Exam Flashcards

Question

health care cost drivers

Answer 1

-High costs of new technologies and the push to use them in managing illness/ disease is driving up health care costs in acute care -increase 3.9% total -1% due to population growth - 0.9% due to aging population - 1.9% general inflation

Answer 2

- the continued aging of the population will steadily increase future health spending - Health care policy and decision-makers will be challenged to innovate in order to reform the way health care is provided - Public drug programs limiting pricing for generic drugs, and expiring drug patents, have saved $; however, spending on specialized meds such as biologics and antivirals to treat hepatitis C have increased - Physician spending has increased since 2005, due to an increase in the supply of physicians and the rise in physician fees - Lack of accountability in the health care system

Answer 3

-Prevalence of poverty and homelessness continues in Canada. -Poverty had decreased significantly in canada, but millions still live in poverty -Poorer people are sicker than people with adequate financial resources. -Psychological effects of poverty include helplessness and lack of control over one’s daily life. - 20% of people in Ontario live in poverty -1 in 7 Canadians live in poverty -1 in 10 families in Canada experience food insecurity -At least 35,000 people are homeless on a given night -Over ⅓ of food bank users are 18 and under -Lower income is associated with increased burden of diseases and higher mortality

Answer 4

1) poor and marginalized are considered the priority population 2) upstream approaches 3) those with the least resources pay the least 4) promote access and ensure quality 5) monitoring, advocating and taking action to address the potential health equity and human rights

Answer 5

-This tool encourages primary providers to screen everyone; consider poverty as a risk factor; and intervene. -20% of families in Ontario are living in poverty

Answer 6

-At least 235,000 Canadians experience homelessness in a year -35,000 Canadians are homeless on any given night -Premature death is 8 to 10 times higher among people who are homeless -Precarious housing - unaffordable, substandard amenities, poor construction, overcrowding, health hazards, hygiene risks Relative homelessness- living in sub-standard housing -Hidden/concealed homelessness- living in a car, with friends and family, moving often -Absolute homelessness- living on the street or in shelters

Answer 7

-Significant interface of poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism -Poverty underpins homelessness -Women experiencing intimate-partner violence move frequently and often deal with homelessness and poverty -Poverty and homelessness are linked to a higher rate of intimate partner violence and other abuse -The elderly may experience homelessness as they face mounting health/ medication costs + living costs on a fixed income -28-34% of the shelter population is indigenous; 24.4% of shelter users are older adults and seniors

Answer 8

1) Improve daily living conditions -Emphasis on early child development, education, living/ working conditions and social policy 2) Tackle the inequitable distribution of power, money, and resources -Strong governance valuing collective action 3) Measure and understand the problem and assess the impact of action -Acknowledge there is a problem, measure and monitor health inequity at the national and international level, and evaluate the health equity impact of policy and action

Answer 9

Minority groups are more likely to be intertwined with poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism.

Answer 10

Employee relationships Accounting practices How to treat suppliers Reporting of misconduct

Answer 11

Case consultation Ethics education Policy development Research on ethical issues

Answer 12

Consultation Education Policy review & development Research

Answer 13

1) Consent, capacity, SDM 2) transition/discharge 3) Withholding or withdrawal of treatment 4) Living at risk 5) Disclosure

Answer 14

Outlines what you should do or should not do Minimum set of rules & obligations Established by a regulating body (eg. CNO)

Answer 15

Frameworks that help support and navigate ethical decision making Ethics decision making tools are often informed by different theories

Answer 16

I - Identify the facts D - determine the ethical principles in conflict E - explore the options A - act on your decision and evaluate

Answer 17

-socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. Society is moving toward acceptance of gender as a more fluid and diverse concept. -Examples of gender characteristics: in most countries women earn less $ than men for similar work

Answer 18

-the different biological and physiological characteristics of males and females, such as reproductive organs, chromosomes, hormones, etc -Aspects of sex will not vary substantially between societies, while aspects of gender may vary greatly.

