Summary NR 222 Unit 3 /NR222 Week 3 Health and Wellness Study guide {2020} - Chamberlain college of nursing {A+}

NR 222 Unit 3 Health and Wellness Study guide {2020} - Chamberlain college of nursing {A+} Unit 3 Edelman: Ch 3 1. Health disparities a. a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage b. adversely affect groups of individuals, especially vulnerable populations c. Medicare and Medicaid were created to aid the poor and older adult populations, but escalating health costs are still an issue d. People who experienced greater obstacles to health based on: race/ethnicity, religion, socioeconomic status, gender, age, mental health, cognitive/sensory/physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion 2. Patient Protection and Affordable Care Act (ACA) a. Signed into law on March 23, 2010 b. Largest change since Medicare and Medicaid in the 1960s c. Will be fully enacted by 2018 d. Designed to address issues of affordability, accessibility, and financing of health care with focus on vulnerable populations e. Requires changes in public insurance programs, private health insurance market regulations, and other components f. If can’t get insurance through job, can go to health insurance exchange 3. Healthy People 2020 a. Goals: i. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. ii. Achieve health equity, eliminate disparities, and improve the health of all groups. iii. Create social and physical environments that promote good health for all. iv. Promote quality of life, healthy development, and healthy behaviors across all life stages. 4. Health indicators of a nation a. Mortality-based indicators reflect general health of nation and are readily available b. International Comparisons of Core Health Indicators compares average life expectancy by gender and infant mortality rates c. Infant mortality rates are very important because reflect maternal health and access to health care (US is slightly worse than other industrialized nations because of the large disparities in health ) d. The higher the education of women, the lower the infant mortality rate (also White women have much better rates than African or Hispanic) 5. Historical Role of Women in Health Promotion a. Florence Nightingale i. Founder of modern nursing ii. While caring for wounded soldiers in the Crimean War, she fought for hospital reform by crusading for cleanliness and against overcrowding and lack of ventilation. iii. Her careful recordings of care outcomes quantified needed reform in health promotion b. Lilian Wald i. Appalled by the lack of medical care, ignorance, and living conditions of the poor in 1893, developed a settlement program in New York City that trained nurses, provided care to families, and developed education programs for the community ii. organized public health in the direction of health promotion for families and communities 6. Institute of Medicine (IOM) a. Nonprofit b. Conducts research from systems approach to advise nation in improving health c. Work environments contribute to nurses’ errors and poor communication d. Medication errors were common and costly 7. World Health Organization (WHO) a. Objective is to influence health opportunities and outcomes for all people so that they can attain highest possible level of health b. Recognizes importance of families and health promotion c. Agenda with 6 goals: i. Promoting development; fostering health security; strengthening health systems; harnessing research, info, and evidence; enhancing partnerships; and improving performance d. History of Health Care i. Early influences 1. Earliest views of health were holistic 2. Primitive people understood illness in mystical terms (sickness linked to cosmic view) 3. Middle ages: a. infectious diseases were leading cause of death b. health was absence of disease ii. industrial influences 1. manufacturing advances during 18th century (flush toilet, sewage system) made sanitary engineering possible, preventing diseases (typhoid, paratyphoid, and gastroenteritis) iii. socioeconomic influences 1. 1834: pauperism a. Moral failure against poor b. If worker didn’t earn a subsistence-level income, attitude toward them was suspicious and punitive c. People are held directly accountable for state in life, and health maintenance is responsibility of individual iv. Public health influences 1. Edwin Chadwick () a. Father of British and American Public Health b. Established English Board of Health c. Emphasized environmental sanitation but excluded physicians outside times of crisis d. Strove to improve health of masses for economic reasons 2. Lemuel Shattuck a. Leader of public health movement in US b. Used British system as model c. Public health has focused on improving health of poor, but welfare has dictated subsistence at minimum level (Puritan influence) v. Scientific influences 1. Louis Pasteur a. Germ theory 2. Robert Koch a. Origin of bacterial infection 3. Joseph Lister a. Antisepsis 4. Paul Ehrlich a. Chemotherapy 5. All expanded public health from sanitation to control of communicable diseases through broad biological base 6. : discovery and use of sulfanomides and other antibiotics reduced death rate to lowest point in history 7. With increase in life expectancy, chronic diseases increase 8. USDHHS a. ACA calls for establishment b. National Prevention, Health Promotion, and Public Health Council c. Required to provide coordination and leadership at federal level among all federal departments and agencies d. Have to develop a plan to improve health status of Americans and reduce incidence of preventable disease, disability, and illness vi. Special population influences 1. Vulnerable populations are at great risk to experience health disparities vii. Political and economic influences 1. Politics determines the decision makers who will negotiate desired outcome 2. Economics defines resources that are distributed and manner in which they are distributed 3. Roosevelt’s New Deal (Social Security Act) is example of how both can influence 8. Organization of health care delivery system a. Public sector i. Voluntary