CHAPTER 1 HEALTH ASSESSMENT
Learning Outcomes 1. Distinguish various definitions of health. • Suggested Classroom Activity: Ask students to distinguish between the older traditional definition of health and the current definitions of health. •
Suggested Clinical Activity: Have students ask a healthcare provider which model of health he or she incorporates in to his or her practice.
2. Relate the goals and objectives of Healthy People 2020 to health assessment in nursing. • Suggested Classroom Activity: Ask students to review the health topics in Healthy People 2020 listed in this chapter and then ask students to provide one healthcare topic they would add to the list of public health concerns and discuss the importance of that topic. •
Suggested Clinical Activity: Ask students to discuss with a healthcare provider how he or she incorporates the goals and objectives of Healthy People 2020 into his or her practice.
3. Explain the steps of the nursing process. • Suggested Classroom Activity: Ask students to choose a healthcare topic of public concern and discuss how they will utilize different elements of the nursing process— assessment, diagnosis, planning, implementing, and evaluation—in assessing that problem in a community or a population. •
Suggested Clinical Activity: Ask students to discuss with a registered nurse the benefits of using the nursing process in managing patients’ care.
4. Identify the key components of health assessment in nursing. • Suggested Classroom Activity: Ask students to discuss the relationship between effective communications and obtaining accurate data in performing a client’s health assessment. •
Suggested Clinical Activity: Ask students to conduct a focused interview related to an impaired body system of a patient.
5. Explain the role of the professional nurse in health assessment. • Suggested Classroom Activity: Ask students to discuss the importance of confidentiality in obtaining a client’s health history. •
Suggested Clinical Activity: Ask students to discuss with a registered nurse the advantages and disadvantages of using electronic medical documentation.
6. Apply the critical thinking process to health assessment in nursing. • Suggested Classroom Activity: Ask students to discuss the role of evidence-based practice in critical thinking. •
Suggested Clinical Activity: Ask students to discuss with a registered nurse his or her definition of critical thinking and explain how he or she uses critical thinking in delivering patient care.
7. Outline the key elements of an effective teaching plan. • Suggested Classroom Activity: Ask students to assume the role of educator and choose two teaching methods. Compare and contrast the advantages and disadvantages of these two methods. •
Suggested Clinical Activity: Ask students to list factors and patient considerations that they must contemplate in developing a health education presentation for a specific population.
Key Concepts 1. Changes in healthcare reform continue to impact professional nursing. 2. Nurses’ roles are influential in community health, health promotion, and disease prevention. 3. Nurses have greater responsibilities beyond the acute care setting including managing the care of consumers of various ages and diverse communities. 4. Nurses are part of a large group including government, communities, and individuals capable of improving access to health care and facilitating changes in the nation’s health. 5. Healthy People 2020 focuses on eliminating preventable health issues in the United States as well as developing equity of health and health resources. 6. Healthy People 2020 focuses on health promotion, screening, preventive measures, and improving health behaviors across the life span. 7. The health topics and objectives of Healthy People 2020 focus on both individuals and communities. 8. Healthy People 2020 encompasses the changing population demographics of the United States as well as cultural, ethnic, geographic, linguistic, and socioeconomic factors that affect health. 9. The World Health Organization defines health as a state of complete physical, mental, and social well-being (1947). 10. The modern definition of health encompasses a holistic approach that includes physical, psychological, and spiritual components. 11. Wellness reflects a lifestyle that encompasses balance, personal satisfaction, the ability to cope and adapt, and to enhance one’s quality of life. 12. Health encompasses both wellness and health promotion. 13. Nursing theorists have developed several definitions and models of health that reflect client holism.
14. Nursing strives for a holistic approach to health that reflects physical, cultural, environmental, psychological, and social factors. 15. Health assessment is systematic data collection from a patient for the purpose of determining the patient’s health status, assessing health-related risk factors, identifying health-promoting activities, and identifying health education needs. 16. Health assessment includes the interview, physical assessment, documentation, and interpretation of findings. 17. Health assessment data collection should be holistic and include physical, social, cultural, environmental, and emotional factors. 18. Effective communication is a key component in collecting accurate subjective and objective patient data.
