1
Q
A key component of Canada’s social safety net for citizens is the provision of hospital & medical insurance which is funded by the general taxation is known as _____________
A
MEDICARE
2
Q
4 COMMON CAUSES OF NURSING SHORTAGES
A
- Aging workers
- High retirement rate
- Lack of full time positions
- Constitute large % of health care budget
3
Q
5 principals of health canada act
A
- Public Administration
- Comprehensiveness
- Universality
- Portability
- Accessibility
4
Q
WHICH PRINCIPAL of Canada Act
provincial insurance programs are publicly accountable for the funds they spend & the province determines the amount of coverage of insured services
A
PUBLIC ADMINISTRATION
5
Q
WHICH PRINCIPAL of Canada Act
Provincial health insurance must cover all medically necessary services for the purpose of maintaining health, preventing disease, dx or tx an illness, injury or disability
A
COMPREHENSIVENESS
6
Q
WHICH PRINCIPAL of Canada Act
provincial health programs must insure Canadians for all medically necessary hospital and physician (NPs also) care
A
UNIVERSALITY
7
Q
WHICH PRINCIPAL of Canada Act
People are covered by their provincial insurance during short absences from their province
A
PORTABILITY
8
Q
WHICH PRINCIPAL of Canada Act
Canadians must have reasonable access to insured services without charge or paying user fees
A
ACCESSIBILITY
9
Q
4 types of payment (direct or indirect) contributions to health care
A
- taxes,
- payments to government,
- private insurance,
- fees
10
Q
- concluded that Medicare is sustainable and must be preserved
A
Romanow Commission, 2002
11
Q
- represents Canadian’s core values
A
Romanow Commission, 2002
12
Q
- recommended changes to Canada Health Act
A
Romanow Commission, 2002
13
Q
- did not make recommendations for cost
A
Romanow Commission, 2002
14
Q
- emphasized accountability for funding
A
Romanow Commission, 2002
15
Q
- concluded that Medicare is not sustainable
A
Kirby Report, 2002
16
Q
- advocated for private sector involvement
A
Kirby Report, 2002
17
Q
- clarified the impact of spiraling health care costs
A
Kirby Report, 2002
18
Q
a foundation of Canada’s Health care system, providing entry point of contact into the health care system, as well as the vehicle for continuity of care
A
PRIMARY HEALTHCARE
19
Q
a philosophy and model for improving health that supports essential health care services (promotive, preventive, curative, rehabliitative, and supportive) with a strong emphasis on the principles of health promotion and disease prevention
A
PRIMARY HEALTHCARE
20
Q
HEALTHCARE SETTINGS ~ INSTITUTIONAL SECTOR (4)
A
- Hospitals
- Long-Term Care Facilities
- Psychiatric Facilities
- Rehabilitation Centres
21
Q
HEALTHCARE SETTINGS ~ COMMUNITY SECTOR (10)
A
- Public Health
- Physicians Offices
- Community Health Centres (CHCs) & Clinics
- Assisted Living
- Home Care
- Adult Day Care Centres
- Community and Voluntary Agencies
- Occupational Health
- Hospice and Palliative Care
- Parish Nursing
22
Q
5 LEVELS OF CARE
A
- Health Promotion
- Disease & Injury Prevention
- Diagnosis & Treatment
- Rehabilitation
- Supportive Care
23
Q
____________ ____________ is the first contact of a client with the health care system that leads to a decision regarding a course of action to resolve any actual or potential health problems. PC providers include physicians and nurse practitioners.
A
PRIMARY CARE
24
Q
___________ _____________ occurs usually in a hospital or home setting, involves provisions of a specialized medical service by a physician specialist or a hospital on referral from a PC practitioner.
A
SECONDARY CARE
25
____________ _____________ is specialized and highly technical care in diagnosing and treating complicated or unusual health problems. Clients have extensive, often complicated pathological conditions.
