Midterm #1 Flashcards
1
Q
Layers of the skin
A
Outer Epidermis & Stratus Corneum (hair/sebaceous glands/sweat glands pass through this layer but originate in dermis)
Dermis (contains capillary network)
Subcutaneous Tissue
2
Q
5 Functions of the skin
A
Protection Thermoregulation Elimination of wastes Synthesis of Vit.D Sesnation/communication
3
Q
Risk factors affecting skin
A
Age Dryness Nutrition/Hydration Disease Environment
4
Q
Age related changes in the skin
A
Increased dryness Decreased sebum Epidermal thinness Loss of elasticity Decreased tissue tolerance
5
Q
What is pressure?
Interventions for pressure.
A
Direct force on an area
Interventions: "offloading" Turn Q2h Position bed at 30 degrees Pillows between bony prominence's
6
Q
What is friction?
Where does damage occur?
A
Rubbing of one surface against another
Skin damage occurs to epidermal/upper dermal layers
Elbows/heels at greater risk
Looks like a blister or an abrasion
7
Q
What is shearing?
Where does damage occur?
A
Underlying bones and soft tissues above them move in opposite directions
Damage occurs at deep fascia level over-top bony areas
8
Q
How does moisture cause skin breakdown?
Interventions?
A
Interferes with the process of wound healing
Decreases the resiliency of the epidermis to external forces.
Interventions:
Use moisture barrier/absorbent pads
Keep moist skin surfaces apart
Do NOT use Telfa
9
Q
How does protein promote healing?
A
Used to build new tissue
Makes skin strong to prevent trauma
Prevents infection
10
Q
How does Zinc help with healing?
A
Builds & binds tissue to give it strength
Helps fight infection
11
Q
How do carbohydrates aid healing?
A
Source of energy for body & collagen formation
Prevents protein from being used as source of energy
12
Q
How do fats aid healing?
A
Source of energy for the body
Helps absorb vitamins
13
Q
How do fluids aid healing?
A
Prevents dehydration by replacing the fluid lost in wound drainage
Maintains adequate circulation of blood and nutrients to the wound
14
Q
Vits A/C role in wound healing
A
Promotes strength
Helps fight infection
15
Q
Interventions for dry skin
A
skin cleanser with pH 4-7 Liquid soap vs bar no rinse cleanser daily moisturizing protect skin with barrier ointment promote nutrition/hydration
16
Q
How can wounds be classified?
A
according to cause: abrasion incision laceration open incision contusion penetrating puncture septic etc.
17
Q
Difference between acute and chronic wounds.
Healability? Host?
A
Acute: heal within 12 weeks, usually a health host
Chronic: will take longer than 12 weeks - usually months to years, usually underlying conditions & may never heal if underlying pathology never corrected.
18
Q
What does wound healing depend on?
A
Type of damage done, and type of tissue damaged
19
Q
Phases of wound healing
A
1) Hemostasis
2) Inflammation
3) Proliferation
4) Remodeling/maturation
20
Q
Hemostasis
A
Day 0
clotting cascade initiated in response to stem blood loss
21
Q
Inflammation
A
Day 0-4
characterized by heat, swelling, redness, pain, loss of function at wound site
22
Q
Proliferation
A
Day 4-21
involves granulation/angiogenesis/epithelialization
quick phase when no infection present
23
Q
Proliferation– Granulation
A
Day 3-14
granulation tissue forms: combo of fibroblasts/inflammatory cells/new capillaries/fibronectin/hyularonic acid
24
Q
Proliferation – Angiogenesis
A
new blood vessels form from pre-existing vessels
Collagen increases from day 3 to 3 months
Fibroplasia occurs parallel to revascularization
Endothelial cells migrate forming capillary buds then loops
25
3 types of healing
Primary: healing from internal layers outwards, wound held together
Secondary: healing from wound base/walls up, open wound
Delayed primary: pt. given antibiotics if high risk of infection which delays healing
26
8 considerations when assessing wound
- braden scale
- holistic approach
- patient hx/medications
- cause of wound
- duration of wound (acute/chronic)
- healability (goal of wound)
- multidisciplinary approach
- accessibility of wound care products
27
Braden scale- risk assessment
| 6 subscales
```
sensory perception
activity
mobility
moisture
nutrition
friction & shear
```
28
How to determine wound goal
Is it healable or non-healable?
