Week1LectureB(1)

NUR501 Class

Health and WellnessPotter & Perry, Chapter 6NUR501, Week 1

Hi Everybody! Welcome to the first lecture of this course Evidence-based primary health care nursing with the chronically ill client. This week we will explore the topics of health and wellness, look at the first step of the nursing process, communication, and infection prevention and control. Be sure to review the key terms for each chapter as they will form the basis for the first quiz. Before we begin, think about your definition of health. Is there any room for illness in your definition? Notice the definition by the World Health Organization (Potter and Perry, 2013, p. 66). 1

This is an image of the Health Belief Model. How does this model compare with the model on the next slide, the Health Promotion Model? Does either seem more (or less) comprehensive than the other? Could you work with either one to help a patient change their behavior? Where do you see room for a nurse to intervene? 2

The Health Promotion Model developed by Nola Pender and colleagues (Potter & Perry, 2013, p. 69). This one has behavioral outcomes.3

Lets look at Maslows hierarchy of needs; do we agree with this structure? What if your job was to rearrange it, how would you do that? [For example, consider love and belonging on the bottom, then security, then the physiological needs, with self-actualization and self-esteem as outcomes. Would that seem more correct?]

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Internal VariablesDevelopmental stageIntellectual backgroundPerception of functioningEmotional factorsSpiritual factors

Internal variables are those factors that affect ones health beliefs which are part of his/her person. Additional explanation of these variables begins on page 68.

How could a nurse address internal variables to move a client to change? e.g. developmental stage

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External variablesFamily practices/habits/traditionsSocioeconomic factorsCultural background

External variables are those elements outside of ones person that influence ones health beliefs and practices. What is one nursing action you could take to address each of these external variables?

Read through Box 6-3 on p. 70 to get a sense of some nursing interventions to address the cultural background of a client.

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TermsHealth promotionWellnessDisease prevention

Health promotion uses exercise and nutrition to maintain or enhance the present level of health. Wellness teaches people to care for themselves in a healthy ways, e.g. stress management, self-standing, control of life. Disease/illness prevention is concerned with strategies to avoid illness, e.g. immunizations7

Levels of PreventionPrimarySecondaryTertiary

Primary prevention (someone who does not have a disease yet) refers to action to prevent a health problem. Examples of primary prevention include immunizations and health education.

Secondary prevention refers to the early identification and treatment of existing health problems. For example, screening and early diagnosis, treating for existing health problems, e.g. hypertension.

Tertiary prevention (minimize effects of long term disease or disability) is an effort to return the client to the highest level of function and prevent further deterioration of health. An example of tertiary prevention would be a maintenance diet for someone in renal failure.

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Quick Quiz!2. After evaluating a patients external variables, the nurse concludes that health beliefs and practices can be influenced by A. Emotional factors.B. Intellectual background.C. Developmental stage.D. Socioeconomic factors.

Answer: D

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Risk factorsAge Genetic factorsEnvironmentLifestyle

A risk factor is something that predisposes one to get an illness. What are some categories of risk factors? [age, genetic factors, environment, lifestyle]

Nurses can engage patients in risk modification strategies to prevent some causes of disease [See Table 6-2 on p. 73 for a list of diseases requiring risk modification for prevention.].

If we want to change someones behavior, what steps could we use? [see next slide]10

Transtheoretical Model of ChangePrecontemplationContemplationPreparationActionMaintenance

See Table 6-3 on p. 74 for an explanation of these stages of change. Read the patient teaching tips in box 6-4 on p. 74 of Potter and Perry.

Identify a behavior in yourself that you would like to change. What stage are you at? What would prompt you to move to the next stage?

This concludes our review of Chapter 6 from Potter and Perry. Be sure to complete the Clinical Application Questions and the Review Questions at the end of the chapter in the textbook for your own review to prepare for evaluation in class.11

Nursing AssessmentPotter and Perry, Chapter 16

Were going to be talking about the Nursing Process all semester. There are 5 steps involved in the nursing process. Can you name them? [Hint: see Fig 16-1 (Potter & Perry, 2013, p. 207).

For this week, we will be focusing on the first step of the nursing process: assessment.

What do you think is involved in nursing assessment? How would one even begin a nursing assessment? What abilities would you use? What tools might you need?

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Method of AssessmentGordons functional health patternsProblem-orientedSystems Assessment (ROS)

There are three types of nursing assessment: a systems assessment, an assessment using Gordons functional health patterns, and a problem-oriented assessment.For the systems assessment, the nurse works through the systems of the body to look, listen, feel, and smell (sound strange?) to identify problems and areas of improvement. The nurse may collect information about a patient directly (patient as primary source) or indirectly by talking to family or other health professionals, checking the medical record (secondary sources).