TERTIARY CARE
26
3 health care cost acclerators
1. TECHNOLOGIES - e-health & nursing informatics
2. DEMOGRAPHICS - aging population, increase in maternal age
3.consumer involvement - demand higher quality care
27
___________ ____________ __________ institute is charged with providing leadership in building and advancing a safer health care system
CANADIAN PATIENT SAFETY
28
___________ ____________ are preventable adverse events occur annually in Canadian hospitals, one per nine clients contract an infection while in the hospital, and the same number experiences a medical-related error
HOSPITAL INFECTIONS
29
a collection of individuals who have in common one or more personal or environmental characteristics. Examples- high-risk infants, older adults, or a cultural group such as aboriginals.
POPULATIONS
30
a group of people who share a geographic (locational) dimension and a social (relational) dimension.
COMMUNITY
31
4 characteristics of healthy community
1. collective PROBLEM-SOLVING capacity
2. adequate LIVING CONDITIONS
3. safe ENVIRONMENT
4. sustainable RESOURCES such as employment, health care, and educational facilities.
32
___________ ___________ ___________ includes public health nursing, home health (community-based) nursing, and community mental health nursing, as well as a variety of other specialities such as street health, telehealth, and parish nursing.
COMMUNITY HEALTH NURSING
33
WHAT TYPE OF NURSING?
- DELIVERS health care where people live, work & learn
- IS Essential for improving health for the general public
COMMUNITY NURSING
34
4 GOALS OF COMMUNITY NURSING
1. KEEP PEOPLE HEALTHY
2. ENCOURAGE CLIENT PARTICIPATION & CHOICE IN CARE
3. PROMOTE HEALTH-ENHANCING SOCIETY
4. PROVIDE IN-HOME CARE
35
____________ _____________ of clients are those who are likely to develop health problems as a result of excessive risk, who experience barriers when trying to access health care services, or who are dependent on others for care
VULNERABLE POPULATIONS
36
cultural competency & sensitivities
???
37
Steps in assessing vulnerable populations:
1. SETTING THE STAGE
2. NURSING HISTORY OF AN INDIVIDUAL OR A FAMILY
3. PHYSICAL EXAMINATION OR HOME ASSESSMENT
see pg. 47 box 4-4 for more detail
38
What are the 7 Roles of Community Health Nurses?
1. UNDERSTAND roles agencies, regulations & laws
2. COORDINATE SERVICES to address needs of community
3. Set up SCREENING PROGRAMS
4. LOCAL HEALTHCARE PROVIDER EDUCATION
5. IMPROVE condition of HOUSING
6. PUBLIC EDUCATION
7. ASSESSMENT & REFERRAL
39
Potentially stigmatizing __________ ___________ include substance abuse and unsafe sexual practices.
RISK BEHAVIOURS
40
3 COMPONENTS OF COMMUNITY ASSESSMENT:
1. Locale or structure
2. Social Systems
3. People
41
__________ ___________ ___________ exemplifies community nursing practice guided by primary health care, health promotion, empowerment, and ethical principles. EX. needle exchange program
HARM REDUCTION NURSING
42
List the 5 types of loss:
1. necessary loss
2. actual loss
3. perceived loss
4. maturational loss
5. situational loss
43
TYPE OF LOSS?
integral part of each person's life
eg. death of loved one, divorce, loss of independence
NECESSARY
44
TYPE OF LOSS?
- loss of person or object that can no longer be felt, heard, known or experienced
- loss of a body part, child, relationship or role at work
ACTUAL
45
TYPE OF LOSS?
- any loss that is defined uniquely by the grieving client
- eg. loss of confidence or prestige
PERCEIVED
46
TYPE OF LOSS?
- includes any change in the developmental process that is normally expected during a lifetime
- eg. parents feeling loss as a child goes to school for the first time
MATURATIONAL
47
TYPE OF LOSS?