Healable: good blood supply, healthy host
Non-healable: poor blood supply, unhealty host
Complete vascular assessments such as ABPI
29
What to do if wound non-healable
Treat as palliative wound: pain management, prevent infection, manage odour
30
Types of wound classifications
partial thickness: epidermis & parts of dermis, superficial & painful, healing by regeneration
full thickness: epiderms & dermis destroyed, damage to underlying structurs, heal by granulation, loss of normal function
31
How do wounds impact the cost of health care
```
Increased:
nursing care
hospital time
supplies/equipment
sepsis
mortality
```
32
National pressure ulcer advisory panel stages (NPAUP)
```
Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
```
33
Stage 1
Non-blanchable erythema (redness)
Area may be painful/firm/soft/warm/cool compared to surrounding areas
Difficult to detect in individuals with dark skin tones
"at risk" persons
34
Stage 2
Partial thickness - through epidermis and into dermis
Shallow crater with pink wound bed- no slough
May have serum-filled blister
This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.
35
Stage 3
Full thickness- through epidermis/dermis and into subcutaneous tissue
May extend down to but not through underlying fascia (bone/tendon/muscle)
Slough, undermining, tunneling may be present
36
Stage 4
Full thickness with exposed bone/tendon/muscle
Eschar (leathery, grey, hard to touch)
Slough, undermining, tunneling
Infection may be present
37
Unstageable
Full thickness -- depth unknown because unable to visualize full extent of damage d/t slough & eschar in wound bed
slough/eschar needs to be removed to expose base of wound
Infection may be present
38
Difference between contamination and infection
Contamination: presence of non-replication bacteria which does not effect wound healing
Colonization: presence of replicating bacteria, but do not effect wound healing
Critical colonization (aka local infection): wound has stopped healing d/t bioburden but may not show S&S of infection
Infection: when microorganisms invade tissue and triggers host response
39
wound infection equation
virulence x # of microorganisms/ host resistance
40
3 types of inflammatory responses
acute: dramatic
chronic: prolongs-- damaging to host
stunned wound: dormant-- little or no response after trying multiple products
41
S&S of infected CHRONIC wound
```
delayed healing
increased exudate
foul odour
new areas of slough/breakdown
bright red tissue
undermining/bridging
probe to bone
```
42
wound assessment
location
measurements (cms, done weekly)
under-mining/tunnelling/sinus tract
base of wound (reveals health status)
granulation tissue
exudate (amount, colour, consistency, odour)
odour
periwound (erythema, maceration, induration)
edema (generalized, localized, pitting/non-pitting)
pain
43
When does undermining occur?
with pressure ulcers & is complicated by shearing
44
3 types of wound pain
non-cyclic acute wound pain: e.g. debridement
cyclic acute wound pain: e.g. daily dressing changes/turning/positioning/mobilization
chronic wound pain: persistent, no apparent mediating factors
45
interventions for non-healing wound
- consider other factors such as infection/inadequate nutrition, trauma, pathology
- educate
46
9 principles of wound management
1) risk assessment
2) wound assessment
3) debridement
4) identify & eliminate infection
5) eliminate dead space
6) absorb extra exudate
7) promote moist wound healing
8) thermal insulation
9) protect healing wound and surrounding skin
47
types of debridement
surgical/sharp
chemical
mechanical
autolytic
48
Autolytic debridement
| type of dressings?
inflammatory response
use of WBC's/enzymes
use dressings that donate/maintain moisture
49
Mechanical debridement
| type of dressings?