19. The nurse uses knowledge of physical and social science in health assessment data collection. 20. Thorough and accurate health assessment forms the foundation of the patient’s plan of care. 21. Level of assessment may differ based on patient status, for example, ambulatory patients, hospitalized patients, or critical patients. 22. The nursing process is a systematic process used by professional nurses to manage patients and provide patient care. 23. The nursing process is applicable to individuals, communities, and to varying populations; to patients of all ages; and is applicable in all levels of health and stages of illness. 24. The nursing process involves five stages: assessment, diagnosis, planning, implementation, and evaluation. 25. The nursing process is a complex process that combines critical thinking, effective communication, and the expansive knowledge base of nursing education. 26. Effective use of the nursing process is predicated upon comprehensive and accurate data collection.
27. Critical thinking is a process of purposeful and creative thinking about resolutions of problems or developing ways to manage situations. 28. Critical thinking is composed of five essential elements: collection of information, analysis of the situation, generation of alternatives, selection of alternatives, and evaluation. 29. Each element in critical thinking consists of skills to assist the nurse in developing a complete, thorough, and competent assessment. 30. Critical thinking applies logic and cognitive skills to the complexities of patient care. 31. Nurses apply critical thinking skills, their knowledge, and available resources to assist patients in achieving their health goals and maintaining their well-being. 32. In the role of educator, the nurse assists patients in maintaining and improving their health, preventing illnesses or injury, managing therapies, and making informed decisions about health and treatment. 33. The nurse teaches patients based on patients’ comprehensive health assessment, patients’ knowledge deficits regarding identified risks, and patients’ readiness to learn. 34. The nurse teaches patients based on the three categories of NANDA-I diagnoses: actual health problems, risk of developing a health problem, and state of wellness. 35. Nurses engage in both informal and formal teaching modalities. 36. The six major components of formal teaching are identified learning needs, teaching goals, learning objectives, content, teaching strategies and appropriate rationales, and evaluation.
CHAPTER 2 HUMAN DEVELOPMENT ACROSS THE LIFE SPAN
Learning Outcomes 1. Relate the principles of growth and development to the nursing process. • Suggested Classroom Activity: Ask students to discuss environmental factors, internal and external, that affect growth and development that nurses must consider in assessing clients across the life span. •
Suggested Clinical Activity: Ask students to choose an adult client and discuss his or her life accomplishments or milestones. Determine if the client has met the developmental milestones appropriate for his or her age according to Erikson’s psychosocial theory.
2. Examine theories of development. • Suggested Classroom Activity: Ask students to briefly paraphrase the three major theories of development and identify the major differences between two of these theories. •
Suggested Clinical Activity: Ask students to select a client age 40 or older and discuss his or her developmental milestones across the life span. Ask students to provide examples that demonstrate successfully meeting milestones according to Erikson’s psychosocial theory.
3. Appraise stages of development. • Suggested Classroom Activity: Ask students to summarize the importance of height, weight, and head circumference in assessing physiological growth of infants. •
Suggested Clinical Activity: Ask students to observe an infant interacting with a parent or primary caregiver and determine goodness of fit between the infant and caregiver. Ask students to note positive and negative observations and suggestions of what can be done to improve interactions between the infant and the adult.
4. Differentiate between various tools used for measurement of growth and development across the age span. • Suggested Classroom Activity: Ask students to compare and contrast the Denver Developmental Screening Test II and the Child Development Inventory.
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Suggested Clinical Activity: Ask students to select a geriatric client and administer the Geriatric Depression Scale. Recommend follow-up to professional staff should the client produce a score greater than 5.
5. Examine growth and development in relation to health assessment. • Suggested Classroom Activity: Ask students to pair off and practice role-playing communication methods when assessing the adolescent patient. •
Suggested Clinical Activity: Ask students to observe adolescents in a group setting. Record methods of communication and interaction including verbal and nonverbal communication as members of the group interact.
6. Appraise factors that influence growth and development. • Suggested Classroom Activity: Ask students to explain the importance of nutrition to growth and development. •
Suggested Clinical Activity: Ask students to select a patient with an international or ethnic background. Discuss with the patient their family cultural practices that differ from Western or typical American norms and what healthcare providers should know about his or her culture or subculture.
