Discussion: Digestive Disorders

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Discussion: Digestive Disorders

Discussion: Digestive Disorders

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. Discussion: Digestive Disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare? Discussion: Digestive Disorders

 

To Prepare

· Review Chapter 36 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.

· Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.

· Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.

· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.

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write

· An explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. (I am looking for an explanation at the cellular or molecular level (whenever possible) Discussion: Digestive Disorders.

· Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder.

· Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

Points to follow when writing a paper Discussion: Digestive Disorders:

· Please all bullets points, bold, red and highlighted area must be attended to.

· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings. Discussion: Digestive Disorders

· Please review all rubrics.

· Check APA format/setting.

· Your final paragraph should be a summary of the key points of your paper.

· Please personalized where necessary.

Refrain from direct quote

Class Rules

Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).

you are required to cite scholarly resources including peer-review journals and current practice guidelines.

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Writer must be familiar with nursing pharmacology Discussion: Digestive Disorders.

Rules for writing (FYI)

Whether writing a discussion posting or a paper, keep a few things in mind—

1) I am looking for an explanation at the cellular or molecular level (whenever possible).

2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states Discussion: Digestive Disorders. 

Rasmussen Contrast two nursing models and theories assignment

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Rasmussen Contrast two nursing models and theories assignment

-Answer the following question in apa format:

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For this discussion, in three to four paragraphs, contrast two nursing models and theories found in your reading. Discuss how they are similar or different in the way the define/discuss health and wellness, illness, the client, the environment, and nursing. Summarize by selecting the one model or theory that aligns best with your beliefs and then describe how this would affect the way in which you would practice nursing. note:refer to the roy adaption model and the The Orem Self-Care theory for this assignment please.

use the apa citing the following book for both initial discussion posts and their responses please (discussion posts 3-4 paragraphs and responses should be at least 200 wds each:

Reference
Catalano, J. T. (2015). Nursing Now! Today’s Issues, Tomorrow’s Trends, 7th Edition.

Your Rating:
1
2
3
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5
According to chapter 3 of our text book, the Orem Self-Care Model of nursing was developed by Dorothea E. Orem and is based on the belief that health care is everyone’s own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health (Catalano, 2015). The Roy Adaptation Model developed by Sister Callista Roy, is very closely related to the general systems theory. The main goal of this model is to allow the client to reach his or her highest level of functioning through adaptation.

Although both models see clients as a human being, there are many differences. The major difference between these two nursing models can be observed in their main goals, and the way that they define health and nursing needs. The Orem Self-Care model follows the theory that clients are self-sufficient, can live life to the fullest through self-care, and only require proper guidance to maintain their own health. Whereas the Roy Adaptation model follows the theory that clients are a dynamic system with input and output stimuli, constantly adapting based upon various stimuli that are affecting them, and nursing is a multistep process that helps the client adapt and reach the highest level of functioning. (Catalano, 2015).

I personally felt that the general systems theory most closely aligned with my beliefs and thought processes. When I can break things down into several different sub-categories (systems) that all build upon a larger item it makes more sense to my brain.

Reference
Catalano, J. T. (2015). Nursing Now! Today’s Issues, Tomorrow’s Trends, 7th Edition.

For this discussion, in three to four paragraphs, contrast two nursing models and theories found in your reading. Discuss how they are similar or different in the way the define/discuss health and wellness, illness, the client, the environment, and nursing. Summarize by selecting the one model or theory that aligns best with your beliefs and then describe how this would affect the way in which you would practice nursing.

Respond to these two postings with apa format and a reference from the book citing listed above for each discussion response:

posting number 1

Compare & Contrast

Collapse

There is many times when a theory and a model are used as the same thing. Often times one is confused over the other. In nursing, it happens just as much, if not more. A theory is defined as a serious of statements that is developed through a process of continued abstractions. It is aimed towards a generalized statement that is explaining a phenomenon. Now a model, is a purposeful view of reality.

The Orem Self-Care theory is based on a a relief that health care is each individual’s own responsibility. The purpose of this model is to allow clients to maintain or improve their health through out activities. The main focus in this model is the client. Health is defined as the clients ability to live as comfortable as possible at a higher level of functioning to promote the person from entering a lower life form that that of what already exists. It is important that the individual is able to carry on one of the key health care activities. They are as follow; air, water, food, excretion of waste, activity and rest, solitude and social interactions, avoiding hazards to life and well being, and being normal mentally under universal self care. The nursing goal in this model is to help and guide the client into proper self care activities.

The Roy Adaption model allows the client to reach his or her highest level of functioning through adaption. The client has a dynamic system with input and output. Health is a continuum with the ability to adapt successfully to illness. The nursing process in the Roy Adaption model is a process that helps the client adapt and reach the highest level of function for that individual.

As you can see it is very easy to get the two confused. They are both similar yet different in their own ways. Each theory and model was designed with the best interest of the client in mind. They also allow the client to feel more involved in their own recovery process.
posting number 2 below
Your Rating:
1
2
3
4
5
According to chapter 3 of our text book, the Orem Self-Care Model of nursing was developed by Dorothea E. Orem and is based on the belief that health care is everyone’s own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health (Catalano, 2015). The Roy Adaptation Model developed by Sister Callista Roy, is very closely related to the general systems theory. The main goal of this model is to allow the client to reach his or her highest level of functioning through adaptation.

Although both models see clients as a human being, there are many differences. The major difference between these two nursing models can be observed in their main goals, and the way that they define health and nursing needs. The Orem Self-Care model follows the theory that clients are self-sufficient, can live life to the fullest through self-care, and only require proper guidance to maintain their own health. Whereas the Roy Adaptation model follows the theory that clients are a dynamic system with input and output stimuli, constantly adapting based upon various stimuli that are affecting them, and nursing is a multistep process that helps the client adapt and reach the highest level of functioning. (Catalano, 2015).

I personally felt that the general systems theory most closely aligned with my beliefs and thought processes. When I can break things down into several different sub-categories (systems) that all build upon a larger item it makes more sense to my brain.

Reference

Catalano, J. T. (2015). Nursing Now! Today’s Issues, Tomorrow’s Trends, 7th Edition.

————————————————————————————

Here Is reading literature to support the two models:

The Roy Adaptation Model
As developed by Sister Callista Roy, the Roy Adaptation Model of nursing is very closely related to systems theory.13 The main goal of this model is to allow the client to reach his or her highest level of functioning through adaptation.

Client
The central element in the Roy Adaptation Model is man (a generic term referring to humans in general, or the client in particular, collectively or individually). Man is viewed as a dynamic entity with both input and output. As derived from the context of the four modes in the Roy Adaptation Model, the client is defined as a biopsychosocial being who is affected by various stimuli and displays behaviors to help adapt to the stimuli. Because the client is constantly being affected by stimuli, adaptation is a continual process.13

Inputs are called stimuli and include internal stimuli that arise from within the client’s environment and stimuli coming from external environmental factors such as physical surroundings, family, and society. The output in the Roy Adaptation Model is the behavior that the client demonstrates as a result of stimuli that are affecting him or her.