Irrigate the wound bed
| Wet to dry dressings
50
Surgical & sharp debridement
Pt. under local or general anesthesia
aggressive tx
sharp debridement: removal of loosely adherent, non-viable tissue with sterile scissors or scapel
Sterile
51
Chemical/enzymatic debridement examples
Biotherapy (maggots)
| Dakin's solution (bleach and chlorine)
52
how are dressings selected
based on 9 prinicples of wound-care
the goal of the wound (healibility)
the form & function of the dressing
**moisture-> if it's dry add moisture, if it's wet manage moisture
53
Examples of dressing forms
```
hydrogels
foams
absorbents
anti-microbials
negative pressure therapy
treatment cream
skin barriers
```
54
5 common functions of dressings
```
absorbent
to add/retain moisture
antimicrobial
barrier
non-adherent
```
55
skin prep purpose?
to protect peri-wound skin from maceration/tape tears
56
skin barrier ointment purpose?
to protect perio-wound skin from maceration
57
When would moisture management be contraindictated
based on healability (if non-healing wound may result in maceration??)
58
What is the moisture vapor transmission rate?
| aka?
when a dressing is <840g/m squared per 24h
aka moisture retentive dressings
59
moisture retentive dressing purpose
acts as an exogenous barrier for water vapor loss from a wound when stratum corneum not intact
60
purpose of hydrogels
for dry wounds when healability determined
61
purpose of transparent film dressings
for minor abrasions & friction (not for skin tears/blisters)
62
purpose of hydrocolloids
stage II or partial thickness wounds with minimal exudate
63
Purpose of foams
for small-moderate drainage on wound with/without border
64
purpose of absorbents
for moderate-large amount of drainage
65
purpose of absorbent antimicrobial dressings
for critically colonized/infected wounds or for prevention of infected wounds
66
purpose of anti-microbial/ odour control dressings
for infection and for odour control
67
purpose of non-adherents
for fragile wound bases e.g. skin tears
68
purpose of composites
e.g. all dress: for lightly exudating wounds
dressing of choice over hydrogels
69
purpose of antiseptic poviodine
antimicrobial protection
| to stabilize/maintain non-healable wounds
70
Protease modulating matrix dressings
e.g. promogran
collagen matrix dressing that attracts cells & supports tissue growth
transforms into soft gel on wound bed
used for foot ulcers, venous&pressure ulcers etc.
71
4 concepts that impact our ability to transition?
vulnerability
powerlessness
empowerment
resilience
72
What is vulnerability?
"to wound" (latin)
capable of being physically or emotionally wounded
73
what increases vulnerability?
the longer the exposure to any kind of risk --> the more vulnerable
e.g. aboriginals, women, mental health illness (astigmatism), teen pregnancy ETC.
74
Predisposing factors for vulnerability
- Very old/very young ages
- Lower socioeconomic status
- Developmental transitions (chronicity, dependency, social isolation)
- Multiple chronic illnesses
- Undergoing crises (disease/violence/gender worldwide)
- Language
- Level of education
75
Impact of vulnerability on HC
- Increases costs
- Increases workload/demand
- High complexity of care (mental as well as physical)
- Holistic approach
76
What are the 6 dimensions of vulnerability?
- limited control (e.g. HC- not being able to provide care to everyone we want to)
- victimization (feeling blamed for situations outside of control)
- disenfranchisement (feeling separated from mainstream/majority e.g. women voting)
- disadvantaged status (no social support)
- powerlessness (no control/choice)
- health risk (family situation, health history, baseline, violence, childhood risk factors*)
LVD-PHD
77
Assessing for RISK in the vulnerable..
| What to assess?
Family situation
Childhood risks
Youth at risk
Violence
Delinquent behaviour
Suicidal behaviour
Coping mechanisms
78
What is the cycle of vulnerability?
predisposing factors
no effective intervention
poor health outcomes
worsening situation
79
Considerations when assessing vulnerability
- It can be biased
- If identified inappropriately, interventions may worsen the situation
- focus on both strengths & limitations to help adapt to change
- involve family- holistic approach
80
physiological effects of vulnerability
stress/anxiety -> GI symptoms, decreased appetite, fatigue etc.