- includes any sudden, unpredictable external event
- often includes multiple losses rather than single loss
- eg. car accident
SITUATIONAL
48
____________ IS THE ULTIMATE LOSS
DEATH
49
Kubler-Ross’s 5 stages of dying
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
50
Bowlby’s 4 phases of mourning
1. Numbing
2. Yearning and searching
3. Disorganization and despair
4. Reorganization
51
4 Types of Grief:
1. normal grief
2. anticipatory grief
3. complicated grief
4. disenfranchised grief
52
WHICH TYPE OF GRIEF?
- normal feelings, behaviours, and reactions to loss
- resentment, sorrow, anger, crying, loneliness, temporary withdrawal from activities
NORMAL
53
WHICH TYPE OF GRIEF?
- process of disengaging or "letting go" before an actual loss or death has occurred
- beginning the process of saying goodbye and settling life affairs after a terminal diagnosis is received
- family members may withdraw emotionally too soon, leaving client with no emotional support as death approaches
ANTICIPATORY
54
WHICH TYPE OF GRIEF?
- when a person has difficulty progressing through normal stages of grieving
- includes 4 types: chronic, delayed, exaggerated, masked
COMPLICATED
55
WHICH TYPE OF GRIEF?
- grief experienced when a loss cannot be openly acknowledged, socially sanctioned, or publicly shared
- eg. loss of partner to AIDS, stillborn
DISENFRANCHISED
56
TYPE OF GRIEF?
| - people verbalize an inability to "get past" the grief
COMPLICATED - CHRONIC
57
- active grieving is held back, only to resurfaces later, usually in response to a trivial loss or upset
COMPLICATED - DELAYED
58
TYPE OF GRIEF?
- grief overwhelms some people to the point where they cannot function
- may be reflected in the form of severe phobias or self-destructive behaviour: addiction or suicide
COMPLICATED - EXAGGERATED
59
TYPE OF GRIEF?
- lack of awareness by survivors that behaviours that interfere with normal functioning are a result of loss
- eg. altered sleeping or eating patterns
COMPLICATED - MASKED
60
7 factors that influence loss and grief
1. Human development
2. Psychosocial perspectives of loss and grief
3. Socioeconomic status
4. Personal relationships
5. Nature of the loss
6. Culture & ethnicity
7. Spiritual beliefs
61
2 GRIEF-RELATED ROLES OF THE NURSE
1. Facilitating grief process effectively
| 2. Assist clients to peaceful dignified death
62
TRUE OR FALSE?
| Nurses must develop an understanding of own feelings towards death
TRUE
63
5 Potential Nursing Diagnoses related to grief
1. HOPELESSNESS related to failing physical condition
2. INEFFECTIVE INDIVIDUAL COPING related to low mood, and inability to manage loss
3. POWERLESSNESS related to perceived poor outcomes
4. SELF-CARE DEFICIT related to inability to perform activities of daily living
5. SOCIAL ISOLATION related to inability to cope with loss
64
4 AREAS OF FOCUS IN CARE PLANNING FOR DEATH & DYING:
support the client
1. physically,
2. emotionally,
3. developmentally
4. spiritually in the expression of grief
65
When caring for the dying client, it is important to devise a plan that helps the client die with ______________ and offers family members the ________________ that their loved one is cared for ______________.
dignity, assurance, compassionately
66
The care planning process is highly _____________ to the client and family. Both must be included as active participants in planning, goal setting, and development of realistic _______________ & ______________.
individual
interventions
timelines
67
What is the aim of palliative care?
- relieve suffering, and improve the quality of living and dying
68
When can someone receive palliative care?
for any age, any diagnosis, at any time, and not just during the last few months of life
69
7 treatments provided with palliative care:
1. RELIEF from pain and other distressing symptoms
2. AFFIRM life and REGARD dying as normal process
3. neither HASTEN nor POSTPONE death
4. INTEGRATE psychological and spiritual aspects of client care
5. HELP CLIENTS LIVE as actively as possible
6. HELP FAMILIES COPE
7. ENHANCE quality of life
70
MASSIVE VAGUE QUESTION ABOUT pg. 465 box 29.8......
