1
Q
3 levels of prevention
A
- primary: protection against disease before signs or symptoms occur
- secondary: activities that promote early detection of disease
- tertiary: activities initiated in the convalescence stage to prevent progression
2
Q
primary health care
A
- a pjilosophy and model for improving health
- the foundation of Canada’s healthcare system
- more effective and efficient than those centred on specialty care
- strong emphasis on principles of health promotion & disease prevention
- importance of determinants of health is recognized
3
Q
4 pillars of primary health care
A
- teams
- access
- information
- healthy living
4
Q
self-regulation of RNs
A
5
Q
health
A
a state of comlete physical, mental, and social well-being, and not merely the absence of disease or infirmity
6
Q
illness
A
subjective to patient
7
Q
disease
A
8
Q
3 approaches to health
A
- medical
- behavioural
- socioenvironmental/population health approaches
9
Q
foundational reports / main findings
A
10
Q
upstream vs. downstream intervention
A
- upstream: solving problems by dealing with the cause of the problem not just the result
11
Q
health disparities
A
12
Q
health inequalities
A
13
Q
health inequities
A
14
Q
health promotion
A
15
Q
disease prevention
A
16
Q
community health nursing
A
17
Q
Ottawa charter for health promotion strategies (5)
A
18
Q
Labonte socioenvironmental approach
A
- reflects qualities of both the actualization and stability perspectives:
- feeling vitalized and full of energy
- having satisfying social relationships
- having a feeling of control over one’s life and living conditions
- being able to do things that one enjoys
- having a sense of purpose
- feeling connected to a community
19
Q
population health approach
A
20
Q
determinants of health
A
21
Q
vulnerable populations
A
22
Q
Canada Health Act principles
A
- public administration
- comprehensiveness
- universality
- portability
- accessibility
23
Q
federal responsibilities
A
- sets and administers national principles
- assists in financing of healthcare services through transfer payments
- delivers health services for indigenous peoples, veterans, federal inmates, and RCMP
- provides national policy and programming to promote health and prevent disease
24
Q
provincial/territorial responsibilities
A
- develop and administer their own health care insurance plans
- manage, finance, and plan insurable health care services and delivery, in alignment with CHA principles
- determine organization and location of hospitals or long-term care facilities; mix of health providers; and amount of money dedicated to health care services
- reimburse physician and hospital costs; some rehabilitation and long-term care services, usually on the basis of co-payments with individual users
25
Romanow commission
- medicare is sustainable and must be preserved
- medicare represents the core values of Canadians
- creating new diagnostic service fund
- building information technology infrastructure
- improving access
- ensuring and measuring quality
- improving and expanding primary health care
- strengthening and expanding home care
- offering catastrophic drug covering
- creating national health council responsible for indicators and performance measures
26
Kirby report
- medicare system not sustainable
- need for stronger private sector involvement
- shifting funding for hospitals to a service-based model
- granting more responsibility to regional health authorities
- reforming primary health care
- offering a health care guarantee to canadians
27
primary care
- focus is on personal health services
28
primary health care
- includes primary care and health education, nutrition, maternal and child health care, family planning, immunizations, and control of locally endemic disease
29
5 levels of healthcare
level 1: health promotion
level 2: disease and injury prevention
level 3: diagnosis and treatment
level 4: rehabilitation
level 5: supportive care
30
challenges to the HC system
- cost accelerators
- equity and quality
31
truth and reconciliation commission
- increased sustainable funding for healing
- embedding of cultural healing practices
- cultural competency & safety training for all healthcare providers
- indigenous professionals in health care
32
3 levels of care
33
barriers to PHC
- individual-level barriers
- practice level barriers
- system-level barriers
34
healthcare delivery settings
- institutional sector
- community sector
35
institutional sector
- hospitals
- long-term care home facilities
- psychiatric facilities
rehab centres
36
community sector
- public health
- physician offices
community health centres and clinics
- assisted living
- home care
- adult day support programs
- community and voluntary agencies
- occupational health
- hospice and palliative care
- parish nursing
37
indigenous health practices
38
Florence Nightingale main discoveries
- founder of modern nursing
- cared for wounded soldiers during the Crimean war
dramatically reduced mortality and morbidity rates with simple nursing care
- elevated status of nursing
- first nurse statistician
39
ICN
International Council of Nurses
- concerned with the professional welfare of nurses, interests of women, and improvement of people's health
- to be a member, nations must have a national nursing organization
- Canada joined in 1909
- federation of more than 130 national nurses associations
- represents 28 million nurses worldwide
40
CNA
Canadian Nurses Association
- national professional voice of registered nurses in Canada
- trusted leader in advocacy and policy development
- provide direction that advances the nursing profession to improve health outcomes and maintain the trust of the public
- developed a code of ethics
41
CNO
College of Nurses of Ontario
- registration process in Ontario (all provinces and territories have professional bodies that oversee licensure and registration)
- these professional bodies:
- set scope of practice
- protect title of nurse
- protect public against unqualified, incompetent practice
42
responsibility
- implies an ability to distinguish between right and wrong
- includes a duty to perform actions adequately and thoughtfully
43
accountability
- being able to accept responsibility or to account for one's actions and refers to being answerable to someone for something one has done