Gordons functional health patterns are listed and described in Box 16-1 on p. 209 of Potter and Perry (2013). These are patterns that have been identified used by some nurses to organize their assessment.

With a problem-oriented assessment, the nurse focuses on the problem at hand, asking follow-up questions (See Table 16-1, p. 209 of Potter & Perry, 2013 for a sample assessment using this strategy).

What is the difference between subjective and objective data?

Review Tips for assessing older adults (Box 16-2, p. 211 of Potter & Perry, 2013).

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Methods of data collectionPatient-centered interviewInterview techniques

See if you can describe two interview techniques and describe them to a colleague (Potter & Perry, 2013, p. 213-4).

Give an example of an open-ended question.

Give an example of a close-ended question (P&P, 2013, p. 213, Box 16-3).

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Nursing Health History

Use this slide to write the components of a nursing health history (P&P, 2013, p. 214-6). Provide one sentence description for each. 15

Data validation

Give an example of validation of data (P&P, 2013, p. 217).

Read about concept mapping (Potter & Perry, 2013, p. 218) as we may use this strategy in this course.

This concludes the presentation about Potter and Perry, Chapter 16. Be sure to review the critical thinking exercise at the end of the chapter along with the review questions.16

CommunicationPotter & Perry, Chapter 24

Next well look at Chapter 24 of Potter and Perry about Communication. Dont forget to review the Key Terms listed at the start of the chapter and look for their definitions throughout the chapter.17

Communication and assessmentWhat communication skills do you use for assessment?What types of patients prove more of a challenge in communication?

Read through Box 24-1 on p. 311 (Potter & Perry, 2013) to get a sense of what communication strategies are involved in each step of the nursing process. Again, lets think about assessment. Notice all the skills involved in a nursing assessment.

See box 24-2 for help with the second question on this slide (P&P, 2013, p. 311). 18

Levels of communicationIntrapersonalInterpersonalTranspersonalSmall-groupPublic

What is the difference between intrapersonal and interpersonal? Which occurs between 2 people? How do these compare with transpersonal communication? (Potter & Perry, 2013, p. 311). 19

Elements of communicationReferentSender and receiverMessageChannelsFeedbackInterpersonal variablesEnvironment

Some of these elements may seem obvious such as sender and receiver. But what is the referent? How about the channels and interpersonal variables? Use this slide to provide your definitions of each key term.20

Forms of communicationVerbalVocabularyDenotative meaningConnotative meaningPacingIntonationClarity and brevityTiming and relevanceNonverbalIncludes 5 sensesPersonal appearancePosture and gaitFacial expressionEye contactGesturesSoundsTerritoriality and personal space

Again, some of these seem clear. Without looking, is timing a verbal or non-verbal form of communication?Give an example of a word that might have a different connotative meaning (different connotation) for one person that another. How about late? Does late mean the same thing to everyone? Probably not. So it has a connotative meaning, while a word like door is more clear or denotative.

Notice the various zones of personal space in Box 24-3 (P&P, 2013, p. 315). Can you see where it would be more appropriate to be closer in some situations than others? 21

Personal space Enjoy this 2-minute Seinfeld video about personal space.(2009, Dec. 4). Social awareness-close talker.wmv. SEINFELD S05E18 The Raincoats - Season 5 - Episode 18. Retrieved from https://www.youtube.com/watch?v=NGVSIkEi3mM

Did it seem like the speaker was a little close? Would you be comfortable with that? Lets be aware of personal space as we meet new people, especially our patients.22

SBARSituation what is happening right nowBackgroundAssessment Recommendation tell doctor what you think you need to do

SBAR is one communication technique used by nurses to organize their thoughts prior to contacting a provider about a patient problem. The acronym stands for situation, background, assessment and recommendation. 23

Communication strategiesActive listeningSharing observationsSharing empathySharing hope, humorSharing feelingsUsing touchUsing silenceProvide information, clarifyFocusParaphraseAsk relevant questionsSummarize Self-disclosureConfrontation

Here are some strategies to improve your communication with a patient. How would you improve communication with an older client?

[HINT: see Box 24-7, Potter and Perry, 2013, p. 318]

These strategies are explained on pp. 320-322 (P&P, 2013).24

Communication strategies to avoidAsk personal questionsGive personal opinionsChange the subjectAutomatic responsesFalse reassuranceSympathy Ask for explanations

Approval or disapprovalDefensive responsesPassive or aggressive responsesArguing

See Box 24-9 for tips on communicating with people with special needs25

CommunicationBlock, P. (May 28, 2013). Gifts: https://www.youtube.com/watch?v=I1pEPAJv8Eg Block, P. (May 28, 2013). Are you the problem? Retrieved from https://www.youtube.com/watch?v=3ZcjLzWWAYY

Here are some videos by speaker Peter Block who came to the Mount for a presentation last fall.