81
psychological effects of vulnerability
oppression
feeling helpless, fearful, angry
uncertainty, loss of control
powerlessness, desperation
82
social effects of vulnerability
stimatization
social isolation
stereotyping
marginalization
83
What is an important aspect of overcoming transitions
power & empowerement
84
what is powerlessness
the *perception* that one lacks the ability to affect an outcome
85
HC providers with powerlessness
may result in an imbalance (HC providers more power than client)
Decisions may be forced on cflient
86
Nursing dx for powerlessness
low self-esteem
self-harm
ineffective coping mechanism
social isolation
87
Interventions for powerlessness
provide info
promote self-care
encourage effective coping mechanisms
assess & utilize strengths
set mutual goals
be realistic
88
power definition
"to be able" (latin)
89
What is empowerement?
to encourage participation of others in decision making
to take action in an environment with equal power
90
interventions for empowerement?
provide info so they can actively make decision
delinquish role
promote independence
set realistic mutual goals
consider patient preferences
value our patients experiential knowledge**
ensure the patients value their life experiences
91
What is resiliency
Adaptive, stress resistant personality that permits one to thrive in spite of adversity
more than just springing back to previous state- involves adjustment, adaption, and transformation in response to changes. When adapting we often will change the environment.
92
What are some inherent qualities of resilience?
```
Flexibility
Adaptability
Optimisim
Self respect**
Autonomy
Coping strategies
Meaninfulness of life experiences
```
93
Why is resilience unique
it is a characteristic OR a state
process of coping
types: physical, emotional, or resiliency to change
dimensions: may have spiritual/religious
94
Internal factors that increase resiliency
- sense of responsibility
- hx of success
- positive self-esteem
- problem-solving/reading skills
- feeling in control over life
- future plans/goals
95
External factors that increase resiliency
| family/support
good relationship with parents/children
effective parenting skills --> structure/rules within house, responsibilities for everyone in the house
good family coping
family hardiness
strong extended family network
96
4 characteristics of a resilient individual
positive
good self-esteem
hopeful
realistic
97
What is hope?
it is the recognizition of possibilities
it is believing in a life worth living both in the present/future
it is unique to each individual
but universal to all
98
3 levels of hope
Level 1: superficial wishes (asking for something for X-mas)
Level 2: involves hope for relationships, self-improvement and self-accomplishments (getting a new job- anxiety if not achieved, relief if achieved)
Level 3: hope arises from suffering, personal trial, or state of captivity (recovering form the loss of a loved one)
99
6 critical elements of hope
- sense of possible
- avoiding absolutes (all or nothing)
- freedome of choice
- purpose & meaning of life
- Optimism
- psychological well-being and coping
ETC.
100
what is despair
aka "giving up"
101
when does despair occur?
when goals/path towards goals are lost
relief not happening
102
what does despair lead to
hopelessness
103
Miller's Hope/Despair model
HOPE
- establish goals
- focus on past success
- plan for alternative actions
- motivates self to succeed
DESPAIR
- unable to set goals
- unachieved outcomes=personal failure
- verbalizes self-doubt
- gives up
104
How does despair trigger hoplessness?
