Exam 2 Study Guide

Understand the levels of prevention

Families: who, concerns, theories
** Provide cultural competent care when providing care for diverse and changing
families
- Family = refers to two or more individuals who depend on one another for emotional,
physical, and/or financial support. The members of the family are self-defined
* may range from traditional notions (biological/genetic blood ties) of the
nuclear and extended families to postmodern structures (adoption,
guardianship, and marriage)
- Family structures changes over time
- Family as client = the family is the primary focus and individual family members are
secondary
- Family as system = implies when something happens to one family member, the other
members of the family system also are affected, and vice versa
* viewed as a interactional system (whole is more than the sums of its
parts)
- interactions among family members become the focus (ALL affected)
- Family as context = individual first, family second
* Family has influence on individual health (family = helpers for health)
- Family as component of society
** Family demographics = can be analyzed by looking at data about the families and
household structures and the events that alter these structure
* Nurses can draw on family demographic data to forecast and predict
family community needs
Theories
1) Family systems theory = families are social systems
- Nurses can learn much from a systems approach
= family as a WHOLE
- view the individual clients as participating members of a
whole family (family interactions)
2) Family development and life cycle theory = focuses on predicted stresses of
families as they change and transition over time
- focuses on the common tasks of family life
3) Bioecologial systems theory = describes how environments and systems
outside of the family influence the development of a child over time
** Health values, health habits and health risk perceptions are effected by and acted out within
the family environment **

Health risks = factors that determine of influence whether disease or other unhealthy results
occur
Health risk appraisal = process of assessing for the presence of specific factors associated with
an increased likelihood of an unhealthy event or illness
1) Biological risks
- Age-related risks
- Social and physical environment risks
2) Environmental risks
- Economic aspects (social and physical aspects)
3) Behavioral risks
Health risk reduction = based on the assumption that decreasing the # of risks or the magnitude
of risk will result in a lower probability of an undesired event occurring
Home-visiting: why, how, challenges, types of visits, tools
Why? = allows for a more accurate assessment of the family, and the role of the
environment on their health (ex. lifestyle, nutrition, and safety)
- can identify strengths/barriers, community resources that they are already
using
- families are most comfortable in their own home
Process (How?)
1) Initiation phase = first contact between the nurse and family (foundation)
& clarifies the purpose of the visit
2) Pre-visit phase (initiation phase) = initiate contact with family and establish
shared perceptions of purpose with family
3) In-home visit phase = actual visit to the home which allows the nurse the
opportunity to assess the familys neighborhood and community resources,
as well as home and family interactions
4) Termination phase = when the purpose of the visit has been accomplished, the
nurse reviews with the family what has occurred and what has been
accomplished
* provides a basis for planning further home visits
5) Post-visit phase = documenting the visits and services provided; plan the next
visit with the family
Advantages and Disadvantages
Advantages
- Client Convenience
- Client control of setting
- Availability of an option for those clients unwilling or unable to travel
- Ability to individualize services
- Natural, relaxed environment for the discussion of concerns and needs
- Identify barriers and provide support for family health promotion goals

Disadvantages
- Time spent with one client
- Cost of pre-visit preparation
- Travel to and from the home
- Post-visit preparation
Types of Home Health Care
Home Health care = focus is on the three levels of prevention
Home health nursing = focus is on empowerment for highest possible levels of
function and health
* Provide INTERMITTENT nursing visits
Hospice and palliative care = focus is on optimizing quality of life for those
experiencing life-limiting, progressive illness
Tools
Genogram = displays pertinent family information in a multigenerational family
tree format
* shows family history and patterns of health-related generations
(biological risks)
Ecomap = visual diagram of the family unit tin relation to other units in the
community
* shows the nature of the relationship among and between family
members and the community (social risks)
Transitions of Care: errors, contributing factors, teams and members, roles of nurses
Errors
- NOT: developing a comprehensive discharge care plan
reconciling patient medication lists from one facility to another
including the family in the planning process
communicating and collaborating with the right people at the new facility
getting in touch with the right community resources to support the patient
starting the planning process soon enough
Contributing Factors
- Use of hospitalists
- Incompatible computer systems
- Staff does not always know drugs well enough to give instructions
- Inconsistent med review before discharge
* Duplicate RXs
* Sent home on discontinued meds
- Unclear role definitions (Who makes the call? Who does the education?)
- Myriad of insurance policies
* What they cover
* In network providers

WHO FOLLOWS UP ON THE FOLLOW UP???