This concludes Chapter 24 of Potter and Perry. Dont forget to complete the Clinical application questions on p. 325 and the review questions for the chapter. Another helpful exercise would be building competency in teamwork and collaboration (p. 316, P&P, 2013). 26

Infection prevention and controlPotter and Perry, Chapter 28

And now on to the final chapter for this week: Infection prevention and control. This is a terribly important chapter in the life of a nurse. If we cant stop the spread of infection, we will not be able to protect our patients. And the spread of antibiotic-resistant organisms is worse than ever. If we protect ourselves and our families as well as our patients and their families, perhaps we can limit the spread of viruses and bacteria. 27

This is the image of the Chain of infection from your textbook. All of these elements need to be present for infection to occur. Where could a nurse intervene to prevent infection?

Notice the modes of transmission reviewed in Box 28-1 (P&P, 2013, p. 401).

Read through Table 28-1 (p. 400, P&P, 2013) concerning various organisms, the diseases they cause and the reservoirs they inhabit to cause infection. Any behavioral changes you might consider after reading this table?

Is there any disease in table 28-1 that seems to be transmitted by the airborne route (Box 28-1)? Which diseases are transmitted by direct contact? Or be vector? 28

termsHealth care-associated infectionsIatrogenic infectionsExogenous infectionsEndogenous infections

What could be one cause of a health care-associated infection (HAI)? What could you do to prevent it? [HINT: read through Box 28-3, p. 404 of P&P, 2013). What do these other terms mean? (P&P, 2013, p. 403)

Why might person A be more susceptible to an infection than person B? [HINT: see Box 28-4 and the text on page 405-6, P&P, 2013]

So identify one nursing intervention to assess the risk your patient might have for acquiring an infection (Box 28-5, p. 406, P&P, 2013).29

Laboratory tests to screen for infectionNormal valuesWhite blood cells: 5,000-10,000/mm3Erythrocyte sedimentation rate: 15 mm/hr men, > 20 mm/hr womenIron level: < 60 g/100 ml

Consider this: What would a WBC < 5,000/mm3 indicate to you the nurse? Immunocompromised30

Tier one/Standard precautions

Read through the standard precautions listed in the top half of Table 28-6 on p. 414 (P&P, 2013). Feel free to make notes on this slide to remind yourself of standard precautions and to know how to protect yourself from diseases carried by any patient or person.

Also, be sure to read through Infection prevention and control-patient safety and Isolation and isolation precautions on pages 412-420. This is an important section which begins to discuss proper care for urinary catheters and wound as well as a review of isolation precautions for patients with known diseases.

We will practice donning personal protective equipment (PPE) in the lab. The explanation of this topic begins on p. 416 (P&P, 2013) and includes gowns, respiratory protection, eye protection, and gloves.

Dont worry about reviewing sterile asepsis yet as well cover that in Week 3.

Read through Box 28-10 (p. 413, P&P, 2013) for ways the health care provider can prevent infection.

Tier two isolation

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Types of precautionsAirborneDropletContact

See Table 28-6, p. 414

Notice that tier two precautions are transmission-based precautions.

What measures do we take for airborne precautions?

When are airborne precautions needed?

Droplet? Contact?

What are the precautions for each category?32

Isolation RoomABC News. (2015). Ebola infected aid workers to be treated in Emory isolation room. Retrieved from http://abcnews.go.com/GMA/video/ebola-infected-aid-workers-treated-emory-isolation-room-24818578

Enjoy this video of transportation of one worker infected with ebola who was transported to an isolation room at Emory. Its an extreme case of isolation and personal protective equipment.33

Infection PreventionHere is a link to the plan for the state of Ohio to decrease Healthcare-associated infections.Centers for Disease Control and Prevention. (2015). State-based HAI prevention. Retrieved from http://www.cdc.gov/HAI/stateplans/state-hai-plans/oh.html

Target areas include catheter-associated urinary tract infections, central-line associated blood-stream infections, and the rates of MRSA (methicillin-resistant staphylococcus aureus). These are areas we need to be especially concerned with decreasing rates of infection.

This concludes our review of Chapter 28. Be sure to review the Clinical application questions (p. 438, P&P, 2013) and the review questions at the end of the chapter. Notice that answers can be found either at the Evolve website or at the end of the chapter. Be sure to register at the Evolve website for both the Potter and Perry text as well as the Lewis text for additional resources. 34

ReferencesPotter, P. & Perry, A. (2013). Fundamentals of nursing: Concepts, processes, and practice (8thed.). St. Louis: C.V. Mosby.