```
through:
enduring
uncertainty
suffering
acceptance
```
(cyclic relationship between all)
105
enduring
begins with awareness of something without fully understanding it
involves:
suspending emotions
using energy to "keep self-together"
attempt to remain in control
106
uncertainty
recognition that the event has occurred
involves:
ready to make goals but not sure where to start
inability to determine benefits/draw-backs of alternatives
107
suffering
acknowledgement: reality sets in leading to feelings of blackness/despair
- support groups beneficial at this time
108
acceptance
accept the situation
| *hope* for a new path/new goal
109
Side effects of hoplessness/despair
- increased sx/illness/disability
- weakness
- decreased concentration
- fluctuating moods
- insomnia
- suicide
- inability to deal with info re: illness
110
5 strategies to maintain hope
- develop relationship with caregiver/create family bonds
- be in control
- be determined
- accomplish goals
- spirituality
111
Anatomy of the brain in relation to hope
- anterior hypothalamus: calms emotions and increases body's immunity
- posterior hypothalamus: fight/flight produces cells to work in immunity
- neuropeptides: translates emotions into bodily events e.g. crying, butterflies
- psychoneuroimmunology: study of how psychological states influence disease (through nervous, endocrine, and immune systmes)
112
Nursing interventions for hope
relinquish control
create therapeutic relationships & connect
identify mutual/realistic goals & modify PRN
effective coping strategies & guard against despair
reality surveillance (clues that hope is in reach)
share experiences
113
Crucial elements of a psychiatric assessment
mental status assessment (MSA)
| psychosocial assessment
114
What is mental status?
a persons emotional/cognitive functioning
optimal when satisfied with work/relationships/self
becomes an issue when ADL's impacted
115
what is an essential aspect in assessments?
communication skills
116
what does a mental status assessment include:
- Presenting problem & history of present illness
- Mood/affect
- Past health history/family history
- Identifying characteristics (appearance, tattoos, sex, age, race, birth marks etc.)
- Physiological data
- Psychosocial data
- Developmental data
- MSE & possibly other diagnostics (MMSE, GAF, DSM-5)
117
Physiological data
are the mental issues impacting the patients body? (stress/anxiety increasing GI symptoms, increased pain, lack of sleep,libido etc.)
118
Psychosocial & behavioural data
Assess for changes in mood, concentration, memory (give pt. three words and ask them to repeat thewords at end of assessment)
Assess any worries/concerns/judement&insight
```
social supports
coping mechanisms (+/-)
family dynamics
cultural norms
values & beliefs
spiritual
work-related issues
```
119
Developmental data
developmental stage, growth, maturation level, school level, best/worst subjects, grades, learning styles, relationships with teachers/peers
120
Presenting problem
Why this person, at this time, with this problem?
What has changed from baseline
```
Assess:
Stressors
Sequence of events
Aggravate/alleviate situation
Impact on life
Inisght (awareness of illness)
Source of referral (how the pt. was brought in)
```
121
Mood
Subjective
Use scale 1-10 re: how they are feeling
Why is there is a difference between days
```
Assess:
Quality
Intensity
Reactivity to external factors
Variation
Stability
```
122
Affect
Objective
Look for incongruencies between mood & affect
```
Assess:
Quality
Intensity/degree
Reactivity/variability
Stability (how long to rebound?)
Appropriateness
```
123
Why assess the patients past medical history/family history
contributes to patients coping strategies
may be less anxious re: hospitalization with the more visits
124
How to increase insight (awareness of illness)
education
experience
support
decrease stigmas
125
What does a MSE include?
```
Appearance
Attitude
Speech
Mood & affect
Perceptions
Thoughts
Sensorium/cognition
Judgement
Insight
Reliability
```
*see notes
126
what is a MMSE
| disadvantage?
concentrates only on COGNITIVE functioning, NOT mood, thought processes, or ADL's
written in english, be aware of language barriers!
127
global assessment of functioning scale (GAF)
examines symptom severity, and ADL's on a hypothetical continuum of mental illness
no longer on the DSM-5 classification
128
What is suicide
voluntary & intentional act of killing onself
action not an illness!
aggression directed inwards
129
what is parasuicide
gestures/attempts that are unsuccessful
130
what is suicidal ideation
thinking about and planning one's own death
131
risks for suicide
youth (d/t life experience & bullying)
elderly (high stressors)
women 4x more likely to attempt suicide
men 3x more likely to complete suicide
```
family hx of suicide
family dyfunction
childhood trauma
lack of support
recent losses
alcohol & substance abuse
chronicity
psychiatric disorders
```
132
What are the 5 levels of suicide behaviour
1) ideation: thought & plan of committing suicide
2) threats: statement of intention
3) gestures: acts it out but doesn't complete (writing letter)
4) attempts: physically follow through will plan (cutting self)
5) completed suicide
133
Suicide assessment
ongoing process that involves nursing intuition!