Answer 19

-Refers to a process of being fair to women and men with the objective of reducing unjust and avoidable inequality between women and men in health status, access to health services and their contributions to the health workforce -Women and men have equal conditions to realize their full rights and potential to be healthy, contribute to health development and benefit from the results. Achieving gender equality will require specific measures designed to support groups of people with limited access to such goods and resources

Answer 20

-Legalization of same-sex marriage in Canada in 2005 through the passing of the Civil Marriage Act -Legalization of same-sex marriage (and the related resistance/ controversy) shows there is still discrimination against lesbians and gay men

Answer 21

-Employment equity, employment opportunities, sexual harassment, role strain

Answer 22

-The feminization of nursing and women’s work, alongside the social construction of gender, has contributed to the real and perceived lack of power of nurses relative to physicians (a historically “masculine” profession) -Gender is an important part of the position of nurses relative to other HCP, in particular physicians -Many would argue this, citing evidence of the increasing numbers of females in medical school and males in nursing school; however, societal views of these two professions remain entrenched in images of the female nurse and male physician

Answer 23

-As nursing continues to be a predominately female profession, social issues that have affected women have also been reflected in nursing, including: -Lack of women in positions of power. -A history of oppression. -Biomedical curative model of health care. -Lower salaries then other comparable professions. -However medicine is predominantly male

Answer 24

-7% male vs 4.6% in 2008 (growing) -Attrition from nursing school (50% vs. 20% for females) and job dissatisfaction are higher for nurses who are male -Some areas of nursing have more male nurses than others: mental health, ICU, OR, ER

Answer 25

-Sexism is the assumption that members of one sex are superior to those of the other -Sexism may manifest itself in power struggles for equal pay, access to opportunities, or recognition -The text refers to a study conducted in 1995 (note this is >20 years ago…) which found physicians view male nurses as being more competent and value their opinions above those of female nurses

Answer 26

-sexual harassment is unwanted words or actions that are related to gender or of a sexual nature Inappropriate touching Staring or making sexual comments Verbal abuse related to gender Making sexual requests, jokes, or remarks Displaying sexually offensive images

Answer 27

- is the assumption that everyone is or should be heterosexual as it is superior and expected

Answer 28

a person’s experience of affection and attraction. Not always binary (male/female) and can be a fluid experience of having feelings for any number of individuals

Answer 29

a person’s internal sense of gender, being male, female, both, or neither

Answer 30

3 categories of health disparities of transgender people - health disorders and risk behaviours (Higher rates of alcohol drug, tobacco use, mental health disorders, suicidal thoughts, lower education, low income, difficulty finding employment, lack health insurance, avoid healthcare from fear of discrimination ) -social influences -access to quality care 3 most common experiences in healthcare setting - insensitivity to sex/gender, including incorrect pronouns and names or not accepting the patient’s gender identification (32%); -experiencing discomfort in providers, making interactions awkward or negative (29%); and -denial of requested health services such as hormone treatments or referrals for gender surgeries (21%) 3 themes of responses from nurses about transgender care -Discomfort -Transition -Harsh consequences of being transgender

Answer 31

-Rainbow Health Ontario (RHO) is designed to improve access to services and to promote the health of Ontario’s lesbian, gay, bisexual, trans, and queer (LGBTQ) communities. -The needs of lesbian, gay, bisexual, trans, and queer people are often overlooked in our health and social service systems, and there are gaps and inequities in services and in the health status of LGBTQ people. Ontario’s Ministry of Health and Long Term Care funds RHO to act as a catalyst in improving services, increasing knowledge, showcasing innovative practice and encouraging networking and collaboration. -RHO works with LGBTQ communities, service providers, researchers, policy makers and the government. -Services include: Info and consultation; education and training; research and policy

Answer 32

- human rights and health equity - Client-Centred, Inclusive, and Appropriate Health Care - Quality Work Environments

Answer 33

-should be regarded as the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs -total lifeways of a group of interacting individuals, consisting of learned patterns of values, beliefs, behaviours, and customs shared by that group. -Culture influences values, beliefs, and behaviours.

