Concrete Operations (7-11): Realistic, present oriented, processes more than 1 idea
- Formal Operations (12+): abstract thinking, future oriented, scientific understanding, social & moral rules
Erik Erikson: Psychosocial Theories of Development
personal development dependent upon social environment & interactions. each stage involves a social crisis that must be positively resolved to successfully pass on to the next stage Trust v. Mistrust Autonomy v. Shame & Doubt Initiative v. Guilt Industry v. Inferiority Identity v. Role Confusion Intimacy v. Isolation Generativity v. Self Absorption Integrity v. Despair
Trust vs. Mistrust
Eriksons 1st stage:
Infant: 0-1
develops trust to meet personal needs, begins to trust himself/herself
Autonomy vs. Shame and Doubt
Eriksons 2nd stage:
Toddler: 1-3
independent, potty training, trusting oneself to be good
Initiative vs. Guilt
Eriksons 3rd stage:
Preschool: 3-6
imitates role models, follows rules, self control in social interactions
Industry vs. Inferiority
Eriksons 4th stage:
School age:
ability to make friends, individually achieve school tasks
Identity vs. Role Confusion
Eriksons 5th stage:
Adolescent:
learns to know oneself & what one believes (career goal)
Intimacy vs. Isolation
Eriksons 6th stage:
Young Adult:
ability to share all aspects of life with others (intimate relationships)
Generativity vs. Self Absorption
Eriksons 7th Stage:
Middle Adult:
contributes to society in a meaningful way
Integrity vs. Despair
Eriksons 8th stage:
Older adult: geriatric
reflecting on life, sense of life achievement
Maslow’s Hierarchy of Needs
Basic needs must be met in order to move toward self-fulfillment
Kohlberg’s 3 Stages of Moral Development
a set of social rules that enables a person to differentiate between right and wrong
Preconventional (toddler, early childhood): obeys rules to avoid punishment
Conventional (school age): conforms to rules to gain recognition/ reward
Postconventional (adolescent, adult): follows rules leading others to believe they are “good”, sense of responsibility
(older adult): develops own sense of principles, independent
The period of infancy
4 weeks to 1 year
toddler age period
1-2 years
preschool age period
2-6 years
school age period
6-12 years
adolescent age period
12 plus years
separation anxiety begins at this age
6 months
pincer action
grasp small objects with the thumb and forefinger around 9 months of age
weight of a child of 1 year
triple the birth weight
tasks to be mastered during early childhood
walking, bowel control, visual maturity
toddler-age child in which of Erikson’s stages?
autonomy vs. shame and doubt
preschool-age child is in which of Erikson’s stages?
initiative vs. guilt
between 12 and 24 months of age, child’s speech includes
three to four word sentences
best disciplinary technique
rewarding good behavior
middle childhood includes children between the ages of
6 and 12 years
a major developmental task of middle childhood
developing positive self esteem and a positive self image
middle childhood play activities
competitive games
middle childhood includes Erikson’s stage of
industry
length & weight of typical newborn
20 inches long
7.5 lbs
length at 1 year old
birth length increases 50%
infant’s weight at 6 months
double birth weight
infant’s weight at 1 year
triple birth weight
emotional development of infant
mimic facial expressions
stranger anxiety
begins at 9 months; doesn’t feel comfortable with strangers
Language development of infant
receptive before expressive, nonverbal, few words by 1 year
sleep patterns of infants
self-regulating skills to return to sleep without prompting
Infant nutrition
breast milk/ formula for 1 year feed every 2-3 hours no solid food before 6 months high fat cows milk at 1 year introduce 1 food at a time (allergies) vegetables 1st, fruits 2nd meat & eggs at 11 months can move to normal eating schedule at 1 year
Infant: Teeth
primary teeth begin at 5-7 months
#months-6= #teeth
teething/chewing/fussy/ drooling
Early Childhood: Walking
begins 12-15 months
Early Childhood: Nutrition
solid foods
plate= fruits, veggies, grains and protein
Toddler: Language
receptive before expressive
1st clear word
responds to simple commands
Preschooler: Language
occurs rapidly
5 years= more than 2000 words
Middle Childhood: Physiological
grows 1-2 inches/year on average
bones growing
starts to lose teeth
mature GI tract & sensory organs
Three phases of moral behavior
- Knowledge- knowing what is right
- Emotion- feeling good/bad about what you did
- Action- behaving according to the rule of what is right
Parallel Play
1-3 years
playing side by side without interaction
Cooperative Play
3-5 years
playing together