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Ambre Ellison

on 20 January 2017

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1. Understand nursing’s role in the health care industry and society.
2. Integrate previous coursework into learning new nursing concepts.
3. Describe nursing care delivery models.
4. Describe factors causing significant changes in the health care delivery system and their impact on the health care field and the nursing profession.
Describe the purposes and significance of health education.
Describe the concept of adherence to a therapeutic regimen.
Identify variables influencing a person’s adherence to a therapeutic regimen.
Describe strategies that facilitate adults’ learning abilities.
Describe the relationship of health education to the nursing process.
Develop a teaching plan for a patient.
Define health promotion and discuss the role of the nurse related to it.
Define “chronic illness.”
Identify factors related to the increasing incidence of chronic diseases.
Describe characteristics of chronic illness and its impact on patients.
Describe implications of caring for patients with chronic illnesses for nursing practice.
Define and compare palliative and hospice care.
Describe the principles and components of hospice care.
Identify barriers to improving care at the end of life.
Identify and describe eight tasks that are essential for nurses to manage patients at the end of life.
Apply skills for communicating with terminally ill patients and their families.
ANA defines nursing as the diagnosis and treatment of human responses to health and illness
The team player
Each nurse has the responsibility to carry out his/her role as described in the Social Policy Statement to comply with the Code for Nurses and the Nurse Practice Act of the state which they are practicing in.
Each state has its own scope of practice, defined by the Nurse Practice Act of that state. The nurse is to use the ANA Code of Ethics (pp.4) to help guide him/her in making ethical decisions re: their role.
The patient
the central figure
needs vary depending on role they fulfill
all people have basic needs (food, water, shelter). As needs are met, the individual progresses up the pyramid
healthcare system is transitioning from disease oriented care in acute care setting to health promotion/preventative care in community
health and illness should be viewed on a continuum
wellness isn't just good health; but, a state that encompasses physical, physiologic and spiritual well being
health promotion is seen in the huge array of strategies to promote health (screening, genetic testing, risk reduction, etc)
Industry of health care
15% of America's GDP
public/private organizations
preventative, diagnostic & therapeutic services
research/developmental groups
professional associations
medical equipment
regulatory bodies
health insurance
Expanded nursing roles
Advanced practitioner, leadership, nurse researchers
improved health and well being are generally obtained the higher up the pyramid one is able to go
Health, Wellness and Health Promotion
Major influences to health care
Health Education & health
an independent function of nursing practice and a primary nursing responsibility
nurses must use opportunities in all healthcare settings to promote wellness
patients and loved ones encouraged to play an active role in their healthcare
Ask me 3
Readiness to learn
assessed prior to teaching
health literacy is a complex group of reading, listening, analytical and decision-making skills & the ability to apply these skills to health situations" (NNLM, 2010.)
As many as 90 million people don't have these skills
esp. among older adults, immigrants, low income and those with chronic health issues
see box 2-1 (pp15) gerontologic considerations
Nursing process: patient teaching
Patient education utilizes nursing process
begin by assessing learning readiness (crucial)
identify relevant diagnosis
box 2-3, pp 17 a guide to pt education
Remember, patients will retain
10% of what they read
25% of what they hear
45% of what they see
65% of what they hear & see
70% of what they say & write
90% of what they say as they perform a task
Health promotion
Chronic illness & end of life care
Phases of chronic illness
trajectory model---table 3-2 (pp29)
long term and persistent
can be predictable and unpredictable
usually requires palliation
Nursing care of patients with chronic illness
direct (hands on) vs supportive care (monitoring)
teaching, case-managing
complex, varied roles and tasks
skilled communication is essential, especially when conveying bad news
End of life care/importance of palliative and hospice
often is the ultimate outcome of chronic illness
clinicians' attitudes toward the terminally ill remain the greatest barrier to improving end of life care
palliative and hospice care have been recognized as important bridges between a medical bias in the direction of cure-oriented treatment and the needs of the terminally ill patients and their families for comprehensive care
palliative care should precede time when provider realizes hospice needed. When there coexists relationship between palliative care and disease oriented treatment, patients and families benefit from more comprehensive treatment

Communication with Chronically ill
must state same info multiple times for pt to understand
guidelines for communication, what are they

Nursing care of terminally ill patients
requires the nurse to know modifiable vs unalterable factors
critical times
before death, death and bereavement
in predeath, pts need to know what is happening & discuss, need to be able to demonstrate feeling bad and participate in end of life decisions;during death event nurse must be present to help guide any well intentioned family member; in bereavement nurse in unique position to listen
at all times, nurses should be empathetic and effective communicators
ethical issues must be addressed (set aside own values/beliefs)
cultural sensitivity is imperative
symptom management

patients suffer unnecessarily when they do not receive adequate attention for those symptoms accompanying serious illness
clinical depression is not an inevitable outcome of chronic illness
when a patient has higher debilitating sx then their pain threshold is lower. The higher their pain, the more likely to have significant mental health complications
their goal should guide symptom management
symptom management continued
pain needs to be treated aggressively & proactively
nutrition & hydration should not be neglected
cachexia/anorexia is common
pharm management dexamethasone (decadron)(short term-interfere with muscle protein), megestrol acetate (megace) (long term) dronabil
pp. 43
confusion and delirium frequently occur
dyspnea is common and can be distressing for family members
Palliative sedation at the end of life
not euthanasia
offered to alleviate symptoms that can not be relieved as death nears
Nursing care in the final hours of life
specific physiologic changes are to be expected
decrease interest in eating
decrease urine output
sleep more
increase confusion
irregular & apneic breathing (Cheyne-Stokes)
can see people from the past
pp 46, box 3-8
family should be kept abreast of changes
allow maximum contact b/t patient, family & friends
considerate after death care must be provided
After death care
as soon as vitals cease, the body starts to change--> becomes dusky-bluish, cold to touch, waxen appearing, urine & stool may have evacuated=> things can do--warm blankets, clean soiled pt
Loss, grief and bereavement
Grief--personal feelings that accompany an anticipated/actual loss (internal)
mourning-indiv., family, group & cultural expressions of grief & assoc. behaviors (external)
bereavement-period of time during which mourning takes place
Kubler-Ross stages of grief
denial, anger, bargaining, depression, acceptance
stages are not sequential and not all indiv. will go through each stage
grief can become "complicated" (self-destructive)
HCPs are not immune to grief

main goal is to enhance patient outcomes
promotes self-care at home & in community
reduces healthcare costs
decreases length of stays (LOS)
promotes earlier discharge
promotes adherence to therapeutic regimen
Models of nursing care have transitioned from team nursing /primary nursing to patient/family centered care and collaborative practice
involving family, patient and all health care personnel in decision making is clinical practice
Models of nursing care
population demographics
aging population
changing diseases
technological advances
What is health promotion?
Case study for creating health teaching plan on blackboard
what does chronic illness mean?
per CDC, over 266 million people have chronic illness
accounts for 86% of $2 trillion in health care costs (CDC, 2015)
Chronic Disease Overview. (2015, August 26). Retrieved January 12, 2016, from http://www.cdc.gov/chronicdisease/overview/
Eberle, M. (2005, September 1). National Network of Libraries of Medicine. Retrieved January 12, 2016, from http://nnlm.gov/outreach/consumer/hlthlit.html
Pellico, L. (2013). Focus on adult health: Medical-surgical nursing. Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Changing trajectory
chronic to end of life care
client will enter different phases and eventually be unable to rebound
time to find peace
enter palliatiive and hospice care
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