Answer 34

ability to incorporate the cultural perspective of the patient into nursing assessments and modify care to achieve congruence

Answer 35

Transcultural issues arise when nurses, patients, and families hold differing views of what is important or necessary regarding health, recovery, illness, or death.

Answer 36

-Cultural misunderstandings can provide grounds for litigation. -Determine patient’s understanding of nurse’s language. -Use skilled interpreters to communicate in the patient’s own language. -Have consent forms and other written documents translated into the patient’s language OR use skilled interpreters to interpret the forms for the patient/family.

Answer 37

-An approach that focuses on practitioners’ attaining skills, knowledge, and attitudes to work in more effective and respectful ways with Indigenous patients and people of different cultures.

Answer 38

-An approach to health care based on humble acknowledgement of oneself as a learner when it comes to understanding a person’s experience. A life-long process of learning and being self-reflective.

Answer 39

-An estimated 20-30% of Canadians live in a rural environment -Demographics of rural communities indicate a higher proportion of individuals <19 or >65 years of age as education and employment opportunities may be limited -Families in rural areas tend to have lower levels of education and lower socioeconomic status -Demanding need for health services in rural areas - Active recruitment of nurses into rural areas is needed

Answer 40

-Higher incidence of smoking and obesity -Lower rates of healthy heart practices such as healthy diets, increased physical activity, and smoking cessation -Higher rate of mortality due to respiratory disease; however, women in some rural areas report less respiratory disease (e.g. asthma) than women in urban environments -Higher rate of deaths due to circulatory disease, suicide, and injuries -Higher rates of accidents (incl. MVA) and disabilities

Answer 41

- Nursing care to a small population - More independent/ autonomous practice and broader scope of practice - Personal relationships with patients; strong ties to community - Communication technology has made it easier to stay connected reducing feelings of isolation in many communities - Opportunities for financial compensation

Answer 42

- Limited resources (funding, equipment, human resources) - Expanded scope of practice - Lack of support and mentorship - Few opportunities for privacy - Isolation (social and professional) - Limited access to goods and services; potentially limited access to communication technology

Answer 43

-Staff shortages -Old equipment/lack of resources -Less interdisciplinary team (nurse takes on broader role) -Increased scope of practice (determined by necessity) -More difficult to attain continuing education (online modules helpful)

Answer 44

1.To promote development and dissemination of standards of practice 2.To facilitate communication and networking 3.To present the views of the CARRN to government, educational, professional and other bodies 4.To explicate the evolving roles and functions of rural and remote nurses 5.To identify and promote educational opportunities 6.To promote the conduct and dissemination of research 7.To collaborate with key stakeholders on the development of sound health policy for those living in rural and remote Canada

Answer 45

1.Knowledge 2.Spirit of inquiry 3.Accountability 4.Autonomy 5.Advocacy 6.Innovation and visionary 7.Collegiality and collaboration 8.Ethics and values

Answer 46

-Need for different recruitment and retention strategies for outpost nursing positions. -Need to determine the best ways to support nurses in remote areas. -More Indigenous history and health needed in nursing curricula. -Need for more opportunities for nursing students to experience clinical placements in rural settings.

Answer 47

Physical environment, poverty, education, health behaviours

Answer 48

-about making sure that First Nations children and youth have the same education opportunities as others but in ways that respect their language and culture and takes into account that they may not be starting from the same place. -Shannen Koostachin, her classmates, and their community of Attawapiskat fought for a new school for over three decades after a diesel spill near the school that was making students and teachers sick. -Shannen sadly passed away in 2010 and never saw the new school that was built in 2014. -With the support of her loving family, friends and community, Shannen’sDream was named in her honour because Shannen believed that all children deserved to go to a good school

