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Lola Oyedele RN MSN CTNLola Oyedele RN MSN CTN

Today's TopicsToday's Topics

TrendsTrends Community health nursingCommunity health nursing Middle aged adultMiddle aged adult Client education standardsClient education standards Teaching and learningTeaching and learning Culture and ethnicityCulture and ethnicity

DefinitionDefinition

The general direction in which things The general direction in which things are changingare changing

Greater focus is on keeping Greater focus is on keeping individuals healthy and well, individuals healthy and well, providing illness care in the clients providing illness care in the clients home environment and containing home environment and containing cost.cost.

Age TrendAge Trend

In general, clients who receive home In general, clients who receive home care tend to be in the elderly care tend to be in the elderly populationpopulation

This trend is likely to continue as the This trend is likely to continue as the baby boomers get oldbaby boomers get old

Disease TrendDisease Trend

Have diverse needsHave diverse needs Circulatory diseaseCirculatory disease DiabetesDiabetes cancercancer

Community HealthCommunity Health

DefinitionsDefinitions

CommunityCommunity

It is a group of people who live in the It is a group of people who live in the same area or who have something in same area or who have something in common with each other. E.g., student common with each other. E.g., student community, community of nursescommunity, community of nurses

Community health nursing is a nursing Community health nursing is a nursing approach that merges with professional approach that merges with professional nursing theories to safeguard and nursing theories to safeguard and improve the health of population in the improve the health of population in the community.community.

Community Health SettingsCommunity Health Settings

Hospital – based Hospital – based health agencieshealth agencies

Private or corporate Private or corporate owned agenciesowned agencies

Others include public Others include public health agencieshealth agencies

Nursing centersNursing centers SchoolsSchools

Occupational Occupational health programshealth programs

Parish nursingParish nursing Clinics for the Clinics for the

homelesshomeless Case managementCase management Wellness centersWellness centers

Reasons for Home Healthcare Reasons for Home Healthcare and Community Focused and Community Focused

Services Services Consumer demandConsumer demand Advent of Medicare Advent of Medicare

reimbursement for reimbursement for home health home health servicesservices

The aging The aging populationpopulation

The rise of The rise of managed caremanaged care

Federal legislation Federal legislation that encouraged that encouraged expansion of home expansion of home carecare

Escalating health Escalating health care costcare cost

Components of a Components of a CommunityCommunity

Structure or localeStructure or locale Structure includes name of communityStructure includes name of community Geographical boundariesGeographical boundaries EnvironmentEnvironment Water and sanitationWater and sanitation Housing and economyHousing and economy

PopulationPopulation Age distribution, sex, growth trends, density, Age distribution, sex, growth trends, density,

education level, predominant cultural groups education level, predominant cultural groups and predominant religious groupsand predominant religious groups

Components cont’dComponents cont’d

Social systemsSocial systems Includes education system, government, Includes education system, government,

communication system, transportation, communication system, transportation, welfare, volunteer program and health welfare, volunteer program and health systemssystems

Vulnerable PopulationsVulnerable Populations

Principle client for community health nursePrinciple client for community health nurse Defined as those clients who are more Defined as those clients who are more

likely to develop health problems as a likely to develop health problems as a result of excess risks, who have limits in result of excess risks, who have limits in access to health care services or who are access to health care services or who are dependent on others for caredependent on others for care

Example are individuals living in poverty, Example are individuals living in poverty, older adults, homeless persons individuals older adults, homeless persons individuals in abusive relationships, drug abusers, in abusive relationships, drug abusers, mentally ill clients, new immigrantsmentally ill clients, new immigrants

Middle Aged AdultsMiddle Aged Adults

Adults between the age of 30’s to Adults between the age of 30’s to late 60’s.late 60’s.

Levinson described this age as the Levinson described this age as the age of settling down and pay off age of settling down and pay off years.years.

This age is characterized byThis age is characterized by

Personal and career achievementsPersonal and career achievements Joy in assisting children and young Joy in assisting children and young

peoplepeople Helping aging parentsHelping aging parents

Physical ChangesPhysical Changes

Major physical changes occur between Major physical changes occur between 40 to 65 years of age40 to 65 years of age

Graying of the hairGraying of the hair Wrinkling of the skinWrinkling of the skin Thickening of the waist – Pot bellyThickening of the waist – Pot belly BaldingBalding Decreased hearing and visual acuity –Decreased hearing and visual acuity –

increased rate of glaucomaincreased rate of glaucoma

Physical Changes Cont’dPhysical Changes Cont’d

Most significant change is Most significant change is Menopause in the femaleMenopause in the female Climacteric in the maleClimacteric in the male