Output, or behavior, is a very important element in the Roy Adaptation Model because it provides the baseline data about the client that the nurse obtains through assessment techniques. In this model, the output (behavior) is always modified by the client’s internal attempts to adapt to the input, or stimuli. Roy has identified four internal adaptational activities that clients use and has called them the four adaptation modes:

1. The physiological mode (using internal physiological process)
2. The self-concept mode (developed throughout life by experience)
3. The role function mode (dependent on the client’s relative place in society)
4. The interdependence mode (indicating how the client relates to others)
Table 3.2 Comparison of Selected Nursing Models

Health
In the Roy Adaptation Model, the concept of health is defined as the location of the client along a continuum between perfect health and complete illness. In this model, health is rarely an absolute. Rather, “a person’s ability to adapt to stimuli, such as injury, disease, or even psychological stress, determines the level of that person’s health status.”13 For example, a client who broke her neck in an automobile accident and was paralyzed but who eventually went back to college, obtained a law degree, and became a practicing lawyer would, in the Roy Adaptation Model, be considered to have a high degree of health because of the ability to adapt to the stimuli imposed.

Environment
The Roy Adaptation Model’s definition of environment is synonymous with the concept of stimuli. The environment consists of all those factors that influence the client’s behavior, either internally or externally. This model categorizes these environmental elements, or stimuli, into three groups: (1) focal, (2) contextual, and (3) residual.

Focal stimuli are environmental factors that most directly affect the client’s behavior and require most of his or her attention. Contextual stimuli form the general physical, social, and psychological environment from which the client emerges. Residual stimuli are factors in the client’s past, such as personality characteristics, past experiences, religious beliefs, and social norms, that have an indirect effect on the client’s health status. Residual stimuli are often very difficult to identify because they may remain hidden in the person’s memory or may be an integral part of the client’s personality.

Nursing
In the Roy Adaptation Model, nursing becomes a multistep process, similar to the nursing process, to aid and support the client’s attempt to adapt to stimuli in one or more of the four adaptive modes. To determine what type of help is required to promote adaptation, the nurse must first assess the client.

Assessment
The primary nursing assessments are of the client’s behavior (output). Basically, the nurse should try to determine whether the client’s behavior is adaptive or maladaptive in each of the four adaptational modes previously defined. Some first-level assessments of the client with pneumonia might include a temperature of 104°F, a cough productive of thick green sputum, chest pain on inspiration, and signs of weakness or physical debility, such as the inability to bring in wood for the fireplace or to visit friends.

A second-level assessment should also be made to determine what type of stimuli (input) is affecting the client’s health-care status. In the case of the pneumonia client, this might include a culture and sensitivity test of the sputum to identify the invasive bacteria, assessment of the client’s clothes to determine whether they were adequate for the weather outside, and an investigation to find out whether any neighbors could help the client upon discharge from the hospital.

Analysis
After performing the assessment, the nurse analyzes the data and arranges them in such a way as to be able to make a statement about the client’s adaptive or maladaptive behaviors—that is, the nurse identifies the problem. In current terminology, this identification of the problem is called a nursing diagnosis. The problem statement is the first part of the three-part PES (problem–etiology–signs and symptoms) formulation that completes the nursing diagnosis (Fig. 3.1).

Setting Goals
After the problem has been identified, goals for optimal adaptation are established. Ideally, these goals should be a collaborative effort between the nurse and the client. A determination of the actions needed to achieve the goals is the next step in the process. The focus should be on manipulation of the stimuli to promote optimal adaptation. Finally, an evaluation is made of the whole process to determine whether the goals have been met. If the goals have not been met, the nurse must determine why, not how, the activities should be modified to achieve the goals.11

Figure 3.1 Together, these components make up the PES (problem–etiology–signs and symptoms) statement: Pain, acute, may be related to surgical wound, as manifested by facial grimacing, increased heart rate, and verbal complaints of pain at the incision site.
The Orem Self-Care Model
Dorothea E. Orem’s model of nursing is based on the belief that health care is each individual’s own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health.14

Client
As with most other nursing models, the central element of the Orem model is the client, who is a biological, psychological, and social being with the capacity for self-care. Self-care is defined as the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. Self-care is a requirement for maintenance of life and for optimal functioning.

Health

Nursing History Best Practices In The Management Of ADHD

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Nursing History Best Practices In The Management Of ADHD

Use reputable nursing journal source within the usa. Cite it in apa format.

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For this written assignment, select one recent (within the last two years) evidence-based article from a peer reviewed nursing journal that describes a “best practice” in an area of nursing you are interested in. For example, if you would like to be a pediatric nurse, select an article that discusses a best practice in pediatric care.

Cite the article and provide a brief overview of how the results or findings were obtained. Then describe the “best practice.” Conclude your discussion by explaining whether you thought the research findings supported the conclusions and the best practice.

This assignment must be no more than 3 pages long. It should include all of the required elements. Use APA Editorial format and attach a copy of the article.

The Field of Nursing Discussion

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The Field of Nursing Discussion

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following:

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Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision-making, differ between the BSN-prepared nurse and the ADN nurse.
Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RN-BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required

Obesity Case Study and Discussion Question

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Obesity Case Study and Discussion Question

The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

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Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

Height: 68 inches; Weight 134.5 kg
BP: 172/96, HR 88, RR 26
Fasting Blood Glucose: 146/mg/dL
Total Cholesterol: 250mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
Ranitidine (Zantac) 300 mg PO at bedtime.
Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.
The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)
What actual or potential problems can you identify? Describe at least five problems and provide the

Time Management Assessment Paper

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Time Management Assessment Paper

Time Management Assessment: This assignment is about you. It is an assessment of your abilities and traits.

Every week you will complete a personal assessment–your own personal leadership framework.

This assignment will help you figure out what style of leadership you have been following and whether this style works for you.

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Through this assignment, you will find the various approaches of leadership that complement each other. There is no one theory that describes the only way to be an effective leader. Each theory focuses on different issues, but they all help you to better understand how to become a successful leader.

Using the South University Online Library or the Internet, research about Time Management Assessment.

