Discussion
1.100-200 words about teenage pregnancy
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2. 100-200 words
Hospital-Acquired Infection
Hospital-Acquired Infection
Serious complications can cause by Hospital-acquired infection if left untreated. When
Discussion
1. In the last century, what historical, social, political, and economic trends and issues have influenced today’s health-care system?
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2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome?
3. How does technology improve patient outcomes and the health-care system?
4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside?
2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions: •
What does the organization/agency do that supports the hallmarks of quality? •
What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession? •
How has the organization/agency affected facilities where you are practicing and your own professional practice?
Tags: APA format nursing
discussion
1—Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?
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2—Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?
each answer should be minimum of 260 words, 2 or more references using in-text citations and source referencing in APA 6th edition.
please all answer should fall in line with the topic, obesity amid adolescent in the united states and primary practicum site is home healthcare agency.
discussion
1—Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?
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2—Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?
each answer should be minimum of 260 words, 2 or more references using in-text citations and source referencing in APA 6th edition.
please all answer should fall in line with the topic, obesity amid adolescent in the united states and primary practicum site is home healthcare agency.
Discussion
Chapter 20 Family Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Working with Families Working with families has never been more complex or rewarding than now. Nurses understand the actual and potential impact that families have in changing the health status of individual family members, communities, and society as a whole. Families have challenging health care needs that are not usually addressed by the health care system. . Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 How Do You Define a Family? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions of a Family Historical definitions: The environment affecting individual clients Small to large groups of interacting people A single unit of care with definable boundaries A unit of care within a specific environment of a community or society Current theorists: Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined. – Hanson & Kaakimen (2005) The family is who they say they are. – Wright & Leahey (2000) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Inclusive Definitions of Family “Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both differentsex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles. – Human Rights Campaign ( 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 The Changing Family Purposes of the family ➢ ➢ To meet the needs of society To meet the needs of individual family members Examples of different family types ➢ Traditional, nuclear family ➢ Multigenerational family household ➢ Cohabitating families ➢ Single-parent families ➢ Grandparent-headed families ➢ Gay or lesbian families ➢ Unmarried teen mothers Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 The “Sandwich” Generation Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Why Is It Important for the CHN to Work with Families? The family is a critical resource. Any dysfunction in a family unit will affect the members and the unit as a whole. Case finding can identify a health problem that leads to risks for the entire family. Nursing care can be improved by providing holistic care to the family and its members. – Friedman, Bowden, & Jones (2003) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Approaches to Meeting the Health Needs of Families Moving from the Individual to the Family Moving from the Family to the Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Moving from the Individual to the Family Family interviewing ➢ Manners ➢ Therapeutic conversations ➢ Genogram and Ecomap ➢ Therapeutic questions ➢ Commending family or individual strengths ➢ Issues in family interviewing • Many locations, family informant, family health portrait, involvement of children Intervention in cases of chronic illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Moving from the Family to the Community The health of communities is measured by the well-being of its people and families. Families are components of communities. Cross-comparison of communities must include health needs as well as resources. Cross-compare the needs of the families within the community and set priorities. Delegation of scarce resources is essential. A double standard in public health is tolerated. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Family Theory Approach 1. Any “dysfunction” that affects one member will probably affect others and the family as a whole. 2. The family’s wellness is highly dependent on the role of the family in every aspect of health care. 3. The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Family Theory Approach (Cont.) 4. Commonalities in risk factors and diseases shared by family members can lead to case finding within family. 5. Individual is assessed within larger context of family. 6. Family is vital support system to individual member. – Friedman (1994) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Systems Theory Approach The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem). – Friedman (1998) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Healthy Families Members interact with each other; listen and communicate repeatedly in many contexts. Healthy families establish priorities. Members understand that family needs are the priority. Healthy families affirm, support, and respect each other. Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Healthy Families (Cont.) The family teaches family and societal values and beliefs and shares a religious core. Healthy families foster responsibility and value service to others. Healthy families have a sense of play and humor and share leisure time. Healthy families have the ability to cope with stress and crisis and grow from problems. They know when to seek help from professionals. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Structural-Functional Conceptual Framework Internal structure ➢ External structure ➢ ➢ Family composition, gender, rank order, functional subsystem, and boundaries Extended family and larger systems (work, health, welfare) Context: ethnicity, race, social class, religion, environment Instrumental functioning (routine ADLs) Expressive functioning ➢ Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Developmental Theory Family life cycle (Duvall & Miller, 1985) ➢ ➢ ➢ ➢ ➢ ➢ ➢ Leaving home Beginning family through marriage or commitment as a couple relationship Parenting the first child Living with adolescent Launching family (youngest child leaves home) Middle-age family (remaining marital dyad to retirement) Aging family (from retirement to death of both spouses) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Family Health Assessment Tools Genogram ➢ Family health tree ➢ A tool that helps the nurse outline the family’s structure Family’s medical and health histories Ecomap ➢ Depicts a family’s linkages to their suprasystems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Family Health Assessment Tools Family Health Assessment ➢ Addresses family characteristics, including structure and process and family environment ➢ Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family ➢ Additional information obtained through observation of family and their environment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Genogram Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Ecomap Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Social and Structural Constraints Identify what prevents families from receiving needed health care or achieving a state of health Usually based on social and economic causes ➢ ➢ ➢ Literacy, education, employment If disadvantaged, often unable to buy health care from private sector Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Family Health Interventions Institutional context of family therapists ➢ ➢ ➢ Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment Social Network Framework: Involves all connections and ties within a group; social support Transactional model: A system that focuses on process as opposed to a linear approach Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Applying the Nursing Process Knowledge of self, previous life experiences, and values is crucial in planning home visits Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home Flexibility is important in working with families Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25