Psychosocial ChangesPsychosocial Changes

It may be due to expected events e.g. It may be due to expected events e.g. children moving away from homechildren moving away from home

Unexpected events e.g. marital Unexpected events e.g. marital separation or death of a close friendseparation or death of a close friend

Family enters the post parental family Family enters the post parental family stagestage

Erickson – primary developmental task Erickson – primary developmental task is to achieve generativityis to achieve generativity

Psychosocial Changes Psychosocial Changes continuescontinues

Carrier transitionCarrier transition Sexuality – Increased marital and Sexuality – Increased marital and

sexual satisfactionsexual satisfaction Family types e.g. single hood, marital Family types e.g. single hood, marital

changes family transition.changes family transition. Care of aging parents – A sandwich Care of aging parents – A sandwich

generationgeneration Health concerns and riskHealth concerns and risk

Health Concerns and Risk Health Concerns and Risk Factors continuedFactors continued

Health riskHealth risk Health patterns of concernHealth patterns of concern

ObesityObesity Cancer riskCancer risk OsteoporosisOsteoporosis Cardiovascular diseaseCardiovascular disease

Risk Factors for DepressionRisk Factors for Depression

Being femaleBeing female Disappointment or lossesDisappointment or losses Departure of last childDeparture of last child Family historyFamily history

Applying the Nursing Applying the Nursing ProcessProcess

AssessmentAssessmentPlanningPlanning

ImplementationImplementationEvaluationEvaluation

Client Education StandardClient Education Standard

There are four standards of client There are four standards of client educationeducation Standard 1 – Assess the client’s learning Standard 1 – Assess the client’s learning

needs, abilities, readiness and preferencesneeds, abilities, readiness and preferences Safe and effective use of medicationSafe and effective use of medication Safe and effective use of medical equipmentSafe and effective use of medical equipment Potential food-drug interaction, counseling on Potential food-drug interaction, counseling on

nutrition and modified dietnutrition and modified diet Rehabilitation techniques to help the patient Rehabilitation techniques to help the patient

adaptadapt

Client Education StandardClient Education Standard

Access to additional resources in the Access to additional resources in the communitycommunity

How to obtain any further treatmentHow to obtain any further treatment Explain family and patient Explain family and patient

responsibilitiesresponsibilities Health maintenance with regards to Health maintenance with regards to

hygienehygiene

Client Education StandardClient Education Standard

Standard 2 – client education is Standard 2 – client education is interactiveinteractive

Standard 3 – Discharge instruction Standard 3 – Discharge instruction given to client and family and given to client and family and organization caring for the clientorganization caring for the client

Standard 4 – The hospital plans, Standard 4 – The hospital plans, supports and coordinates activities supports and coordinates activities and resources for client and familyand resources for client and family

Purpose and Significance of Purpose and Significance of Health EducationHealth Education

Maintenance and promotion of health Maintenance and promotion of health and illness preventionand illness prevention

Restoration of healthRestoration of health Coping with impaired functioningCoping with impaired functioning

Teaching and LearningTeaching and Learning

Definition – Teaching is an interactive Definition – Teaching is an interactive process that promotes learning. It consists process that promotes learning. It consists of a conscious deliberate set of actions of a conscious deliberate set of actions that help individuals gain new knowledge, that help individuals gain new knowledge, change attitudes, adopt new behaviors or change attitudes, adopt new behaviors or perform new skills.perform new skills.

Learning is the purposeful acquisition of Learning is the purposeful acquisition of new knowledge, attitudes, behaviors and new knowledge, attitudes, behaviors and skills.skills.

Behaviors Involved in Behaviors Involved in LearningLearning

Cognitive – refers to understanding Cognitive – refers to understanding e.g. disease processe.g. disease process

Affective – refers to attitude e.g. Affective – refers to attitude e.g. acceptance/denialacceptance/denial

Psychomotor – refers to motor skills. Psychomotor – refers to motor skills. E.g. learning to test sugar levels and E.g. learning to test sugar levels and give insulingive insulin

Cognitive LearningCognitive Learning

Includes all intellectual behavior and requires Includes all intellectual behavior and requires thinkingthinking

Six behaviors are needed for cognitive Six behaviors are needed for cognitive learninglearning KnowledgeKnowledge ComprehensionComprehension ApplicationApplication AnalysisAnalysis SynthesisSynthesis evaluationevaluation

Affective LearningAffective Learning

Deals with expression of feelings and Deals with expression of feelings and acceptance of attitudes, opinions or values.acceptance of attitudes, opinions or values.