Key Concepts 1. Nurses’ knowledge of normal growth and development across the life span is essential in order to determine abnormalities when assessing patients. 2. Nursing interventions across the life span should reflect and synchronize with the health-related goals of Healthy People 2020. 3. Growth is defined as measurable physical changes that are normally rapid in infancy, slower in childhood until puberty, and slow in adulthood. 4. Development reflects a dynamic and progressively complex evolution of several aspects of the total person beyond physical changes. 5. Rates of growth and development vary based on heredity as well as environmental factors such as nutrition, family, religion, climate, culture, school, community, and socioeconomic status. 6. A single theory does not encompass all aspects of human development. 7. Cognitive theory explores how individuals learn to think, reason, and use language. 8. Piaget theorized that cognitive development is orderly and occurs in four stages: sensory motor, preoperational skills, concrete operations, and formal operations. 9. Psychoanalytical theory is based Freud’s theories of personality development and the structures of personality: the id, ego, and super ego. 10. Psychoanalytical theory posits that children pass through five stages of psychosexual development in which needs must be met without overindulgence or fixation: oral phase, anal phase, phallic phase, latency phase, and the genital stage.
11. Erikson’s psychosocial theory describes eight stages of ego development across the life span. 12. Tasks in each of Erikson’s stages must be met in order to achieve the essential task or milestone in the next stage. 13. Infancy describes ages 1 month to 1 year. 14. Infants develop close relationships with their primary caregiver, and interact with and relate to their environment.
15. Height, weight, and head circumference measurements provide the most consistent growth markers of infants.
16. Early development, infancy to adolescence, focuses on motor development based on neurological maturity, language development, cognitive development, and psychosocial development. 17. Young adulthood represents independence from parents and choices in lifestyle and career. 18. Middle-age adulthood is a time for evaluation of the past and adjustment for the future. 19. Middle-age adulthood represents the beginning of physiological signs of aging such as hormonal changes in both men and women and visual decline. 20. Older adults vary greatly in both psychosocial and physical changes, but generally include adjusting to declining health and physical strength, adjusting to retirement, adjusting to death of friends and spouse, conducting a life review, and preparing for death.
21. Health assessment includes gathering objective and subjective data to develop plans to maintain health or address health needs in patients of all ages. 22. When conducting health assessments, the professional nurse must be able to obtain accurate data and interpret findings in relation to expectations and predicted norms and ranges for patients at various stages of physical and emotional development.
23. Knowledge of anatomical and physiological changes as well as theoretic information about cognitive, psychoanalytical, and psychosocial events and expectations at each stage of human development is invaluable for the nurse. 24. Health assessment includes the use of clinical growth charts to index individual patient measurements of height and weight (and head circumference in infants) as expected normal values for age and gender. 25. In addition to expectations about physical growth and development, there are expectations about cognitive, psychosocial, and emotional development across the age span. 26. Numerous standardized instruments and tools measure growth and assessment from infancy to older-adulthood. 27. Many instruments assess depression, stress, intelligence, and several other personality traits and characteristics. 28. The U.S. Preventive Services Task Force (USPSTF) provides numerous health screening and assessment tools across the life span as preventive measures to healthcare problems. 29. The Geriatric Depression Scale is one instrument that assesses elements of depression in the older-adult population. 30. Malnutrition can delay and prevent growth and development.
31. Slow growth of a child, when compared to growth charts, may indicate inadequate nutrition. 32. The family reflects a social system that influences physical and emotional development and influences values and rituals, safety, nutrition, and support. 33. Cultural factors such as child rearing and family roles influence growth and development. 34. Socioeconomic status is a major factor in growth and development of children. 35. Poverty impacts the ability of a family to meet nutritional needs of children and affects children’s health status and their physical well-being.
CHAPTER 3 WELLNESS AND HEALTH PROMOTION
Learning Outcomes 1. Distinguish between concepts of wellness and health promotion. • Suggested Classroom Activity: Instruct students to ask a fellow student to distinguish between the concepts of wellness and health promotion. •
Suggested Clinical Activity: Ask students to interview a healthcare provider and ask the provider how he or she implements health promotion activities in caring for patients.