Team and Members of Comprehensive Collaborative Care
- Pharmacists
- Dieticians
- Someone from the transitioning agency
- Family
- Primary care provider
- Community resources
Role of Nurses
- BE PART OF THE D/C PROCESS THE MOMENT YOU ENTER THE
ROOM
- Find out what went on in the hospital
- Act like an conductor w/ family, facility, primary care, and community
- Monitor for any health changes (~ during first 48-72hrs)
- Promote and evaluate the patients ability to self manage their conditions
Chapt 38 - Violence and Human Abuse
Prevention of violence
Primary prevention (PREVENT)
- Addressing social determinants
- Teaching parents positive child-rearing and management skills and
strategies that are safe and nurturing
- Educate young children on conflict resolution, health relationships
Secondary Prevention (SCREEN & PROMPT)
- Screening for violence - ask the questions
- Crisis Lines
- Respite Care
Tertiary Prevention (TREAT)
- Counseling - providing a safe place to talk
- Mandatory reporting (Referral)
- Family support and resilience training
Community violence
* Contributes to significant mortality and morbidity often results
* Unemployments is a factor
* HIGH CRIME RATE = only community characteristic of violence
* Mostly occur in recreational facilities, jails, care settings, schools, gangs,
terrorism, war, workplaces, bullying
Child Abuse
* Mostly occurs :when parents have a lack of social support
- history of abuse as a child
- have minimum education
- tendency towards depression
- multiple stress factors

- unemployed
Emotional Neglect = omission of basic nurturing, acceptance, and caring
of a child
Physical Neglect = failure to provide adequate food, shelter, proper
hygiene, or necessary medical care
* Required by law that all nurses report any SUSPICION OF CHILD ABUSE
* Increased risk = less than 4yo & children with special needs
Intimate Partner Violence
* Greatest risk factor for suicide for women
* Feel grief for leaving the relationship
* Signs = physical marks; low-self esteem, PTSD, or depression
* Abuse as a process
1) Victim initially downplays/denies seriousness; period of self-blame;
moral conflict; leave or stay?
2) As violence escalates - abusers remorse lessens
3) Moment of leaving the relationship is moment of greatest risk for
homicide
Elder Abuse
* Risk for financial abuse through fraud
- coercion to relinquish property rights
- money mismanagement
* Prevention = increased training in screening and awareness
* Frequently underreported
- Victims are reluctant to report it
- Elders bruise easily - can be misinterpreted
- Elders are frequently socially isolated
- Many providers do not consider it or report it

Motivational Interviewing
= tool used to help clients state their motivations to change
- collaborative partnership between the teacher and the learner designed to help people
make their own decisions
- Seeks to help clients resolve their ambivalence about change and uses the techniques of
elaboration, affirmation, reflection, and summary to engage people in talking
about change
Techniques and Strategies
- Use open-ended questions
- Ask for permission
- Reflective listening
- Exploring Ambivalence
- Developing a discrepency
- Readiness to change ruler
- Exploring importance and confidence/scaling questions
- Affirmation statements
Distributive Justice (social justice)
= allocation of benefits and burdens to members of society
* Benefits refer to basic needs including material and social goods, liberties,
rights, and entitlements.
- Wealth, education and public services
* Burdens include such things as taxes, military service, and the locations of
incinerators and power plants
* Justice requires the distribution of benefits and burdens in society be fair or
equal
Chapter 44 - Forensic Nursing: Jobs, purpose, collection of evidence
Jobs
- Sexual Assault Nurse Examiner (SANE)
- Clinical forensic nurse
- Forensic nurse examiner
- Forensic psychiatric nurse
- Forensic correctional nurse
- Legal nurse consultant
- Nurse attorney
- Nurse coroner or death investigator
Purpose = Address social justice as well as care for offenders
- Synthesis of biopsychosocial and spiritual aspects of nursing care with an
expert understanding of forensic science and the criminal justice process

Trace of Evidence from victims of violence

- clothing
- bullets
- bloodstains
- hairs
- fibers
- small pieces of material (fragments of metal, glass, paint, and wood)
Collaborate with:
- correctional officers and law enforcement
- epidemiologist
- emergency department providers
- psychiatric practitioners
- public health nurses
Communicable Disease Transmission: Processes, time periods, communicable disease movement
in populations, chain of infection, epidemiologic triad, immunity

Epidemologic Triad

Immunity = species-determined resistance to an infectious agent (Host)