Note: You can also use the following link to access the Time Management Assessment: http://literacynet.org/icans/chapter03/timemgmt.html

Based on your research and understanding, create a paper in a 3- to 4-page Microsoft Word document that:

  • Incorporates your time management self-assessment information and the concepts learned this week (leadership theories, leadership versus management, professional nursing organizations, and time management).
  • Includes identification of one leadership theory, which you feel best describes your leadership style.
  • Includes a comparison between leadership and management.
  • Includes a suggestion on how to apply this week’s concepts to the work environment.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

  • Use this APA Citation Helper as a convenient reference for properly citing resources.
  • This handout will provide you the details of formatting your essay using APA style.
  • You may create your essay in this APA-formatted template. Time Management Assessment.

Benchmark EBP Project Diagnostic Tools For Treatment Of Diabetes

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Benchmark EBP Project Diagnostic Tools For Treatment Of Diabetes

Details:

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Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

Please see Rubrics for question bellow

Benchmark – Evidence-Based Practice Project—Paper on Diabetes

1
Unsatisfactory 0-71%
0.00%

2
Less Than Satisfactory 72-75%
75.00%

3
Satisfactory 76-79%
79.00%

4
Good 80-89%
89.00%

5
Excellent 90-100%
100.00%

80.0 %Content

30.0 %Research or Evidence-Based Article Identified. Article Focuses on a Specific Diabetic Intervention or New Diagnostic Tool.

Research or evidence-based article not identified.

Research or evidence-based article identified but does not address a specific diabetic intervention or diagnostic tool.

Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in general.

Research or evidence-based article identified that focuses on a specific diabetic intervention and a diagnostic tool.

Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in a comprehensive manner, allowing all criteria of assignment to be fully addressed.

50.0 %Summary of Article Includes the Following Content: Discussion of Research Performed Clinical Findings, and Significance to Nursing Practice.

Content is incomplete or omits most of the requirements stated in the assignment criteria. Does not demonstrate an understanding of the basic principles. Does not demonstrate critical thinking and analysis of the overall program subject.

Content is incomplete or omits some requirements stated in the assignment criteria. Demonstrates shallow understanding of the basic principles only a surface level of evaluation is offered, methods are described but flawed or unrealistic and strategies are discussed, but incomplete.

Content is complete, but somewhat inaccurate and/or irrelevant. Demonstrates adequate understanding of the basic principles. Reasonable but limited inferences and conclusions are drawn but lack development. Supporting research is inadequate in relevance, quality, and/or currentness.

Content is comprehensive and accurate, and definitions are clearly stated. Sections form a cohesive logical and justified whole. Shows careful planning and attention to details and illuminates relationships. Research is adequate, current, and relevant, and addresses all of the issues stated in the assignment criteria.

Content is comprehensive. Presents ideas and information beyond that presented through the course, and substantiates their validity through solid, academic research where appropriate. Research is thorough, current, and relevant, and addresses all of the issues stated in assignment criteria. Final paper exhibits the process of creative thinking and development of proposal. Applies framework of knowledge, practice and sound research. Shows careful planning and attention to how disparate elements fit together.

15.0 %Organization and Effectiveness

5.0 %Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

5.0 %Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

5.0 %Format

3.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)

Inappropriate word choice and lack of variety in language use are evident. Writer appears to be unaware of audience. Use of ‘primer prose’ indicates writer either does not apply figures of speech or uses them inappropriately.

Some distracting inconsistencies in language choice (register) and/or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.

Language is appropriate to the targeted audience for the most part.

The writer is clearly aware of audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.

The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.

2.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)

No reference page is included. No citations are used.

Reference page is present. Citations are inconsistently used.

Reference page is present. Citations are inconsistently used.

Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.

In-text citations and a reference page are complete. The documentation of cited sources is free of error.

100 %Total Weightage

 

Evidence-Based Practice Project— Intervention Presentation on Diabetes

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Evidence-Based Practice Project— Intervention Presentation on Diabetes

Details:

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Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment:

Develop a PowerPoint presentation (a title slide, 6-12 slides, and a reference slide; no larger than 2 MB) that includes the following:

A brief summary of the research conducted in the Evidence-Based Project – Paper on Diabetes.
A descriptive and reflective discussion of how the new tool or intervention may be integrated into practice that is supported by sound research.
While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

French Canadian And German Heritage discussion

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French Canadian And German Heritage discussion

Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Culture Larry Purnell,

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PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ Over 50 million Americans are of Germans heritage. ▪ The first wave of German immigrants came to the USA for religious freedom. ▪ The second wave arrived between 1840 and 1860 and was fleeing political persecution, poverty, and starvation. ▪ Many worked as indentured servants. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ The 1930s and 1940s saw a third wave because of the rise of fascism in Germany. ▪ Germans receive a stronger education than Americans. ▪ The German undergraduate degree is equal to the American master’s degree, except for nursing which is at a lower level than that of the USA. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ German is the official language of Germany. ▪ German is a low-contextual language, with a greater emphasis on verbal than nonverbal communication. ▪ A high degree of social approval is shown to people whose verbal skill in expressing ideas and feelings is precise, explicit, and straightforward. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ For traditional Germans, sharing one’s feelings with others often creates a sense of vulnerability or is looked on as evidence of weakness. ▪ Expressing fear, concern, happiness, or sorrow allows others a view of the personal and private self, creating a sense of discomfort and uneasiness. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ “Being in control” includes harnessing one’s emotions and not revealing them to others. ▪ Newer generations are more demonstrative in sharing their thoughts, ideas, and feelings with others. ▪ In families where the father plays a dominant role, little touching occurs between the father and children. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Affection between a mother and her children is more evident. ▪ Germans generally are careful not to touch people who are not family or close friends. ▪ Most individuals place a high value on privacy. People may live side by side in a neighborhood and never develop a close friendship. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Germans would never consider dropping in on another German neighbor because this behavior is incongruent with their sense of order. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Even looking into a room from the outside is considered a visual intrusion. ▪ Eye contact is maintained during conversations, but staring at strangers is considered rude. ▪ A closed door requires a knock and an invitation to enter, regardless of whether the door is encountered in the home, business, or in-patient facility. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ To focus on the present is to ensure the future. ▪ The past, however, is equally important, and Germans often begin their discussions with background information. ▪ There are rarely good excuses for tardiness, delays, or incompetence that disturbs the “schedule” of events. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Those in authority, older people, and subordinates are always addressed formally. ▪ Younger generations or the more acculturated may be less formal in their interactions. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Traditional families view the father as head of the household. ▪ In the USA, the husband and wife are more likely to make decisions mutually and share household duties. ▪ Older people are sought for their advice and counsel, although the advice may not always be followed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Helping parents or grandparents to remain in their own home is important to families. ▪ Prescriptive behaviors for children include using good table manners, being polite, doing what they are told, respecting their elders, sharing, paying attention in school, and doing their chores. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Prescriptive behaviors for adolescents include staying away from bad influences, obeying the rules of the home, sitting like a lady, and wearing a robe over pajamas. ▪ Restrictive and taboo behaviors for children include talking back to adults, talking to strangers, touching another person’s possessions, and getting into trouble. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Restrictive and taboo behaviors for adolescents include smoking, using drugs, chewing gum in public, having guests when parents are not at home, going without a slip (girls), and having run-ins with the law. ▪ One’s family reputation is considered part of a person’s identity and serves to preserve one’s social position. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Because families are concerned about their reputations in the community, an unwed mother taints their reputation and may result in the family being ostracized by others. If marriage follows the pregnancy, less sanctioning occurs. ▪ The fact that pregnancy existed before marriage creates a stigma for the woman, and sometimes for the child, that may last the rest of their lives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Family Roles and Organization ▪ Many older gays and lesbians may fear exposure because of the extreme discrimination homosexuals experienced in Nazi Germany. ▪ Younger generations of gays and lesbians are less likely to fear exposure of their sexuality. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Workforce Issues ▪ For Germans being on time is important. ▪ Business communication should remain formal: shaking hands daily, using the person’s title with the last name, and keeping niceties to a minimum. ▪ Employees are not addressed by their first names. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Common German cultural individualist is values include a. Timeliness and sharing emotions. b. Timeliness and direct communication. c. Smooth inexact communication and readily sharing emotions. d. Readily sharing emotions and present orientation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B German and German Americans value direct communication and timeliness in work and in social engagements. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Biocultural Ecology ▪ Germans range from tall, blond, and blue-eyed to short, stocky, dark-haired, and brown-eyed. ▪ Common health conditions for German Americans include cardiovascular disease, stomach cancer, muscular dystrophy, hereditary hemochromatosis, sarcoidosis, Dupuytren’s disease, peyronie’s disease, cystic fibrosis, hemophilia, and cholelithiasis. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German High-Risk Health Behaviors ▪ Smoking and excessive alcohol consumption remain high-risk behaviors for most Germans. ▪ Most individuals enjoy the outdoors, fresh air, and exercise. ▪ Sports are played for exercise and the pleasure of participating in group activities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Food is a symbol of celebration for Germans and is often equated with love. ▪ Children are rewarded for good behavior with food. ▪ Real cream and butter are used. ▪ Gravies, sauces, fried foods, rich pastries, and sausages are only a few of the culinary favorites that are high in fat content. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Foods are also fried in butter, bacon fat, lard, or margarine. ▪ Traditional food preparation methods use highfat ingredients that add to nutritional risks. ▪ Garlic and onions are eaten daily to prevent heart disease. ▪ Those who are ill receive egg custards, ginger ale, or tomato soup (without cream) to settle their stomach. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Nutrition ▪ Ginger ale or 7-Up relieves indigestion and settles an upset stomach. ▪ After gastrointestinal illnesses, a recuperative diet is administered to the sick family member beginning with sips of ginger ale over ice. ▪ Coddled eggs, a variation of scrambled eggs prepared with margarine and a little milk, is used for recuperation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Pregnancy and Childbearing Practices ▪ Heterologous artificial insemination, use of contraceptive pills, and unnatural contraception are forbidden among strict Catholic Germans. ▪ Therapeutic or direct abortion is forbidden as the unjust taking of innocent life. ▪ Prescriptive practices during pregnancy include getting plenty of exercise and increasing the quantity of food to provide for the fetus. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Pregnancy and Childbearing Practices ▪ Restrictive practices during pregnancy include not stretching and not raising the arms above the head to minimize the risk of the cord wrapping around the baby’s neck. ▪ Prescriptive practices for the postpartum period include getting plenty of exercise and fresh air for the baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ Death is a transition to life with God. ▪ Because illness is sometimes perceived as a punishment, the duration and intensity of the dying process may be seen as a result of the quality of the life led by the person. ▪ Careful selection of the clothes to be worn by the deceased and the flowers that represent the immediate family is important. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ The body of the deceased is prepared and “laid out” in the home where support from family and friends is readily available ▪ A short service is held in the home before the body is taken to the church, where family and friends can attend a funeral service. After the church services, the body is taken to the cemetery for burial. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ After a short graveside service, the minister invites everyone at the graveside service to go to the home of the deceased for food. ▪ The viewing provides an opportunity for family, friends, and acquaintances to view the body. ▪ Crying in public is permissible among some families, but in others the display of grief is private. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Death Rituals ▪ A tradition of wearing black or dark clothing when attending a viewing or a funeral may be expected of both family and friends. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Spirituality ▪ Major religions among Germans include Roman Catholicism, Methodism, and Lutheranism. ▪ Other religions, such as Judaism, Islam, and Buddhism, have substantial membership. ▪ Prayers are often recited at the bedside with all who are present joining hands, bowing their heads, and receiving the blessing from the clergy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Spirituality ▪ Family and other loved ones are also sources of support in difficult times. ▪ Home, family, friends, work, church, and education provide meaning in life for individuals of German heritage. ▪ Family loyalty, duty, and honor to the family are strong values. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ In traditional families, the mother usually ensures that children receive check-ups, get immunizations, and take vitamins. ▪ Women in the family often administer folk/home remedies and treatments. ▪ German Americans use a variety of over-thecounter drugs, believing that individuals are responsible for their own health. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ Common, natural folk medicines include roots, herbs, soups, poultices, and medicinal agents such as camphor, peppermint, and spirits of ammonia. ▪ Folk medicine includes “powwowing,” use of special words, and wearing charms. ▪ Many value being stoic when experiencing pain. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practices ▪ Mental illness may be viewed as a flaw, resulting in this group being slow to seek help because of the lack of acceptance and the stigma attached to needing help. ▪ Physical disabilities caused by injury are more acceptable than those caused by genetic problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-Care Practices ▪ Blood transfusions, organ donation, and organ trans-plants are acceptable medical interventions unless a religious choice contradicts them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Health-care Practitioners ▪ Health-care providers hold a relatively high status among Germans. ▪ This admiration stems from the love of education and respect for authority. ▪ Most individuals accept care from either gender. Some younger and older, more traditional women prefer intimate care from a same-sex health-care provider. Transcultural Health Care: A Culturally Competent Approach, 4th Edition French Canadian Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ More than 2.2 million people of French Canadian descent reside in the United States. ▪ Nowadays, French speaking Canadians, unlike those of the 19th century living in the USA, may have been raised within the French culture but descended from a variety of ethnicities. ▪ The Multiculturalism Canada Act of 1988 provides guidelines for implementing policies regarding multicultural diversity. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Before the latter half of the 18th century, most French immigrating to Canada were Catholics. ▪ French Protestants tended to come directly to the United States. ▪ After the French Revolution, more Catholics sought shelter in the US, most coming via Canada settled in the New England states and later dispersed throughout the United States. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ The Métis, descendants of Native Americans and Europeans, are mainly, though not entirely, Frenchspeaking. ▪ Another major portion of Canada’s French-speaking population are the Acadians who are the descendants of the early French colonists. ▪ Canadians whose first language is French are called Francophones. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Canada has become an increasingly diverse society composed of various ethnocultural groups with more than 100 different languages as mother tongue. ▪ Much like that of the US, interethnic marriage patterns have dramatically changed from a multiethnic society to multiethnic individuals. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Canada has two official languages, French and English. ▪ In many homes in the US and in Canada English and French may be used equally. ▪ The French-speaking population may lack sufficient knowledge of the English language to access the workforce and other material. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Among French Canadians, a conversation may be conducted with high voice crescendos, which do not necessarily mean anger or violence. ▪ Volume can increase with the importance and the emotional charge invested in the content of the message. ▪ French Canadians encourage sharing thoughts and feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Using hand gestures for emphasis when speaking is common. ▪ Facial expressions for men and women of all ages are a part of communication, often replacing words. ▪ Spatial distancing for differs among family members, close friends, and the public. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ When in the intimacy zone, people may touch frequently and converse in close physical space; however, they tend to avoid physical contact in public. ▪ When greeting another person, men usually shake hands. ▪ Close female friends and family members may greet each other with an embrace. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Maintaining eye contact is an important French Canadian value. ▪ Most French-speaking Canadians have a past, present, and future orientation in their worldview. ▪ More traditional people, and many from rural backgrounds, attach primary importance to living in the present. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Until the late 1970s, women and children took the father’s surname. ▪ Today, under Quebec law, a woman keeps her maiden name throughout her lifetime, although in other parts of Canada this practice is decided between the spouses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Québécois family of two spouses and two children may well include four different surname combinations: one child may have the father’s surname or the mother’s surname alone or a hyphenated or non-hyphenated surname composed of those of the father and mother. For a second child, the surnames are the same, but in reverse order. ▪ The decision for using surnames rests entirely with the parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The Métis in Canada are a. Mostly English Speaking. b. Mostly speak an indigenous dialect. c. Descendants of Native Americans and Europeans. d. Descendents of French and Arabic. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C a. Descendants of Native Americans and Europeans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many older people with a strong religious background maintain a future worldview regarding life after death. ▪ Many of the younger generation reject past traditions and attempt to maintain a balance by enjoying the present, working, and planning for their future. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, in French-speaking Canadian families, the man was seen as the moral authority and responsible for material wellbeing, such as economic provider and purveyor of affection and security. ▪ The woman served as the family mediator and social director as well as being responsible for household activities, child care, and health care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ With more women working, family roles are becoming more egalitarian. ▪ French Canadians have always attributed great value to family relationships and obligations. ▪ Research reports that Francophones are less committed than Anglophones to with respect to marriage, sexual activity, and non-married parenthood. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The greatest source of pride for French Canadian families is to see their children well established with a good education. ▪ The French Canadian family is more nuclear and autonomous than its counterpart in France. ▪ French-speaking Canadian family is known for its closeness, and some families are a “closed” family system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, the Catholic Church dictated the parameters of sexual behavior for French Canadians. ▪ There is a growing trend for couples to live together without marrying. ▪ Many young couples answer that they cannot financially afford to get married. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In 1996, the Canadian government extended health, relocation, and other job benefits to same-sex partners of federal employees. ▪ The Ontario Court of Appeals ruled that samesex couples must be treated as common-law couples under the Family Leave Act. ▪ Canada is one of the few countries in the world where same-sex marriage is legalized. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Opportunities for Francophone nurses to function successfully outside Quebec and in the US are limited if they have not mastered the English language. ▪ Because Francophone culture is more collevistic than individualistic, some may initially have difficulty adapting to an environment where autonomous decision-making is required. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Canadians of French descent are white or Caucasian; however, Francophones, as a linguistic group, represent a mosaic of ethnocultural characteristics, including racial differences prompted by acculturation, adoption, and the children of mixed marriages. ▪ Assess individuals for biological risks according to their racial and cultural heritage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Higher incidences of prostate and breast and ovarian cancers have been seen among Francophones. ▪ A high rate of suicide and suicidal ideation, particularly among Francophone adolescents and young adult males, is seen in Canada. It is unknown if this extends in the US. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Genetic and hereditary diseases include spastic ataxia Charlevoix-Saguenay type, cystic fibrosis, tyrosinaemia, cytochrome lipase deficiency, familial chylomicronemia resulting from the lipoprotein lipase (LPL) deficiency, hyperlipoproteinemia type I which has been traced to migrants from the Perche region of France. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ An increased incidence of cystic fibrosis and muscular dystrophy occurs among Frenchspeaking Canadians. ▪ Sickle cell anemia is also higher among Francophones than the general population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Misuse of alcohol, tobacco, marijuana, and psychotropic drugs are major health problems. ▪ Tobacco and alcohol use is highest among French-speaking males and is associated with masculine sex roles, higher self-esteem, and an external locus of control. ▪ The rate of individuals who do not exercise on a regular basis has increased over the last decade. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ For French Canadians, food is associated with hospitality and warmth. Food is part of all meetings and celebrations. ▪ Common vegetables enjoyed by French Canadians include potatoes, turnips, carrots, asparagus, cabbage, lettuce, cucumbers, and tomatoes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Meat choices are mainly beef, pork, and poultry. Lately, however, lamb has gained popularity. ▪ In Acadia, due to the proximity of the coastal areas, fresh fish and seafood are part of the diet. ▪ Common foods include fricot (stew made with a special spice called summer savory). ▪ French Canadians do not escape the overall trend toward being overweight. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Until the middle of the 20th century, French Canadians maintained high fertility rates, which is uncommon for a population living in an industrialized country. ▪ This phenomenon, called the “revenge of the cradles,” has never been explained. ▪ The number of children per family has been declining since the mid-1960s. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Effective contraception and family planning methods such as the pill, intrauterine devices, and tubal ligation have become available to all women. ▪ The pill remains the primary reversible method for birth control. ▪ On the basis of relative frequency, tubal ligation and vasectomy follow the pill as nonreversible methods of fertility control. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Diaphragms, foams, and creams are not commonly used for birth control, partially because perceptions imply that women are not supposed to, or do not like to, touch their genitals. ▪ The beliefs that condoms reduce the level of sexual feeling during intercourse, or that contraception is not a man’s responsibility, are inversely proportionate to the age of men. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Few French Canadians practice natural childbirth. ▪ Men are welcomed and encouraged to be in the delivery room with their wives. ▪ Breastfeeding has regained importance after years of bottle feeding. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ In Canada, maternity and paternity leaves are available with pay for a period ranging from 6 to 20 weeks. ▪ Although the movement used in washing a floor resembles that of an exercise aimed at strengthening the perineal muscles, this activity in the past was associated with the onset of labor and early or preterm deliveries. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ French Canadians do not differ from Canadians and others of European origins on issues related to death and death rituals. Expectations are closely related to Christian religious practices, in particular, those of the Roman Catholic Church. ▪ Whether one is an active church-goer or not, religious funerals are the norm. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Cremation is an acceptable practice. ▪ Supports for those who have lost a family member include openly acknowledging the family’s right to express grief, being physically present, making referrals to appropriate religious leaders, and encouraging interpersonal relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ While most French Canadians identify themselves as Roman Catholic and are baptized at birth, they may or may not remain active church members. ▪ Older adults are more inclined to use prayers for finding strength and adapting to difficult physical, psychological, and social health problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ In times of illness and tragedy, French-speaking Canadians use prayer to help recovery. ▪ Many of the younger generation are not strongly influenced by religious values, beliefs, and faith practices. ▪ The younger generations turn towards spirituality rather than religion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Canada’s ensures free, universal health coverage at any point of entry into the system. ▪ Many people in the upper socioeconomic classes call on their family physicians instead of the local community service centers. ▪ Many lower socioeconomic individuals many do not seek health care until their health becomes a crisis situation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ French-speaking Canadians have joined the current trend toward over-the-counter drug use. ▪ Language differences may be a barrier to accessing health care. ▪ French-speaking subjects rate acute pain as more intense than chronic pain, and more affectively laden than the English-speaking subjects. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck ▪ On issues of death and dying, which religion most influences French Canadian’s decision making? ▪ Baptist ▪ Methodist ▪ Catholic ▪ Islamic Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C The Catholic religion has the most influence on decision making for death and dying issues for French Canadians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ As a cultural group, French Canadians have no official proscriptions against receiving blood or blood products. ▪ The decision to donate or receive an organ is an individual decision without cultural influence for French Canadians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Health-care providers hold a favorable status in the eyes of French Canadians, especially among older people. ▪ The universal health insurance system in Canada makes the folk practitioners less appealing. ▪ Professionals throughout Canada are vigilant in trying to avoid exploitation by traditional and folk healers, who are viewed as practicing outside the law.
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Chamberlain Our Future Leaders in Nursing discussion