and nonprofit agencies ii. Official and voluntary public health agencies operating at local, state, federal, and international levels iii. US Dept of Health and Human Services- principal federal regulatory agency charged with providing health and other essential human services iv. State governor appoints health commissioner who directs health agency to protect citizens v. State health authority is based on 10th Amendment vi. States create local government and delegate authority to them vii. Department of Health and Human Services is federal viii. 16th Amendment gave federal government power to promote health and welfare ix. New Deal began to displace power from state and local to federal x. Patient Protection and Affordable Care Act was signed in 2010, goals: 1. reduce number of uninsured Americans 2. pay for coverage without adding to national debt 3. slow rising cost of health care 4. encourage more efficient health care system xi. Institute of Medicine (IOM) 1. 4 key messages and 7 recommendations: a. Nurses should practice to the full extent of their education and training. b. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. c. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. d. Effective workforce planning and policy making require better data collection and an improved information infrastructure. xii. Chief nursing officer serves in US Public Health Service and is responsible for providing leadership and coordination of Public Health Service nursing professional affairs for Office of Surgeon General and Department of Health and Human Services xiii. Federal Emergency Management Agency (FEMA) 1. Assist states when a disaster overwhelms a state’s capacity to respond 2. Supports citizens and first responders to build, sustain, and improve capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards xiv. Military Health Systems at Federal Level 1. Partnership of medical educators, medical researchers, health care providers, and support personnel who are prepared to respond anytime or anywhere with comprehensive medical capability to military operations, natural disasters, and humanitarian crises around world and to ensure world class health care to military xv. Americans with Disabilities 1. Disabilities Act of 1990 a. Prohibition of discrimination b. Requirement for provision of services to people with disabilities xvi. WHO 1. Worldwide guidance in field of health 2. Setting global standards for health 3. Cooperating with governments in strengthening national health programs 4. Developing and transferring appropriate technology, info, and standards xvii. Voluntary agencies 1. Tax free 2. Influential in promoting health affairs 3. American Cancer Society (campaigns against smoking) 4. John A. Hartford Institution a. Supports efforts to improve health care for older Americans 5. American Red Cross a. Aids victims of war and natural disasters b. Largest supplier of blood xviii. Medicaid 1. For low-income individuals and families 2. As cost of program increases/ number of people enrolled increases, then taxpayers have to pay more because there’s only so much government funding 3. Is entitlement program with no cap so any individual who meets requirements, receive benefits 4. Pays providers directly if participate 5. Pays Medicare premiums, deductibles, and co-insurance for certain recipients xix. Medicare 1. Finances medical care for people older than 65, the disabled entitled to Social Security, and people with end-stage renal disease requiring dialysis or transplant 2. Part A a. Covers inpatient care in hospitals, skilled nursing facilities, home health services, and hospice care 3. Part B a. Voluntary medical insurance b. Covers physician visits, outpatient services, preventive services, and home health visits c. offers comprehensive coverage d. deductibles, set amounts that the individual must pay for each type of service before Medicare begins to pay, and co-insurance, a percentage of charges paid by the individual 4. Part C a. Refers to Medicare Advantage program 5. Part D a. Voluntary, subsidized outpatient prescription drug benefit b. Private sector i. Independent practice 1. Contract directly with health care provider for individual care based on fee-for-service 2. Care may be delivered from inpatient to outpatient (any health care services that aren’t provided on basis of overnight stay in which room and board costs are incurred) settings 3. Nursing centers a. Nurse-managed health centers, usually in underserved rural and urban areas b. Started when nurse practitioner job started ii. Move to managed care 1. Indemnity insurance plans a. Before 1990s b. Choose a PCP and they would bill insurance or be paid on gee-for-service c. To control costs, physicians contracted with insurance company for negotiated fee-for-service 2. Network of providers a. In choose in network, then have full coverage i. Choose PCP who is gatekeeper and coordinates and oversees individual’s care to reduce self-referral to specialists and to protect from unnecessary procedures b. Outside network= little to no coverage 3. Health Maintenance Organizations (HMOs) a. Deliver comprehensive health maintenance and treatment services to group of enrolled individuals who prepay a fixed fee b. Must see PCP first to be referred to specialist c. Attempt to lower health care cost d. s by emphasizing preventive rather than curative care e. Medicare advantage plans i. Private health plans that receive payments from Medicare for each enrollee f. Independent practice associations i. Organizations composed of independent physicians in solo or group practices who provide health care services to members of HMO in private offices, eliminating expense of staff model HMO g. Accountable care organizations (ACOs) i. Similar to HMOs ii. An organization (public or private) would be created that has group of primary care physicians, providers, specialists, and hospitalists, to provide health care in local area iii. Will have financial incentives to keep costs down h. Concierge medical practices i. Physicians charge individuals a membership fee ($1500-$1900 per year) in return for enhanced health care services or amenities (same or next-day appts for nonurgent care, 24-hour telephone access to physician, and routine preventive examinations) i. Hospitalist movement i. Formed to control hospital costs without compromising quality or satisfaction with client care ii. Hospitalists are physicians or advanced practice nurses whose professional focus is caring for hospitalized client iii. Provide direct inpatient primary, critical and consultative care to hospitalized clients, and are available 24 hours in hospitals 4. Point-of-Service Plans (POS) a. Evolved in response to concern with restrictions of consumer choice in selecting providers and services b. Allow members to use providers outside of individual HMO network (30%-40% more) c. Enable enrollees to choose whether to use plan’s provider network or seek care from non-network providers d. High-deductible health insurance plans (HDHPs) i. Structured to have very high annual out-of-pocket deductible of $1000-$2000 ii. Good for healthy, young people for low monthly premium 5. Preferred Provider Organizations a. Managed care plan in private sector that has preselected list of providers who have agreed to provide health services for those enrolled in plan b. Incur additional costs if provider is outside of PPO c. Both are organized by local, state, and national, consists of private providers with official or voluntary public agencies 9. Financing health care a. Health expenditures in US are greater than any other country and have most uninsured b. Factors increasing costs: inflation, health care cost inflation, application of new and more advanced technologies, growth in proportion of older adults, government financing of health care services, growth of prescription drug usage and costs, misdistribution of health care providers and services, expansion of medical technology and specialty medicine, and growing number of uninsured and underinsured people (updating technology enhances capabilities of medicine, while increasing costs) c. Reasons for hospitals having less time to offer prevention or health promotion education: i. Changes in hospital care and use of hospitalists ii. Increased utilization of outpatient services iii. Shorter inpatient stays iv. Increased time caring for chronic illness v. Work force shortages 10. Canada’s health care i. Medicare 1. Group of socialized health insurance plans that provide health coverage to all Canadian citizens regardless of medical history, personal income, or job status 2. Doesn’t include physical therapy, dental coverage, corrective lenses, home care, or prescription medicine (provinces can change this) 3. Pay for health insurance through taxes 4. 5 principles: universality, portability, accessibility, comprehensiveness, and public administration 5. increasing health care costs, access issues, delays in treatment, and workforce shortages of health care providers have caused political controversy and debate in Canada because might have to wait for months for important procedures   Edelman: Chp 5 1. Code of ethics: a. Nurse practices with compassion and respect for inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or nature of health problems b. Nurse’s primary commitment is to person, whether individual or part of family, group, or community c. Nurse promotes, advocates for, and strives to protect health, safety, and rights of person d. Nurse is responsible and accountable for individual nursing practice and determines appropriate delegation of tasks consistent with nurse’s obligation to provide optimal person care e. Nurse owes same duties to self as to others, including responsibility to preserve integrity and safety, to maintain competence and continue personal and professional growth f. Nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to provision of quality health care and consistent with values of profession through individual and collective action g. Nurse participates in advancement of profession through contributions to practice, education, administration, and knowledge development h. Nurse collaborates with other health professionals and public in promoting community, national, and international efforts to meet health needs i. Profession of nursing is responsible for articulating nursing values, from maintaining integrity of profession and its practice, and for shaping social policy 2. Health care ethics a. Origins of applied ethics in moral philosophy i. Moral philosophy- concerned with discovering or proposing what’s right or wrong, or good or bad, in human action toward other humans and other entities such as animals and environment ii. Value theories 1. Concerned with either discovering what humans seem to value (descriptive theories) or proposing what they ought to value (normative theories) to achieve predetermined goals iii. Types of ethical theories 1. Descriptive value theories a. Based on observations of human behavior over time and in variety of settings b. Don’t’ tell what actions ought to take c. Aren’t directive, merely tell us how people act toward each other and their environments and what they seem to believe are good or moral actions 2. Normative value theories a. Concerned with ensuring good actions b. Reasoned explanations of moral purpose of human interactions, or are divinely “revealed” truths about good action (religious ethics) c. Actions that are in accord with foundational principles of theory are type of right or good actions we should take given that we believe principles (fairness and trust are valid; golden rule) d. Permit judgments about value of actions based on extent to which actions are consistent with assumptions of the theory e. Key to decision-making and relevant for health promotion 3. Consequentialism theories a. Foundational principle of John Stuart Mill’s theory b. Proposes actions are good insofar as they are aimed at yielding greatest amount of happiness or pleasure or causing least amount of harm or pain to individuals and overall society c. Greatest good for greatest number d. Viewed pleasure as complex