2. Compare and contrast selected theories of wellness. • Suggested Classroom Activity: Ask students to select a wellness theory they believe to be applicable to their patient population and discuss their reasons for choosing the theory. •
Suggested Clinical Activity: Ask students to discuss wellness theories with two healthcare providers and determine if wellness and wellness theory are active parts of the providers’ patient care model.
3. Relate perspectives of health promotion to the individual, family, and community. • Suggested Classroom Activity: Ask students to list their personal and current health promotion activities. •
Suggested Clinical Activity: Ask students to review a patient’s admission record and note if health promotion activities are included in the general admission assessment. Interview the patient to determine his or her participation in health promotion activities.
4. Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice. • Suggested Classroom Activity: Ask students to develop a list of determinants they believe affect individual and community health without referring to the text or to the Healthy People 2020 website. Then have students review determinants on the Healthy People 2020 website or the text and compare to their individual lists. Ask students to discuss the similarities and differences between their list and the Healthy People 2020 list.
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Suggested Clinical Activity: Ask students to interview a patient and determine the patient’s familiarity with Healthy People 2020, its goals, and its objectives. Ask students to discuss what can be done to increase individual and community awareness of Healthy People 2020.
5. Demonstrate how to use the nursing process to encourage health promotion. • Suggested Classroom Activity: Ask students to interview each other and develop a diagnosis related to a potential problem. Instruct students to use the nursing process, and with the interviewed student develop interventions and plans for implementation and for evaluation of progress. •
Suggested Clinical Activity: Ask students to interview a patient and develop a diagnosis on an identified current, ongoing, or potential problem. Instruct students to use the nursing process, and with the patient, develop interventions and plans for implementation and for evaluation of progress.
Key Concepts 1. Wellness describes a state of life that is balanced, personally satisfying, and characterized by the ability to adapt and to participate in activities that enhance quality of life.
2. Major concepts of wellness include decisions regarding self-responsibility, nutrition, fitness, stress management, emotional growth and well-being, personal safety, and health care.
3. Perceptions of wellness influence the nurse’s approach to patient care.
4. The nurse focuses on patients’ personal strengths and their abilities to enhance their health.
5. The nurse focuses on the wellness concerns specific to each patient including, when appropriate, the patient’s spiritual and end-of-life needs.
6. Dunn defines wellness for the individual as an integrated method of functioning focused on maximizing the individual’s potential.
7. Leavall and Clark describe the levels of prevention as primary, secondary, and tertiary with actions taken to maintain health, to prevent illness or provide early detection of disease, and to restore the individual to the highest level of optimum functioning.
8. Hattie, Myers, and Sweeney propose a holistic model of wellness and prevention influenced by global events, family, community, religion, media, government, education, and business.
9. Health promotion activities are actions that increase health and well-being.
10. Health promotion is applicable to individuals, families, and communities, and includes actions such as weight-control measures, exercise, stress management, and coping.
11. Individual health promotion includes identifying lifestyle and environmental risks that influence the level of wellness and promote efforts to reduce or eliminate those risks.
12. The Health Belief Model is based on an individual’s perceptions of illness vulnerability, the effect of an illness, prevention, and risk-reduction modifying factors that influence an individual’s decision to act in order to prevent or minimize illness.
13. Pender, Murdaugh, and Parsons define health promotion as “behavior motivated by the desire to increase well-being and actualize human health potential.”
14. Health promotion activities include weight-control measures, exercise, stress management, and methods of coping.
15. Individual health promotion includes identification of lifestyle and environmental risks that influence the level of wellness and promote efforts to reduce or eliminate those risks.
16. The Health Belief Model is a predictive model that analyzes who will participate in health promotion activities.
17. The health promotion model is a framework that describes the interactions between an individual’s interpersonal and physical environments that affect health promotional behaviors.
18. The Theory of Reasoned Action/Planned Behavior hypothesizes that an individual’s intention to perform a health-promoting act is a determinant to actual performance of that behavior and is influenced by subjective norms, attitudes, and self-efficacy.