Five behaviors are needed to facilitate Five behaviors are needed to facilitate affective learningaffective learning ReceivingReceiving RespondingResponding ValuingValuing OrganizingOrganizing characterizingcharacterizing

Psychomotor LearningPsychomotor Learning

Involves the acquisition of skills that Involves the acquisition of skills that require integration of mental and require integration of mental and muscular activity such as the ability muscular activity such as the ability to walk or to use an eating utensil. to walk or to use an eating utensil. The simplest is perception, the most The simplest is perception, the most complex is originationcomplex is origination

Behaviors Associated with Behaviors Associated with Psychomotor LearningPsychomotor Learning

PerceptionPerception SetSet Guided responseGuided response MechanismMechanism Complex overt responseComplex overt response AdaptationAdaptation originationorigination

Three Basic Learning Three Basic Learning PrinciplesPrinciples

Motivation to learnMotivation to learn The ability to learnThe ability to learn The environmentThe environment

Developing a Teaching PlanDeveloping a Teaching Plan

AssessmentAssessment Nursing diagnosisNursing diagnosis PlanningPlanning ImplementationImplementation EvaluationEvaluation

In Organizing a Teaching In Organizing a Teaching PlanPlan

Set prioritiesSet priorities TimingTiming Organize teaching materialOrganize teaching material Maintain learning attention and Maintain learning attention and

participationparticipation Build on existing knowledgeBuild on existing knowledge Select a teaching methodSelect a teaching method

Types of Teaching MethodTypes of Teaching Method

Instructional methodInstructional method One on one discussionOne on one discussion Group instructionGroup instruction Preparatory instructionPreparatory instruction DemonstrationDemonstration AnalysisAnalysis Role playingRole playing DiscoveryDiscovery

Evaluation of TeachingEvaluation of Teaching

Noting barriersNoting barriers Measuring objectivesMeasuring objectives Identify need for clarificationIdentify need for clarification Identify ineffective interventionsIdentify ineffective interventions Noting areas that need clarificationNoting areas that need clarification Success is measured by performance Success is measured by performance

of expected behaviorof expected behavior

Documentation of Client Documentation of Client TeachingTeaching

Assessment of learning needAssessment of learning need Specific contentSpecific content Method of teachingMethod of teaching Reinforced informationReinforced information Evaluation of learningEvaluation of learning

Culture and EthnicityCulture and Ethnicity

USA – Multicultural societyUSA – Multicultural society Population projection for 2020Population projection for 2020

53% white as compared to 70.9% in 53% white as compared to 70.9% in 19981998

2021, # of Asians and Hispanics will 2021, # of Asians and Hispanics will tripletriple

African American population will be African American population will be doubleddoubled

Culture and EthnicityCulture and Ethnicity

Variations exists across cultures and Variations exists across cultures and subcultures. It is essential to subcultures. It is essential to remember that regardless of race, remember that regardless of race, ethnicity, culture or cultural heritage, ethnicity, culture or cultural heritage, every human being is culturally every human being is culturally uniqueunique

Definition of TermsDefinition of Terms

Culture refers to patterned life ways, Culture refers to patterned life ways, values, beliefs, norms, symbols, and values, beliefs, norms, symbols, and practices of individuals, groups or practices of individuals, groups or institutions that are learned, shared, institutions that are learned, shared, and usually transmitted from and usually transmitted from generation to the next over time.generation to the next over time.

Definition of TermsDefinition of Terms

Ethnicity refers to groups whose Ethnicity refers to groups whose members share a common social and members share a common social and cultural heritage that is passed on to cultural heritage that is passed on to successive generations.successive generations. Ethnicity confers a sense of identity.Ethnicity confers a sense of identity.

Emic is the local, indigenous or insiders Emic is the local, indigenous or insiders views and values about a phenomenon.views and values about a phenomenon.

Etic is the outsiders or more universal Etic is the outsiders or more universal views and values about a phenomenon.views and values about a phenomenon.

DefinitionsDefinitions

Transcultural nursing is a humanistic and Transcultural nursing is a humanistic and scientific care discipline and profession with scientific care discipline and profession with the central purpose to serve individuals, the central purpose to serve individuals, groups, communities, societies and groups, communities, societies and institutionsinstitutions

Acculturation refers to the process by which Acculturation refers to the process by which an individual or group from another culture an individual or group from another culture learns how to take on many values, learns how to take on many values, behaviors, norms, and life ways of another behaviors, norms, and life ways of another culture.culture.

DefinitionDefinition

Religion is a system of organized Religion is a system of organized beliefs and worship that a person beliefs and worship that a person practices to outwardly express their practices to outwardly express their spirituality.spirituality.