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Chamberlain Our Future Leaders in Nursing discussion

conference coverage WHAT SKILLS WILL THE N Carol Huston – a brave new nursing world K eynote speaker at the

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conference, American nursing professor and former president of the international honour society of nursing, Sigma Theta Tau, Carol Huston, painted a picture of a brave new nursing world in 2020, in her opening presentation, Preparing nurse leaders for 2020. She outlined eight leadership competencies every nurse leader would need in the 2020. The first was a global perspective. “Every health care issue has to be looked at from a global perspective. We used to think pandemics were confined to developing countries. We now know they are just one short flight away.” There was a more urgent need for international standards for basic nursing education. The nursing shortage was one of the most serious threats to global health, she said, and it would get significantly worse before it got better. Nurse migration was a global problem. (See news p7.) The second leadership competency was better use of technology to connect people. Technology had driven so many changes already in health care but knowledge and information acquisition and distribution was going to multiply exponentially. “Forty percent of what we know today will be obsolete in three years,” Huston said. She listed a range of technological developments that would have a major impact on health care in the next 20 years. By 2030 diagnostic body scans, which could identify underlying pathology, would become part of showering. Improvements in body scanning technology would mean there would be no need for invasive surgery or tests. “Nano bots” circulating in the blood stream would identify disease processes and begin to repair them. Gene therapy would mean what was now untreatable would be treatable and could see cancer abolished completely 14 within two decades. Stem cell therapy would eliminate the need for organ transplants “as we will grow new organs. It is predicted we will be able to grow heart, kidneys and livers by 2020. There are already clinical trials underway growing new teeth – instead of dentures you would grow you own new teeth.” Merging of the human and the machine would advance significantly and by 2020 there would be pancreatic pacemakers for diabetics and the technology to enable blind people to see and deaf people to hear. Robotics would continue to develop, with physical service robots which could wash patients and help feed and carry patients. There was the potential for the use of robots in therapeutic roles. Paro, a robotic seal developed in Japan, responded to patting by closing its eyes and moving its flippers and was already being used as a therapeutic device for those with autism and Alzheimers. Kansei (emotion) robots are being developed and are programmed so key words trigger facial expressions. Robotic simulation for nursing education provided a safer environment for students and mannequins could now cry, sweat, and become cyanotic. “The challenge for nurse leaders in 2020 will be how much simulation is too much? How important is human contact to learning the art of professional nursing?” Huston said. Other areas of development would be digital records of health care history, the continued development of biometrics, with confidentiality protected by biometric signatures, the increasing use of “smart” objects, including a bed that could call a nurse if the patient was attempting to get out of bed, or a coverlet which could take a patient’s vital signs as they lay in the bed. “Nursing leaders will have to balance technology and the human element. I’m not worried about the science of nursing but I am a little worried about the art of nursing. Technology can supplement but not replace nursing care,” Huston said. The third leadership competency was expert decision-making skills rooted in both empirical science and intuition. She referred to “wicked” problems, ie those with no right answers. Clinical decision support software packages will, with provider input of data, come up with a list of differential diagnoses and best practice. There would be increasing numbers of tools to help decision makers, including the opportunity to buy information and advice from expert networks of thinkers. Nurse leaders with both right brain and left brain skills were needed and Huston suggested that nurse leaders should surround themselves with people with a different brain dominance from their own. The fourth leadership competency was the development of organisational cultures which emphasised quality patient care and worker and patient safety. “There has been an inordinate amount of money spent on medical errors but we haven’t seen that greater reduction in error rates. Part of the reason is how health care systems are created.” If as much energy was focused on fixing the underlying processes which caused errors as was focused on blame, much more would be learnt. “I’m not absolving individual health providers. We must find a balance between creating safer health care systems and individuals’ responsibility for the care they provide.” Being politically smart was the fifth leadership competency. “Nurses are the largest group of health care professionals but they are not always an integral part of health care decision making. This has something to do with how women are socialised to view power and with how they have been controlled by outside forces, notably medical and administrative. Politics can be defined as the art of using power effectively. In 2020 nursing input will be needed more than ever. Nurses must use their political skills to solve problems such as workforce shortages, turnover rates, reforming broken health care systems and bringing nursing education entry levels up to that of other professions,” Huston said. Team building skills Nurse leaders of 2020 must also have highly developed collaboration and team building skills. The key to leadership success in 2020 would be the ability to integrate the priorities of industrial age leadership, with its emphasis on productivity, and relationship age leadership. “Health in 2020 will be characterised by highly educated, multidisciplinary experts and this will complicate, not ease teamwork. The key will be to create teams of experts, not expert teams. The nurse leader will have to be a team builder.” The nurse leader of 2020 must be visionary and proactive in response to an environment which will be increasingly characterised by chaos and change. “Health care organisations in the 21st century will be in a state of constant, dramatic change and will be more fluid, more flexible and more mobile. Nurse leaders in 2020 will be experts in addressing resistance KAI TIAKI NURSING NEW ZEALAND > JULY 2010 > VOL 16 NO 6 to change and helping followers work through that change.” The final leadership competency was ensuring leadership succession, given the average age of a nurse in the United States is 47. “We must do a better job of mentoring the newest members of our profession.” She explained the “Queen Bee Syndrome”, a characteristic of female occupations – “the nurse leader who has had to struggle to get to the top and is so embittered by the struggle she thinks every nurse should have to go through that to get to the top.” Huston said mentoring and nurturing was the key to advancement in traditionally male occupations. She referred to “demographic invisibles”, ie those people not even considered for leadership roles because of their ethnicity, gender, age or nationality, and “stylistic invisibles”, ie those who didn’t fit the stereotype of a leader. “Nursing education programmes must be much more open about where the next generation of leaders is going to come from. Education and management development programmes must ensure nurse leaders have the skill set and competencies to be successful.” Huston said the ability to achieve a balance between old and new skills, technology and the human element, national and international perspectives, empirical science and intuition, productivity and relationship, and using power wisely for the benefit of self and others, would be critical for future nurse leaders. “We must be proactive in identifying, preparing and supporting our nursing leaders to address the realities in 2020.” • Huston’s second presentation on the last day of the conference, was a light-hearted look at her own nursing leadership journey and examined her mistakes and what she learnt from them. • PRISON NURSES WORK IN UNIQUE PRIMARY HEALTH CARE ENVIRONMENT P rison nurses provide primary health care nursing services to around 8680 prisoners in the unique and challenging environment of the country’s 20 prisons, the Department of Correction’s clinical director Debbie Gell told the conference. Prisoners, on the whole, were not a healthy group, with a high prevalence of mental illness, communicable and chronic diseases and up to 70 percent of prisoners were alcohol and drug dependent, she said. “The prison environment is not very conducive to supporting health needs and this is compounded by isolation and worries about home and family,” Gell said. The average length of stay was nine months, with some remand prisoners staying just a few days, so nurses had to get positive health messages across within short timeframes. Nursing practice was also affected by security con- cerns, with prisoners having to be escorted to health clinics or to hospital by custodial staff, sometimes up to three. Nurses on medication administration rounds had to be accompanied by custodial staff and a round always involved myriad locked gates. There are 280 prison nurses and last year they were involved in 200,000 nursing consultations. Gell outlined a “typical” day in the life of a prison nurse, with the aid of videos of nurses talking about their work. Nursing clinics were held in prison health centres and included immunisation, sexual health clinics, dental health and chronic care management. In large prisons, doctors visited daily but care was led by nurses with the support of doctors. “Prison nurses see a wide variety of presentations from serious traumatic injuries to minor injuries, alcohol and drug withdrawal, sexually transmitted infections to sport injuries. They can encounter very complex self-harm behaviours. They need excellent assessment skills, for example they must assess whether a prisoner’s severe abdominal pain is genuine or a way of securing a drug drop at the emergency department.” Each prisoner underwent a “reception health triage” when first arriving in prison and then a full health assessment within 24 hours to seven days of arrival. “The full assessment is a great opportunity to engage prisoners to look at their own health. Nurses are dealing with a high-needs population who are usually in prison for a relatively short period of time. Nurses must use that time effectively to help improve the prisoner’s health and hopefully the health of the prisoner’s family and wider community,” Gell concluded. • ASTHMA ASSESSMENT TOOL PROVING ITS WORTH The three-day conference programme featured a plethora of speakers, including five plenary speakers. As well as Carol Huston, Michal Boyd and Debbie Gell, the other two plenary speakers were MidCentral District Health