19. Healthy People 2020 focuses on health determinants versus the healthcare system.
20. Health determinants include personal, social, economic, and environmental factors that influence both individual and population health.
21. Social determinants related to health include family, community, income, education, gender, race/ethnicity, place of residence, and access to health care.
22. Healthy People 2020 offers practical guidelines on using information, providing education, and implementing interventions to improve health.
23. A major focus of Healthy People 2020 is access to health services that has increased with implementation of the Affordable Care Act of 2014.
24. With the influx of individuals receiving health care under the Affordable Care Act, social issues, including cultural sensitivity for the diverse American population such as foreign immigrants and lesbian, gay, bisexual, and transgender individuals, must be addressed.
25. Healthy People 2020 encourages implementation of educational and communitybased programs that focus on numerous health issues including chronic diseases, injury and violence prevention, mental illness, unintended pregnancy, oral health, tobacco use, substance abuse, physical activity, nutrition, and several other factors that influence general health.
26. Comprehensive patient assessment is essential to health promotion.
27. Health-related risk factors are revealed through data collected including age, gender, race, and family history, and information on fitness, lifestyle, stressors, and stress management.
28. The nurse works with the patient to identify current, ongoing, or potential health problems.
29. Diagnoses are established that reflect patients’ problems as well as strengths.
30. The nurse assumes the role of educator, counselor, facilitator, nurturer, and role model upon implementing a plan of care in concert with the patient.
31. The nurse and the patient are involved in ongoing evaluation of progress and meeting established goals as the nurse–patient relationship continues.
32. During evaluation, the patient has the opportunity to modify, continue, or discontinue established goals.
CHAPTER 4 CULTURAL CONSIDERATIONS
1. Examine the components included in the definition of culture. • Suggested Classroom Activity: Ask students to define culture in their own words and discuss how their personal definition of culture differs from the definitions of other students. •
Suggested Clinical Activity: Ask students to review a patient’s admission assessment and determine if culture is addressed in the admission process, what questions are asked of patients with regard to their culture, and after speaking with the patient determine if culture is addressed sufficiently during the patient’s hospitalization.
2. Practice using terms related to culture. • Suggested Classroom Activity: Ask students to define and discuss the differences between race, ethnicity, and heritage. •
Suggested Clinical Activity: Ask each student to identify and interview a patient of different ethnic or cultural background and discuss with the patient the assimilation and acculturation process of living in the United States with attention paid to healthcare considerations.
3. Describe the impact of cultural phenomena on health and wellness. • Suggested Classroom Activity: Ask students to reflect on their culture and cultural beliefs and discuss how culture affects their personal healthcare beliefs. •
Suggested Clinical Activity: Ask students to interview a patient born and raised in a country other than the United States. Discuss with that patient his or her cultural beliefs regarding health and wellness, and factors related to health beliefs and health practices (e.g., magicoreligious, biomedical, and holistic health beliefs).
4. Demonstrate culturally sensitive methods of communication when interacting with patients. • Suggested Classroom Activity: Ask students to interview each other on a given health or nursing topic of their choice. Instruct the interviewer to note nonverbal and body language cues. After the interview have the interviewer document these cues, interpret their meaning, and discuss these interpretations with the interviewed student to determine their accuracy. •
Suggested Clinical Activity: Ask students to determine and document the linguistic competence of a local healthcare organization or institution and the institution’s
ability to accommodate patients with limited English proficiency, limited literacy skills, a disability, or a hearing impairment.
5. Formulate strategies to promote cultural competence when assessing patients from specific cultural groups. • Suggested Classroom Activity: Ask students to complete the Cultural Assessment database on a fellow student and discuss new information discovered about the culture of that student. •
Suggested Clinical Activity: Ask students to conduct the Mini Cultural Assessment on a patient with limited English proficiency and then discuss with a member of the nursing staff challenges in completing an assessment for patients with limited English proficiency as well as the benefits of cultural assessment in caring for the patients.