Answer 49

-Jordan was born in 1999 with multiple disabilities and stayed in the hospital from birth. -When he was 2 years old, doctors said he could move to a special home for his medical needs. However, the federal and provincial governments could not agree on who should pay for his home-based care. -Jordan stayed in the hospital until he passed away at the age of 5. -In 2007, the House of Commons passed Jordan's Principle in memory of Jordan. It was a commitment that First Nations children would get the products, services and supports they need, when they need them. Payments would be worked out later. -Today, Jordan's Principle is a legal obligation, which means it has no end date. While programs and initiatives to support it may only exist for short periods of time, Jordan's Principle will always be there. Jordan's Principle will support First Nations children for generations to come.

Answer 50

-Mobile clinics to serve rural communities in Robinson-Superior Treaty district -Goal is to provide services in remote communities to minimize need to travel to access care -Implemented in 2018, this phase included building trust and relationships with communities (ongoing) -Team includes: RNs (mental health nurses), RPNs, NPs, social workers, pharmacist, dietician, psychologist, chiropodist, traditional healing liaison, speech pathologist (coming soon) -Challenges: health records/ documentation (siloed systems, intra and inter team, multiple providers), recruitment and retention (some roles hard to recruit into, willingness to travel), travel time and logistics (distance/ geography, weather, charting, clinic times, rental cars, etc.)

Answer 51

-Member of Parliament for Thunder Bay-Superior North since 2015 -Minister of Status of Women, Minister of Employment, Workforce Development and Labour, Minister of Health and is currently the Minister of Indigenous Services and Minister responsible for FedNor. -previously worked in public health and focused on drug policy, youth development and homelessness -she ran the largest homeless shelter in Northwestern Ontario (served 80% indigenous people at shelter house)

Answer 52

-paternalism -Presumption that a patient’s values, knowledge level, and ways of dealing with issues are consistent with those of health care providers. -Failure to acknowledge a different level of understanding regarding health -Greater attention to technology than caring. -Availability of resources. -Economic circumstances

Answer 53

-Paternalism implies well-intended actions of benevolent decision making, leadership, protection, and discipline. - In relation to health care, paternalism manifests itself in the making of decisions on behalf of patients without their full consent or knowledge.

Answer 54

- Professional practice standard – the disclosure is consistent with the standards of the profession. - Reasonable person standard – what a reasonable person in similar circumstances would need in order to make an informed decision. - Subjective standard – what the particular person wants or needs to know.

Answer 55

-Verifying that the patient is aware of options and the implications of each. -Advocating for the patient to ensure criteria for autonomous decision making is met. -If the nurse believes the patient does not understand the implications of the choices, the nurse is required to intervene on the patients behalf (notify the physician, request further information for the patient, stop the process until the patient can make the decision) -Nurse’s signature as witness attests the patient is giving consent willingly, is competent in that moment to consent, and the patient signature is authentic.

Answer 56

- instructions indicating health care interventions to initiate or withhold, or that designate someone who will act as a surrogate/proxy in making decisions in the event that we lose decision-making capacity. -To ensure patients have the end-of-life care they prefer, it should be discussed openly and clearly with family, surrogate/proxy, and health care professionals and then placed in writing. -Advance directives include living wills and durable power of attorney

Answer 57

- legal documents giving directions to health care providers related to withholding or withdrawing life support if certain conditions exist.

Answer 58

This person would be responsible for ensuring that the patient’s wishes are carried out in the event of the patient’s incapacity.

Answer 59

set of instructions for the SDM to carry out

Answer 60

-Ability to understand all relevant information. -Ability to communicate understanding and choices. -Personal values and goals that guide the decision. -Ability to reason and deliberate over the available choices

Answer 61

-Competence is the ability to make meaningful life decisions. -Legally, a person must be ruled incompetent by a judge, and this ruling will generally remain in effect for the rest of the patient’s life. -If someone is deemed incompetent someone must become the SDM -If no one is appointed in the advanced directive the healthcare workers work closely with the family to decide who would be the best option -If no family to become the SDM, a court-appointed guardian becomes the SDM (recall the hierarchy!)