- Behaviour: IS PATH WARM?
- Hx: from patient, family/friends, previous attempts/gestures
- MSE
- Physical exam (S&S of substance abuse/previous attempts, medical conditions)
134
IS PATH WARM
```
Ideation
Substance abuse
Purpose
Anxiety
Trapped
Hoplessness
Withdrawal
Anger
Recklessness
Mood changes
```
135
how to determine level of lethality
imminence + intent + patient's level of hopelessness
136
Imminence
Does the patient have a time period, specific plan, access to plan, and admission of wanting to die?
137
Ideation vs. intent
Is is conscious or unconscious? e.g. youth participating in high risk behaviour
138
Severity index for suicide risk
can be SI, moderate, advanced, severe
139
Nursing Dx/goal
Dx: Risk for suicide/self-directed violence
Pt. will verbalize absence of SI, and self-work in 2 weeks
140
Nursing interventions for suicide
```
SAFETY:
remove hazards
roommate
search belonging for sharp objects
search visitors
close observation
```
```
COPING:
identify strengths
offer support & resources
increase independence
be realistic
```
141
Difference between violence and suicide
violence is directed outwards, suicide is directed inwards
142
What is anger
and affective state in attempt to warn/intimidate threats
143
Difference between anger and aggression
anger is the feeling, aggression is the behaviour
144
Risks for anger/violence/aggression
```
family hx of anger/violence/aggression
personal hx of " "
alcohol/drug use --> poor coping mechanisms
mental illness
medical illness
```
145
What can violence/aggression lead to
```
Injury to self/others
Distrust
Guilt
Isolation
Judgement
Crime
```
146
S&S of violent behaviour
** history of assualtive behaviour
increased motor activity (pacing, restless)
verbalized threats (response to threats/hallucinations/delusions)
intensified affect (jumpy)
alcohol/substance use (intoxication or withdrawal)
organic brain syndrome
147
What is organic brain syndrome
changes in brain structure on CT which can cause alterations such as...
```
LOC changes
disorientation
impaired memory
hallucinations
abnormal motor movements (tics, jerks)
```
148
4 levels of crisis development
1) anxiety (changes in behaviour, restlessness, muttering to self, wringing hands)
2) defensive/anger and hostility (verbal/non-verbal cues)
3) acting out (loss of control, physical abuse)
4) tension reduction (emotionally drained, remorseful, apologetic, withdrawn)
149
How to respond level 1 Anxiety
Supportive approach!
active listen - validate- reassure
non-judgemental
provide helpful actions
150
How to respond to level 2 Defensive
Directive approach!
```
offer information
limit choices
be clear, concise, simple
consequences to person
remain calm
```
151
How to respond to level 3 Acting out
Non-violent approach!
offer PRN
activate seclusion
152
How to respond to level 4 Tension
Therapeutic approach!
Reflect
Consequences
153
Voluntary admission procedure
can voluntarily admit self if over age 16
Form 1 - request for admission, Dr. and director must agree to admission
Form 2 - Consent for treatment
Can discharge self at any time
154
3 types of involuntary admission
3 different ways:
- Through Dr.'s medical certificate
- Through police
- Through order by judge
155
Involuntary admission procedure
Form 4: to treat pt. for 48h (completed by Dr.)