Key Concepts 1. An individual’s culture, race, and ethnicity impact beliefs about health and illness and practices related to both. 2. The United States continues to become an increasingly culturally diverse country. 3. Nurses must possess a knowledge base of how cultural groups perceive life processes, define health and illness, maintain health, determine the causes of illness, and provide care and cure specific to each culture. 4. Culture is defined by the National Institutes of Health (NIH) as a combination of knowledge, beliefs, and behaviors that often are specific to racial, ethnic, geographic, social, or religious groups. 5. Culture frames an individual’s perception of health and illness, and influences how health care information is received, what is considered to be a health problem, how symptoms are perceived, and the types of treatments that may be provided. 6. Subcultures are phenomena that exist within larger cultural groups and are composed of individuals who have a distinct identity based on occupation, membership in a social group, or heritage. 7. Race refers to the identification of an individual or group by shared genetic, heritage, biological, or physical characteristics. 8. Heritage is defined as the full range of inherited traditions, monuments, objects, and culture. It is the range of contemporary activities, meanings, and behaviors drawn from these traditions. 9. Ethnicity is the awareness of belonging to a group in which certain characteristics such as culture and biology differentiate the members of one group from another and reflects shared interests, ethnic heritage, religion, food, politics, or geography and nationality. 10. Ethnocentrism is the belief that one’s own beliefs, way of life, values, and customs are superior to those of others. Ethnocentrism promotes the belief that
one’s customs and values are the standard for judging the customs and values of others. 11. Diversity is defined as the state of being different, and occurs both between and within cultural groups. Characteristics of diversity include nationality, race, color, gender, age, and religion as well as socioeconomic status, education, occupation, and areas of residency. 12. Acculturation refers to the process of adaptation and change that occurs when members of different cultures are exposed to one another. 13. Assimilation refers to the adoption and incorporation of characteristics, customs, and values of the dominant culture by those new to that culture. 14. Cultural competence is the capacity of nurses or health services delivery systems to effectively understand and plan for the needs of a culturally diverse patient population. Cultural competence is complex and includes a combination of knowledge, attitudes, and skills used by healthcare providers to deliver services that attend to patients holistically across cultural boundaries.
15. Culture and heritage influence an individual’s perceptions about internal and external factors that contribute to health or cause illness, as well as the practices individuals follow to prevent and treat health problems. 16. The beliefs and practices of immigrants, families, and groups influence the ways in which individual health care is managed. 17. Adoption of Western or scientific beliefs and practices is influenced by the length of time individuals reside in the United States and often by the age of individuals at the time of immigration. 18. Exposure to and knowledge of a variety of cultural beliefs and healthcare practices have promoted inclusion of many treatments, remedies, and therapies from foreign cultures by healthcare practitioners in the United States. 19. Culture influences patients’ perception of healthcare providers. In many cultures, physicians are perceived as head of the healthcare team and held in high regard.
20. The view of nurses is often dependent on the cultural view of women’s roles in society. In some cultures, nurses continue to be viewed as subservient to physicians. 21. Patients’ health-seeking behaviors are influenced by type of illness, language barriers, and family concerns that cultural rituals surrounding care of the sick and dying will not be respected or permitted in Western health care. 22. Categories of cultural phenomena that impact the provision of health care include communication, patient–provider relationships, family patterns, dietary patterns, health beliefs, and health practices.
23. Communication refers to the verbal and nonverbal methods with which individuals and groups transmit information. Nurses must have knowledge of personal and cultural significance of nonverbal communications as well as body language. 24. Communication is the mechanism through which individuals establish relationships and is dependent on how senders encode and how receivers decode messages. 25. Communication is dependent on numerous factors including culture, ethnicity, religion, nationality, education, health status, level of intelligence, and level of education. 26. Linguistic competence is the ability of an organization and its members to communicate effectively and convey information in such a way that diverse populations (e.g., individuals with limited English proficiency, limited literacy skills, a disability, or a hearing impairment) may easily comprehend intended meaning of information. 27. Nurses should have general familiarity with culturally based beliefs and practices as well as an understanding of implications of culturally based beliefs for nursing care. 28. Healthcare providers should avoid bringing stereotypical cultural beliefs to the communication process.