board clinical nurse specialist community, Denise White, and respiratory programme manager at Harbour Health Primary Health Organisation in Auckland, Wendy McNaughton. McNaughton spoke about the web-based asthma assessment and decision support tool, GASP (giving support to asthma patients) she was instrumental in developing and which enables health professionals to follow the New Zealand Guidelines on asthma. She introduced her presentation with a rundown of international and national asthma statistics, including that there are 300 million sufferers worldwide, New Zealand is second only to the United Kingdom for asthma prevalence, asthma is the most common chronic condition among children, that in 2007 asthma was one of the top three avoidable hospital admissions in the Waitemata DHB region and that there are huge disparities between Mâori and non-Mâori asthma rates. She said more than 300 GASP nurses had completed a two-day, New Zealand Qualifications Authority-accredited course based on the Asthma Foundation’s course but with sections on critical thinking and how to establish nurse-led clinics added. Two GASP audits of 205 patients ranging in age from five to 64, had revealed a 76 percent decrease in hospital admissions, a 58 percent decrease in exacerbations and a 46 percent decrease in use the of oral steroids. McNaughton “implored” the government to fund nurse-led respiratory clinics. KAI TIAKI NURSING NEW ZEALAND > JULY 2010 > VOL 16 NO 6 continued on p16 15 conference coverage HE NURSE LEADERS OF 2020 NEED? Copyright of Kai Tiaki Nursing New Zealand is the property of New Zealand Nurses Organisation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. EVIDENCEBASED CARE SHEET Budgeting Principles What We Know › A budget is a financial forecast that estimates expenses and revenue for a specified period of time, typically 1 year. A budget is developed based on a set of assumptions regarding what can and cannot be achieved with a specific set of resources in a defined period of time; the more accurate a projected budget is, the better the healthcare organization can efficiently utilize its resources(3,5) • Expenses include all monies paid out by the healthcare organization.(5)The two main types of expenses are – employment costs (e.g., salaries, wages, overtime costs, benefits)(5) – The greatest expenses in a healthcare organization are related to personnel because health care is very labor intensive(3) – non-salary expenses (e.g., supplies, equipment, equipment repairs, travel costs)(5) • Revenue is the income the organization receives for services provided(5) –For healthcare organizations, revenue is provided by payments made by private insurers, Medicare, Medicaid, and patients • Each nursing unit is a cost center and has an operating budget. Nursing budgets are developed and managed by nurse managers and typically account for a large share of the expenses of a healthcare organization(3,5) › The three most common types of budgets are the • personnel budget, in which personnel needs are managed to prevent under- or overstaffing(3) • operating budget, in which the costs of supplies are managed(3) • capital budget, in which the long-term costs of the organization are managed(3) – Physicians play a dominant role in the capital budgeting process(4) Authors Hillary Ittner, RN, MSN Cinahl Information Systems, Glendale, CA Tanja Schub, BS Cinahl Information Systems, Glendale, CA Reviewers Alysia Gilreath-Osoff, RN, BSN, CEN, SANE Cinahl Information Systems, Glendale, CA Nursing Executive Practice Council Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA › The four most common budgeting methods are • incremental budgeting, which is performed by multiplying current expenses by a certain figure (e.g., the consumer price index) to project the budget for the following year(3) • zero-based budgeting, in which the manager examines and justifies all current activities and expenses to prioritize spending for the following year(3) • flexible budgeting, in which the budget adjusts up and down based on the needs of the organization. This type of budgeting is useful in healthcare organizations because it can fluctuate based on changes in patient census and staffing needs.(3) (For more information, see Evidence-Based Care Sheet: Flexible Budgeting ) • performance budgeting, in which the outcomes of services are used as the basis for budgeting (3) › Nurse managers who are in charge of budgeting must • balance the competing priorities of containing costs and ensuring quality of care(3) –After a budget is created, it must be continuously assessed to verify that costs are remaining within the budgeted limits. Variances are created when there is a discrepancy between expected budget expenditures and actual expenditures; nurse April 20, 2018 Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 managers must work to eliminate any variances and remain on budget. Variances can be created when nursing hours exceed the number required by the patient census(3) – The following factors influence variance analysis:(3,5) – Differences in the mix of staff and staff salaries. For example, payroll for registered nurses will cost more than payroll for medical assistants (for more information, see Evidence-Based Care Sheet: Nursing Skill Mix ) – Ranges in staff salaries – Differences in the levels of staff needed to provide care on night and weekend shifts – Incongruity between the number of staff members working on a unit and the number actually needed (e.g., there might be too many nurses working during a period of low patient census) – Changes in work practices and workload; workload is the volume of work in a specific department (for more information, see Evidence-Based Care Sheet: Nursing Workload Measurement ) – Lack of control regarding ordering goods and services and irregular purchasing patterns (e.g., fluctuating levels of stock and supplies) • have a thorough understanding of fiscal planning/financial analysis(3) –Fiscal planning in health care requires nurse managers to – identify of long- and short-term unit needs and document and communicate these to administrators(3) – verify that unit goals are congruent with organizational goals(3) – have knowledge of factors that influence healthcare reimbursement(3) – be flexible in financial goal-setting(3) – be creative and have the ability to motivate others(3) – provide opportunities for staff members to participate in budgeting activities(3) – recognize and effectively report to administrators if cost containment activities prevent the achievement of organizational goals(3) – ensure that cost containment does not impact patient safety(3) – role-model leadership(3) – ensure that patient care documentation is clear and complete to facilitate reimbursement(3) – effectively plan personnel needs(3) –Many nurses report that financial planning is difficult, most often because they lack formal education in budget planning and forecasting(2,3) – Researchers in Korea developed a financial-analysiseducation plan for nurses based on the following six key components: “Understanding the need for financial analysis, introduction to financial analysis, reading and implementing balance sheets, reading and implementing income statements, understanding the concepts of financial ratios, and interpretation and practice of financial ratio analysis” (Lim et al., 2015). Learning objectives and course content topics were developed based on these components(2) • demonstrate knowledge of budgeting methods(3) –Budgeting requires – assessment of budgetary needs(3) – determining long- and short-term goals(3) – developing the budget(3) – monitoring and analyzing expenditures(3) – evaluating the budget throughout the fiscal year(3) –Programme Budgeting and Marginal Analysis (PBMA) is a toolkit used in the U.K., Australia, New Zealand, and Canada to assist managers with decision-making regarding the most effective use of resources and with the setting of priorities in health care(1,7) – Senior and middle managers who took part in PBMA at a children and women’s tertiary care facility in Canada reported that PBMA implementation was a good experience and an improvement over previous practice(6) What We Can Do › Become knowledgeable about budgeting principles so you can accurately assess your organization’s fiscal goals and participate in developing a fiscally responsible budget; share this information with your colleagues › Adhere to the principles of the accounting method used in your facility and collaborate with others to successfully meet facility budgeting responsibilities › Learn about budgeting conflicts in your facility so you can participate in successful resolution › Communicate details regarding the budget to your colleagues and promote commitment in meeting your healthcare organization’s fiscal goals. Be prepared to • defend your budget • negotiate details of your budget • resolve budget challenges and conflicts • perform a variance analysis for your budget Coding Matrix References are rated using the following codes, listed in order of strength: M Published meta-analysis SR Published systematic or integrative literature review RCT Published research (randomized controlled trial) R Published research (not randomized controlled trial) RV Published review of the literature RU Published research utilization report QI Published quality improvement report L Legislation C Case histories, case studies PGR Published government report G Published guidelines PFR Published funded report PP Policies, procedures, protocols X Practice exemplars, stories, opinions GI General or background information/texts/reports U Unpublished research, reviews, poster presentations or other such materials CP Conference proceedings, abstracts, presentation References 1. Edwards, R. T., Charles, J. M., Thomas, S., Bishop, J., Cohen, D., Groves, S., … Bradley, P. (2014). A national Programme Budgeting and Marginal Analysis (PBMA) of health improvement spending across Wales: Disinvestment and reinvestment across the life course. BMC Public Health, 14, 837. doi:10.1186/1471-2458-14-837 (R) 2. Lim, J. Y., & Noh, W. (2015). Key components of financial-analysis education for clinical nurses. Nursing and Health Sciences, 17(3), 293-298. doi:10.1111/nhs.12186 (R) 3. Marquis, B. L., & Huston, C. J. (2015). Fiscal planning. In Leadership roles and management functions in nursing: Theory and application (8th ed., pp. 204-234). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. (GI) 4. Mukherjee, T., Al Rahahleh, N., Lane, W., & Dunn, J. (2016). The capital budgeting process of healthcare organizations: A review of surveys. Journal of Healthcare Management, 61(1), 58-77. (RV) 5. Sherman, R., & Bishop, M. (2012). The business of caring: What every nurse should know about cutting costs. American Nurse Today, 7(11), 32-34. (GI) 6. Smith, N., Mitton, C., Hiltz, M. A., Campbell, M., Dowling, L., Magee, J. F., & Gujar, S. A. (2016). A qualitative evaluation of program budgeting and marginal analysis in a Canadian pediatric tertiary care institution. Applied Health Economics and Health Policy, 14(5), 559-568. doi:10.1007/s40258-016-0250-5 (R) 7. Tsourapas, A., & Frew, E. (2011). Evaluating ‘success’ in programme budgeting and marginal analysis: A literature review. Journal of Health Services Research & Policy, 16(3), 177-183. doi:10.1258/jhsrp.2010.009053 (RV)