Answer 62

physician both provides the means of death and administers it

Answer 63

patient recives means of death from physician but activates the process themselves

Answer 64

explore the reasons why the patient feels that way Attending to the nature and cause of the patient’s suffering and providing treatment for those should be explored

Answer 65

-courage/bravery -humility -truth -honesty -respect -love -wisdom

Answer 66

-Facing the event that sends you reeling and the event that sends you healing. - The historic legacy Indigenous peoples (and others) have inherited would heal if the experience of critical (childhood) trauma stopped. - Many families have learned how to create safe circumstances and “break the cycle” as it is sometimes referred to. - The incidence of trauma remains high in every population, but we can change the outcomes by acknowledging the past, responding differently in the present, and providing strong supports for the future. How? Learning about Cultural Intelligence, Safety and Humility, creating sanctions against discrimination, no longer by-standing, creating reassuring circumstances and following up with statements of care and inclusion. By addressing societal influences directly…

Answer 67

- universe is unified - body of knowledge stable but subject to modification - honesty, inquisitiveness - perserverance - open mindedness - pattern recognition - verification through repetition - empirical observation in natural settings - interference and prediction - plants, animals, ecosystem - properties of objects and materials - position and motion of objects - cycles, connections, and changes in earth systems

Answer 68

- Show honour and sincerity - True to yourself and others - Adverse childhood experiences - It began in 1985 with a miss-step…a question asked that revealed a secret, a secret that continues to resonate into the present for too many intergenerational survivors of IRS, War, Parental Addictions.

Answer 69

abuse neglect household dysfunction

Answer 70

1. We move between several different cultures – often without even thinking about it. 2. Cultural humility is distinct from cultural competency and reflexivity. 3. Cultural humility requires historical awareness.

Answer 71

- Honour all creation - What is cultural intelligence? - Cultural intelligence is related to emotional intelligence, but it picks up where emotional intelligence leaves off. A person with high emotional intelligence grasps what makes us human and at the same time what makes each of us different from one another. - A person with high cultural intelligence will tease out in a person’s or group’s behavior those features that would be true of all people and all groups, those peculiar to this person or this group, and those that are neither universal nor idiosyncratic.

Answer 72

- Accepting inclusion - Integrity - Is to know yourself and your own values, biases and beliefs, to speak from the heart and soul, to allow yourself to truly be seen, know and be known by others. - The teaching of honesty is about being open in an emotional and spiritual sense and recognizing what is regarded as right. -embracing a process of introspection, even when what one is likely to find within is extremely painful and brings personal and communal shame out into the open. -It is also about developing services that are appropriate and flexible, suited to the needs of individuals within a community and framed to reflect the capacity of the group.

Answer 73

Generously applying compassion and empathy to every encounter & relationship

Answer 74

- Transforming policy and practices Don’t get wisdom until you complete the other teachings Arriving at an expansive and inclusive view of the world. To cherish knowledge, know what is true/right These teachings and stages are not exclusive or final and each one has something that enhances and illustrates the others – they are launching points! In order to understand the underlying principles of wisdom, we look at wise practices, those things Indigenous peoples have done for millennium and that continue to have good utility today. It is important to understand how these values can be expressed as tools for change, where they might impact community mores, and how they potentially transform unhealthy behaviours in society today. We might also ask how these values can move leaders and leadership training into a collaborative and inclusive experience.

Answer 75

equity harmony restoration critical conversation about Canada

Answer 76

Use of technology Quality of life Medical futility Decision making at the end of life

Answer 77

save lives, improve quality of life, alleviate suffering, decrease incidence of some diseases

Answer 78

availability, quality of life, does physical existence = living? Use of technology may promote conflict between beneficence (do good) and nonmaleficence (do no harm)

Answer 79

all human life should be valued no matter what, all biological life must be preserved (pro life)

Answer 80

- A subjective appraisal of factors that make life worth living and contribute to a positive experience of living. - Includes fulfillment, satisfaction, conditions of life, happiness, experiences of life, comfort, functional status, independence, socioeconomic status, environment.