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Discussion
Chapter 18 Men’s Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Longevity and Mortality in Men Rates of longevity are increasing for both men and women. Gender disparity for life expectancy and mortality has decreased, but mortality rates for men remain higher than those for women. Factors influencing mortality rates include race or ethnic origin, socioeconomic status, and education. Males continue to be at risk for death resulting from unintentional injury and homicide. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Morbidity in Men’s Health Men tend to perceive themselves to be in better health than do women. Women are more likely to be ill, whereas men are at greater risk for death. Incidence rate for acute and chronic conditions is higher for women than for men; injuries are higher for men than women. Women have higher morbidity rates than men, but men have higher morbidity and mortality rates for conditions that are the leading causes of death. . Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Precursors of Death Frequently NOT Addressed by the Present Health Care System Heart disease and stroke Hypercholesterolemia Hypertension Diabetes mellitus Obesity Type A personality Family history Lack of exercise Cigarette smoking Cancer Sunlight Radiation Occupational hazards Water pollution Air pollution Dietary patterns Alcohol Heredity Certain medical conditions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Men’s Use of Medical Care Men do not engage in health protective behaviors at frequently as women. Most men do not have routine check-ups, including screenings. Men seek ambulatory care less often than women. ➢ Men delay medical treatment → are sicker when they do seek health care → therefore they require more intensive medical care. Men tend to have longer lengths of stay in the hospital than women. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Male-Female Health Paradox Females are sicker, but males die sooner? – Verbrugge and Wingard (1987) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Male-Female Health Paradox (Cont.) Biological factors ➢ Genetics, effects of sex hormones, and physiological differences Influenced by genetics, hormones, and environment Socialization ➢ Men enculturate their sons to believe that risking personal injury demonstrates masculinity. ➢ Men are more likely to change health behaviors when supported by female family members. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Male-Female Health Paradox (Cont.) Orientation toward illness and prevention ➢ Stereotypical view of men as strong and invulnerable is incongruent with health promotion. ➢ Men lack the somatic awareness and are less likely to interpret symptoms as indicators of illness. ➢ Men may have a desire to rationalize symptoms and deny their susceptibility to disease, thus delaying treatment. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Male-Female Health Paradox (Cont.) Data collection on health behaviors may not be accurate: ➢ Males are less likely than females to participate in the data collection process. ➢ Social pressure for males to be less expressive (suppress their emotions) may help explain gender differences in reporting health behaviors. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Nurse’s Responsibilities with Men’s Health Use gender-specific interview techniques to obtain the most accurate health history. Be aware of personal gender bias in data collection. Be aware of the accuracy and interpretation of secondary sources of information. Help men learn how to provide support to the caregiver or to develop a caregiver role. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Nurse’s Responsibilities with Men’s Health (Cont.) Acknowledge that gender-linked behaviors increase risks: ➢ ➢ ➢ Lifestyle factors (e.g., use of tobacco, substance abuse, poor preventive health habits and stress, lack of emotional channels) Men’s unwillingness to seek preventive care Men’s unwillingness to seek health care when a symptom arises Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Barriers to Health Care for Men Little effort has been made to create a malespecific health care climate Access to care ➢ Focused on maintaining an effective workforce ➢ Financial support for curative—not preventive— care ➢ Reluctance to take time off from work for care Lack of health promotion ➢ ➢ Disease prevention and health promotion not often reflected in a man’s perception of health Focus on disease cure in the present health care system Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Men’s Health Care Needs Permission to have concerns about health and talk openly to others about them Support for the consideration of gender role and lifestyle influences on their physical and mental health Attention from professionals regarding factors that may result in illness or influence a man’s expression of illness, including such things as occupational factors, leisure patterns, and interpersonal relationships Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Men’s Health Care Needs (Cont.) Information about how their bodies function, what is normal, what is abnormal, what action to take, and the role of proper nutrition and exercise Self-care: testicular and genital self-exams Physical exam and history-taking that include sexual and reproductive health and illness across the lifespan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Men’s Health Care Needs (Cont.) Treatment for problems of couples, such as interpersonal problems, infertility, family planning, sexual concerns, and STDs Help with fathering (i.e., being included as a parent in child care) Help with fathering as a single parent, particularly with a child of the opposite sex, in addressing the child’s sexual development and concerns Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Men’s Health Care Needs (Cont.) Recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change Adjustment of the health care system to men’s occupational constraints regarding time and location of health care sources Financial ways to obtain these goals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Primary Prevention Measures Provide health education and screening in the workplace Participate in interest groups and research focused on men’s health Encourage interest in physical fitness and lifestyle changes Include the male perception of health in policy formation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Secondary Prevention Measures Tailor health care clinics to men’s needs Provide screening services for men ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Dental examination: Yearly Eye examination: Every 3 to 5 years Blood pressure check: Every 2 years Blood cholesterol check for men aged 53 years and older Prostate examination: Every year after age 50; blacks every year after age 40 Colorectal screening: Every 3 to 5 years Tobacco use and cessation information every year One-time screening for abdominal aortic aneurysm for men 65 years old if the male has smoked – The U.S. Preventive Services Task Force (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Tertiary Prevention Measures Provide rehabilitation with sex role and lifestyle considerations ➢ Provide counseling on lifestyle, role changes, and job retraining. ➢ Give men permission to express emotions. ➢ Adapt goal setting to meet men’s needs. ➢ Keep time away from work to a minimum. Develop new concepts of community care ➢ Provide specific services for men; adapt care to meet needs of male population in the community. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19
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