Second certificate to be completed within 48h by a different physician (to hold patient for up to one month from admission date)
to extend past one month, Form 6 is a renewal form that can hold pt. for additional month
156
Involuntary admission criteria
MUST meet all 4:
- has mental illness that impairs ability to react to others/environment
- requires psychiatric tx
- requires care/supervision to prevent harm to self/others
- is not suitable as a voluntary
157
Rights for involuntary patients
they must be verbally informed & given form 13
```
Form 13 includes:
hospital name/location
reason why pt. admitted
the right to contact lawyer or advocate
the right to apply for panel hearing
the right for regular reviews by Dr.
the right for second opinion
the right to apply to court for discharge
```
158
What is a review panel hearing
3+ people who decide whether pt. should be discharged from involuntary status
once requested, has to be done within 14 days
159
Purpose of extended leave
so patient can have long-term support following discharge
Form 20
160
What is collaboration?
teams work together to explore different persectives and search for solutions that go beyond what they thought was possible
161
5 Characteristics of collaborative practice
it is an outcome
shared power
involves interaction
working towards common goal
trusting
162
What is intersectoral collaboration?
projects that involve various levels of decision making
involves three levels: micro, meso, macro
health groups & other groups that normally are not involved with health, but have an impact on health, work together to improve health outcomes
163
Levels of intersectoral collaboration
Micro: the individual and their desired care population
Meso: community and the private sector
Macro: central and local government agencies
164
4 main concepts of collaboration
Sharing
Partnership
Interdependency
Power
165
What is sharing?
| what does it involve
making sure everyone is heard
involves:
multidisciplinary
responsibilities
decision-making
HC philosophy/values
data/planning/intervention
e.g. collective problem solving
166
What is partnership?
| what does it involve
authentic/constructive relationships -- there because you want to be there
```
involves:
honest communication
mutual respect/trust
common goals
assertiveness/cooperation
```
*if no interactive engagement then no partnership can be formed
167
What is interdependency
| what does it result in
everyone working together (not autonomy)
results in synergy effect: come to better conclusion when work all together, involves interdependence.
the whole is greater than the sum of its parts
168
Power in collaboration
power&information *shared* between all team members
based on knowledge/experiences that is relate able to everyone
power is the product of relationships and interactions!
169
Examples of 3 accents that lead to attributions
knowing own role/expertise --> willing participation & team approach
based on knowledge/expertise not title/role --> power shared
good communication skills, respect & trust lead to non-heirarchical relationships
170
Characteristics required to collaborate
```
good communication/ leadership
problem solving skills
conflict management
assessment
be aware of own feelings
```
171
Examples of collaboration in nursing
collaborating with pt./family about overall goals/patient care
pt. deteriorating--> call Dr. or specialist for collaboration
makes referrals to ensure contunuity of pt. care following discharge
172
3 types of teams
1) Unidisciplinary
2) Multidisciplinary
3) Interdisciplinary
173
Unidisciplinary team
care delivered by 1 health care professional to patient/family
174
Multidisciplinary team
several different professionals from different expertise work independently of each other e.g. referral/consult
175
Interdisciplinary team
HCP work together to care for patient/families
176
3 Antecedents (Pre-requisites) to collaboration
collaboration concepts (power, sharing, interdependency, partnership)
personnel factors (individual readiness, personal confidence)
environmental factors (organizational support/structure, collaborative atmosphere, team oriented)
177
CNA's 7 essential elements for collaboration
```
Assertiveness
Accountability
Autonomy
Cooperation
Communication
Coordination
Mutual respect/trust
```
AAA
CCC
M
178
What are 4 requirements for inter-professional collaboration
focus on client
quality care & services
trust & respect
effective communication
179
What is the inter-professional/professionalization paradigm shift?
a shift in thinking from *current inter-professional practices*
include other professionals input to help understand patients viewpoint
180
Levels of collaboration
micro
meso
macro
181
Micro collaboration
| What can impact this level?
- HCP, other providers, and patients
- 1 team member
i. e. mutual goal setting with pt.