There are Six Cultural There are Six Cultural PhenomenonPhenomenon

CommunicationCommunication SpaceSpace Social organizationSocial organization TimeTime Environmental controlEnvironmental control Biologic variationBiologic variation

CommunicationCommunication Communication means to make common, Communication means to make common,

share, participate or import share, participate or import All behavior verbal or non verbal in the All behavior verbal or non verbal in the

presence of another individual. presence of another individual. It establishes a sense of commonality and It establishes a sense of commonality and

permits sharing of information, signals, or permits sharing of information, signals, or messages in the form of ideas and feelingsmessages in the form of ideas and feelings

Culture influences how feelings are Culture influences how feelings are expressed and what verbal and non verbal expressed and what verbal and non verbal expressions are appropriateexpressions are appropriate

SpaceSpace

Personal space is the area that surrounds Personal space is the area that surrounds a person’s body including the space and a person’s body including the space and objects within the space.objects within the space.

Western culture: there are 3 primary Western culture: there are 3 primary dimensions of spacedimensions of space Intimate zone 0-18 inchesIntimate zone 0-18 inches Personal zone 18 inches – 3ft. Used with Personal zone 18 inches – 3ft. Used with

friendsfriends Social or public space 3ft – 6ft, used for Social or public space 3ft – 6ft, used for

impersonal and business purposesimpersonal and business purposes

Social OrganizationSocial Organization

Refers to how cultures organize itself Refers to how cultures organize itself around particular units such as families, around particular units such as families, racial or ethnic groups, religious groups racial or ethnic groups, religious groups and community or social groupsand community or social groups

In some culture, the family is the most In some culture, the family is the most important unit of organization e.g. important unit of organization e.g. Mexico, ChineseMexico, Chinese

In some cultures, religion is the second In some cultures, religion is the second most important social organizationmost important social organization

TimeTime

Cultural groups construct system of Cultural groups construct system of time that measure social events and time that measure social events and agricultural activities. agricultural activities.

Many cultures use time to schedule Many cultures use time to schedule future activitiesfuture activities Americans are future time orientedAmericans are future time oriented Chinese – use past eventsChinese – use past events Native Americans/Mexicans are present Native Americans/Mexicans are present

time orientedtime oriented

Environmental ControlEnvironmental Control

Refers to the ability of an individual Refers to the ability of an individual from a particular cultural group to plan from a particular cultural group to plan activities to coordinate with nature. It activities to coordinate with nature. It refers to the individuals perception of refers to the individuals perception of their ability to control factors in the their ability to control factors in the environment e.g. what a person environment e.g. what a person believes about the cause of illness will believes about the cause of illness will affect their behavior in preventing and affect their behavior in preventing and treating the illness.treating the illness.

Biologic VariationsBiologic Variations

People differ culturally.People differ culturally. Differences that are biologic in Differences that are biologic in

nature exist among the different nature exist among the different races. races.

Some illnesses and diseases are Some illnesses and diseases are more prevalent in some groups than more prevalent in some groups than others.others.

Practice AssignmentPractice Assignment

Explain what the following means in Explain what the following means in your culture. Give examplesyour culture. Give examples Space, time orientation, respect, caring Space, time orientation, respect, caring

behavior, healing practices, food and behavior, healing practices, food and meaning of food, age, illness beliefs and meaning of food, age, illness beliefs and practices, healing practices, what practices, healing practices, what causes illness.causes illness.

Case Study – Middle Aged Case Study – Middle Aged AdultAdult

J. D, age 48, married and the father J. D, age 48, married and the father of 13 and 16 year old sons has of 13 and 16 year old sons has recently had to assume responsibility recently had to assume responsibility of caring for his 78 year old mother of caring for his 78 year old mother after she suffered a stroke. Describe after she suffered a stroke. Describe the nurse’s role in assisting J.D. in the nurse’s role in assisting J.D. in caring for his mother.caring for his mother.

Case Study – Client Case Study – Client TeachingTeaching

Kay is a 50 year old nurse who recently had a Kay is a 50 year old nurse who recently had a heart attack. Her medical history reflects that she heart attack. Her medical history reflects that she has a family history of heart disease and has had has a family history of heart disease and has had HTN and high Cholesterol for 15 years. She HTN and high Cholesterol for 15 years. She reports eating a high fat diet and does not reports eating a high fat diet and does not exercise regularly. She complained of chest pain exercise regularly. She complained of chest pain x 2 days that worsened with activity before she x 2 days that worsened with activity before she went to the hospital. Kay blames her husband for went to the hospital. Kay blames her husband for her diet because “he won’t eat a low fat diet, and her diet because “he won’t eat a low fat diet, and I had a heart attack because I have been worried I had a heart attack because I have been worried about my husband’s health”. List your teaching about my husband’s health”. List your teaching priorities.priorities.