* nursing care planning with dying patients
* dealing with and treating the symptoms
* from a symptoms perspective
???
71
symptoms displayed in the terminal stages
- discomfort
- fatigue
- nausea
- constipation
- diarrhea
- urinary incontinence
- inadequate nutrition
- dehydration
- INEFFECTIVE BREATHING PATTERNS
(air hunger, shortness of breath)
- confusion
72
management of air hunger:
- oxygen therapy
| - morphine and antianxiolytics
73
treatment for TERMINAL STAGE discomfort:
- skin care
- special mattress
- oral care
- artificial tears to reduce corneal drying
74
treatment for TERMINAL STAGE fatigue
- help client identify priority tasks
- help client conserve energy for those tasks
- time and pace care activities
- encourage use of energy-saving devices
75
treatment for TERMINAL STAGE nausea
- nutritional supplements
| - clear liquid diet
76
treatment for TERMINAL STAGE constipation
- increase fluid & fiber intake
| - laxatives
77
treatment for TERMINAL STAGE diarrhea
- medication
| - low-residue diet
78
treatment for TERMINAL STAGE urinary incontinence
- protect skin
| - catheter or brief
79
treatment for TERMINAL STAGE dehydration
- mouth care
| - ice chips
80
treatment for TERMINAL STAGE ineffective breathing patterns
- oxygen therapy
- medications
- semi-fowlers position
- comfort and reassurance
81
treatment for TERMINAL STAGE confusion
- ensure safe environment
- monitor client frequently
- reorient client as needed
82
PREPARING THE DYING CLIENT'S FAMILY objectives
improve family's ability to provide:
- appropriate physical care
- appropriate psychological support
83
PREPARING THE DYING CLIENT'S FAMILY teaching strategies
demonstrate:
- feeding technique
- bathing, mouth care
- safe transfer techniques
instruct family on need to take rest breaks
teach family to recognize signs & symptoms of worsening conditions
answer questions & provide info as needed
84
TRUE OR FALSE?
| Cultural beliefs are not important in post-mortem care
FALSE
85
Maintaining the integrity of rituals and mourning practices helps families ____________ the client's death and achieve inner ____________
accept
| peace
86
WHO?
| * Premier of Saskatchewan
TOMMY DOUGLAS
87
WHO?
| * 1961 - Introduced first hospital insurance plan in Saskatchewan
TOMMY DOUGLAS
88
WHO?
| * Well-known founder of both Medicare & Canada’s social democratic movement
TOMMY DOUGLAS
89
WHO?
| * One of nation’s most eloquent orators
TOMMY DOUGLAS
90
differences in care between volunteer & professional person
- volunteers can offer emotional support
| - professionals can provide hands-on care
91
3 major environmental threats
1. Indoor air pollution
2. Outdoor air pollution
3. Unsafe water, sanitation, and hygiene
92
Environmental agents that trigger changes, or mutations, in the genetic material (DNA) of living cells are called ______________
MUTAGENS
93
______________: mutagen that causes cancer
CARCINOGEN
94
8 Community Environmental Concerns:
1. Pollution
2. Water
3. Food
4. Pesticides
5. Chemical weapons
6. Cosmetic chemical
7. Radiation
8. Noise pollution
95
____________ ______________ can cause floods, heat waves, changes in patterns of infectious diseases, water supplies, and food availability
CLIMATE CHANGE
96
This is known as any long term significant change in the “average weather” that a region experiences
CLIMATE CHANGE
97
____________ ____________: small amounts of solar radiation pass through the Earth’s atmosphere so heat is generated – rest of the solar radiation bounces back into space
GREENHOUSE EFFECT
98
6 greenhouse gases
1. water vapor,
2. carbon dioxide,
3. nitrous oxide,
4. methane,
5. chlorofluorocarbons1,
6. ozone
99
____________ ____________ an agreement among the industrialized nations of the world to reduce emissions of six greenhouse gases over a certain period of time
KYOTO PROTOCOL
Nursing Theory
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