```
What can impact this level of collaboration:
Poor understanding
Poor attitudes
Education (boundary work)
Group dynamics
```
182
What is boundary work
Divisions between different fields of knowledge created
tool used by professional to promote own thoughts, does not take in other perspectives (thinks they are dumb)
183
Meso collaboration
| examples?
- Organizations
- Involves the community & facility
i.e. hospital board creates vision/values behind collaborative policies/programs, UFV students teaching community about heatlh
184
Macro collaboration
- community, regional, provincial, federal government
- involves intersectoral collaboration
- goal is to: create shared vision for health care delivery, create policies/programs that link health and social services, patient-centered practice
185
Benefits to collaboration
- better pt. outcomes
- Health care system: less readmits, decreased staff absenteeism, less staff burn-out, decreased costs
- Collaborative team: better coordination/cohesiveness, less burn-out, more respect
- HCP: less burn out, provides different perspectives. improved communication, more consistent collaboration, peer feed-back, creative ideas are shared** (cross fertilization)
- Synergy effect
186
Barriers to collaboration
- poor leadership skills
- poor patient participiation
- organizational issues (no meetings/collaboration)
- time & cost
- education (boundary work)
- poor group dynamics
187
Evidence for collaboration
- to be successful, need support from all levels
e.g. community level needs support from regional/national level
national level needs support from community/local levels
188
Medical Approach Perspective of Health
until 1970
Disease-Treatment model
```
Health= absence of disease
Focus= fixing problems as they arise
```
189
Benefits/disadvantages of the medical approach
Works best for diseases that have very clear cause- treament
Disadvantages:
Very costly
Only effective for diseases
Doesn't look at long-term health only short-term
Still present in areas that are developing
190
Behavioural approach to health
1970-1980
Risk factor- behavioural model
*Individual responsible for health
```
Health= depends on lifestyle, behaviour, genetics
Focus= decrease behavioural risk factors
```
191
Benefits/Disadvantages of the behavioural approach
```
benefits:
promotes physical well-being
smoking rates decreased
people started going to gym well
highlights risk factors
```
disadvantages:
puts blame on individuals
192
Socioenvironmetal approach
1980's
Health promotion/social justice model
```
Health= defined by social determinants
Focus= increase social resources
```
suggests that health related behaviors cannot be separated from the social contexts of individuals
*the patient is a product from the situation that they are living in*
193
social determinants of health
```
income
education
physical/social environment
employement
coping
```
194
Advantages/disadvantages of the socioenvironmental approach
```
Advantages:
Empowering individuals
encourages participation in community/families
encourages lifestyle improvements
more distribution of wealth
collaborative
```
Disadvantages:
not as much research into diseases
tons of policies
resources have to be organized
195
what can a lack of material/social deprivation lead to
chronicity
shorter life expectancy
suicide
196
income distribution
```
middle class jobs losing more quickly
more people either in poverty or in high paying jobs
```
197
Benefits of education/literacy
provides necessary skills for problem solving
provides more job opportunities --> income security
more able to access/understand health information
198
Impact of physical environment on health
```
housing location:
neighborhood safety
quality food/water
road safety
green space
community design/transportation systems
```
indoor environment: air quality
199
Impact of social support on health
Help with problem solving
Provide life satisfaction
Positive role model
Minimize stress
*can have negative impact if a negative role model e.g. smoking, or if you feel need to keep up with them
200
Impact of social environment on health
- strength of social networks within the community/region/organizations
- provides networking and sharing
201
Impact of employement/work conditions on health
if unemployed = poorer health
if unsafe work conditions= poor health
work condition has direct impact on mental/social/physical health
202
What are personal health pracitices
actions to prevent disease/promote self-care
203
What impacts personal health pracitces/coping skills
depends on:
exposure to stressors
cultural impacts
social supports
sense of control over health/decisions
* all dependent on socioeconomic environment
204
how does health impact socioeconomic factors
poor health --> low socioeconomic status
and visa versa
205
how does genetic factors impact socioeconomic
cognitive abilities, personality impacts education/income
females have lower income
males use health care services less