44
advocacy
- acting on behalf of another person, speaking for persons who cannot speak for themselves, or intervening to ensure that views are heard
45
code of ethics for nurses (CNA)
- statement of the ethical values of nurses and nurses' commitments to persons with health care needs
- intended for nurses in all contexts
- provides guidance when nurses are working through an ethical callenge
- include responsibility, accountability, and advocacy
46
deontological ethics
- don't look at the consequences of actions to determine rightness or wrongness
- a moral and honest action is taken regardless of the outcome
- deontology is developed from the word duty
47
utilitarianism
- no absolute principles, duties, or rules
- the end justifies the means
48
bioethics
- concept that actions are abligation based, outcome oriented, and based on reason
49
feminist ethics
- focuses on inequalities between people
- being attentive to issues of difference, power dynamics, and context and relatedness
- gives consideration to relationships and context in ethics
- empathetic vs. rational, rule-based reasoning
50
relational ethics
- a response to the limits of philosophical theories of justice for healthcare practice
- emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
51
bioethical principles
- autonomy: the ability to make informed personal choices
- beneficence: doing or promoting good for others
- non-maleficence: avoidance of harm or hurt "Do No Harm"
- justice: fairness
52
ethical dilemma examples
big picture
- abortion
- futile care
- human cloning
- MAID
everyday ethical issues
- end-of-life decisions
- incompetent or unethical practices of colleagues
- pain management
- informed consent for procedures
- breaches of patient confidentiality
- staffing
53
steps to analyze ethical dilemmas
1. determine whether the issue is an ethical dilemma
2. gather all relevant information
3. examine and determine your own values on the issues
4. verbalize the problem
5. consider possible courses of action
6. reflect on the outcome
7. evaluate the action and the outcome
54
first nurses / Canadian nursing history
55
nursing education
- new and continually developing curriculum
- increased access through online and distance modalities
- educational standards monitored by the provinces and territories by Canadian Association for Schools of Nursing (CASN)
- ensures greater quality and response to change
56
value clarification
- the process of appraising
57
2 ethical approaches
- oberle & raffin model
- the model for ethical decision-making for policy and practice (Storch, 2013)
58
4 themes of relational ethics
- environment
- embodiment
- mutuality
- engagement
59
theory
- provides a systematic view for explaining, predicting, and prescribing phenomena
- purposeful set of assumptions or propositions that identify the relationships between concepts
60
nursing theory
- communicates a systematic view for explaining, predicting, and prescribing nursing care
- articulates the role of nurses and differentiates nursing from other professions
61
nursing science
- unique body of knowledge about the practice of nursing
62
steps of the nursing process
1. assessment
2. diagnosis
3. planning
4. intervention
5. evaluation
63
different ways of knowing
64
evidence-based practice
- an approach to decision-making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best
65
steps to evidence-informed practice
1. ask
2. collect
3. critique
4. integrate
5. evaluate
6. disseminate
66
qualitative research
- poses questions about nursing phenomena that cannot be quantified and measured; requires understanding the perspective of the person in the situation
67
qualitative designs
- ethnography
- phenomenology
- grounded theory
- symbolic interactionism
68
quantitative research
- the investigation of nursing phenomena that can be precisely measured and quantified
69
quantitative designs
- experimental research
- non-experimental
- cohort
- case control
- survey
70
nursing metaparadigm
- person
- nursing
- environment
- health
71
nursing metaparadigm: person
person is the recipient of nursing care and may include individuals, patients, groups, families, and communities
72
nursing metaparadigm: nursing
the attributes characteristics,a nd actions of the nurse providing care on behalf of or in conjunction with, the client
73
nursing metaparadigm: environment
environment (or situation) is defined as the internal and external surrounds that affect the client
74
nursing metaparadigm: health
health is defined as the degree of wellness or well-being that the client experiences
75
grand theories
- are abstract, broad in scope, and complex, therefore requiring further research for clarification
- do not guide specific nursing interventions but rather provide a general framework and nursing ideas
76
middle theories
- more limited in scope and present concepts and propositions at a lower level of abstraction
- address specific phenomenon in nursing
77
practice theories
- situation-specific theories that are narrow in scope and focus on a specific patient population at a specific time
- provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice
78
9 entry practice competencies
1. clinician
2. professional
3. communicator
4. collaborator
5. coordinator
6. leader
7. advocate
8. educator
9. scholar
79
competency categories
- address professional responsibility and accountability, knowledge-based practice, ethical practice, service to the public and self-regulation
- there is a total of 101 competencies organized thematically under 9 roles
80
PICOT
P - patient population of interest
I - intervention of interest
C - comparison of interest
O - outcome
T - time
81
evidence hierarchy
level 1: systematic review
level 2: single RCT
level 3: single non-randomized trial (quasi-experiment)
level 4: single prospective/cohort study
level 5: single case-control study
level 6: single cross-sectional study
level 7: a single in-depth qualitative study
level 8: expert opinion, case reports, etc
82
rights of research participants
- research ethics board
- informed consent
83
principles of research
- respect for human dignity
- respect for persons
- concern for welfare
- respect for privacy and confidentiality
- justice
NSG 2113
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