Answer 81

the quality of life is highly personal and tied to deeply held values of what is meaningful

Answer 82

contextual view of self based on our environment in which we live, our idea of what constitutes well being – related to our physical functioning and social, emotional and spiritual lives

Answer 83

Ideas and beliefs about life, death, and dying. Medical futility. Advance directives – DNR orders. Patient self-determination. Nursing care

Answer 84

- Attitudes and beliefs about when life begins and ends. - Attitudes about what constitutes death and who decides. - Unreasonable expectations of medical interventions. - Differing opinions regarding use of technology.

Answer 85

comfort company

Answer 86

Comprehensive, interdisciplinary, and total care focusing primarily on comfort and support of patients and families who face illness of a chronic nature or who are not responsive to curative treatment. Delivery of coordinated and continuous services in home, hospice, hospitals, skilled nursing facilities, and bereavement care.

Answer 87

- Support dignity and self-respect of patient and family. - Coordinate palliative care teams. - Provide appropriate care and facilitate effective communication regarding concerns and understandings of care among all involved. - Explain and negotiate patient care decisions.

Answer 88

Situations in which interventions are judged to have little or no medical benefit or in which the chance for success is low

Answer 89

removing life sustaining measures (ventilators) and allowing the person to die as a natural progression of the illness

Answer 90

causing painless death of a person in order to end or prevent suffering

Answer 91

- Nurses need to know which of their patients have DNR orders and that these orders are documented clearly. - DNR orders apply only to resuscitation–other treatment and comfort measures may be provided (code Levels at TBRHSC) - Document requests by patients or surrogate for DNR, and bring to attention of physician when needed.

Answer 92

- The federal legislation does not force any person to provide or help to provide medical assistance in dying - Cancer is the most frequently cited underlying medical condition, followed by respiratory, neurological and cardiovascular conditions. - MAID is currently not allowed for, requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition

Answer 93

- Removes the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for MAID - Introduces a two-track approach 1) Existing safeguards are maintained and, in some cases, eased for eligible persons whose natural death is reasonably foreseeable 2) New and strengthened safeguards are introduced for eligible persons whose natural death is not reasonably foreseeable - Temporarily excludes eligibility for individuals suffering solely from mental illness - Allows eligible persons whose natural death is reasonably foreseeable, and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim

Answer 94

- be 18 years of age or older and have decision-making capacity (competent) - be eligible for publicly funded health care services - make a voluntary request that is not the result of external pressure - give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision - have a grievous and irremediable medical condition (serious and incurable disease or disability) (excluding a mental illness, still under review) - be in an advanced state of irreversible decline in capability - Enduring and intolerable suffering

Answer 95

- only MDs and NPs can administer MAID - nurses may perform activities such as educating clients, providing support to clients and family, or inserting an intravenous line (with an order) that will be used to administer medications that will cause the death of a client and acting as and independent witness

Answer 96

- The law does not compel an individual to provide or assist in providing medical assistance in dying - nurses objection of MAID must not be directly conveyed to the client - nurses must transfer care of the client to another nurse - Until a replacement caregiver is found, a nurse must continue to provide nursing care, as per a client’s care plan, that is not related to activities associated with medical assistance in dying

Answer 97

Abortion Reproductive technologies Medical assistance in dying Organ donation Informed consent Access to care

Answer 98

Confidentiality of health records Health care reform Listing and delisting of provincially covered health services Tobacco legislation

Answer 99

Entry to practice Scope of practice Safety and workplace legislation Non-regulated HCPs

Answer 100

Harm reduction programs Emergency preparedness and pandemic planning Water quality Mandatory reporting of STIs, child abuse/ neglect, etc.

Exam Flashcards

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