concept with qualitative and quantitative aspects e. Consequentialist- consequences or intended consequences of actions matter f. Any decision about intended actions or interventions must take into account all knowable potential consequences g. Data gathering must be thorough and complete h. Direct what is needed for moral action or for doing the right thing 4. Duty-based theories a. Not as healvily weighted toward producing good consequences b. Immanuel Kant; religions c. Depend more on adherence to duties than on good consequences d. Individuals viewed as having certain duties (telling truth) that can’t be circumvented, even if deliberately avoiding duty would result in good outcomes e. Capacity to reason is what permits moral action iv. Limitations in moral theory: 1. Metaethics allows to critique ethical approaches 2. Religious based moral theories depend on idea that good actions are those that obey laws of supreme being a. What might be a moral action from Jew, might be morally prohibited from Catholic b. Tenets of different sects or branches might not always lead to same conclusions about good actions 3. Can’t have one single approach because of differing cultures and beliefs 3. Feminist ethics a. Presents a viewpoint on moral problems in health care and other areas of life that have been historically neglected b. Other theories have been unable to capture nature and origins of health care problems c. Moral decision-making must include an investigation of hidden and over power relationships implicit in ethical problems d. Characteristics: i. Understanding that humans are inseparable from their relationships with others ii. Focus on care and responsibility aspects of relationships, not abstracts iii. Concern with development of character and attitudes iv. Concern for rights and equality of all individuals e. Focuses on imbalances of power and oppression attributable to gender, sexual orientation, ethnicity, socioeconomics, politics, and other characteristics 4. Ethic of care a. Calls for knowledgeable and skillful health professional to assume responsibility for unique needs of individual in all complexities b. Care- alleviation of vulnerability; promotion of growth and health; facilitation of comfort, dignity or good and peaceful death c. Requires understanding of situational particularities, ensuring we try to understand a given individual’s needs in context of his or her life d. Limits: i. Issue of moral predictability or certainty ii. If emphasis is on relationships and there are no criteria for right and wrong actions, how can one be assured of morally correct action in given situation? 1. Morally correct action emerges as result of nursing judgment based on prior knowledge, experience, and relationship with person iii. Problem is choosing between person’s needs and needs of others who might be affected by chosen actions 5. Professional responsibility a. Accountability to individuals and society i. Professions 1. Members can be held accountable for practice formally by professional licensure boards 2. Are morally accountable for practicing according to discipline’s implicit or explicit code of ethics 3. Have to establish personal perspective on ethical practice within framework of professional codes ii. Trust 1. Professional has to have knowledge and skills to meet needs 2. Have to trust that professional will keep best interests as primary goal and strive to meet needs b. Code of ethics i. provide normative framework for professional actions ii. examples of normative ethics because prescribe how members of profession ought to act, given goals and purposes of profession related to individuals and society iii. provide direction and express expectations of ethical behavior iv. also have to anticipate future health needs c. Advocacy i. Aggressive action taken on behalf of individual to protect or secure their rights ii. Have to speak up on behalf of other people because they may not know the care is substandard or what their rights are iii. Have to balance health needs of individual with that of population d. Problem-solving: issues, dilemmas, risks, and moral distress i. Many ethical problems are issues, not dilemmas ii. Moral problems interfere with goals of promoting health, well-being, or relief of suffering; can be due to health care system arrangements, interprofessional conflicts, a/o lack of resources iii. Dilemma- special ethical issues; situations in which a choice must be made between two or more equally undesirable options iv. Neglected issues can become dilemmas v. Moral distress- occurs when nurse knows ethical correct action to take but feels powerless to take that action e. Preventive ethics i. Aims to forestall ethical problems before they develop ii. Includes individual action by nurse, as well as social and political activism with other nurses or organizations iii. Requires health promoter to envision potential problems and institute actions that halt their development (discussing will/ views on life support) 6. Ethical principles in health promotion a. Ethical principles provide important starting point for moral judgment and policy evaluation, but principles alone aren’t enough (autonomy, beneficence and justice) b. Have to decide which principles are important to consider c. Requires exploration of case d. Use advanced directives to make sure treatment matches predetermined wishes e. Autonomy as civil liberty i. From perspective of public health: extent of individual autonomy (freedom of action) may be limited by duty of protecting health and safety of society ii. Struggle between civil rights and public safety f. Autonomy as self-determination i. Has to do with individual choice ii. Moral principle that underlies concept of informed consent to treatment, interventions, and health-promotion efforts iii. People have ability to reason, and consequence of ability is capacity to make choices iv. Have to give info needed to make choices v. Criteria for autonomous choice: 1. Cognitive maturity 2. Possession of appropriate info to permit decision-making 3. Intact mental capacities (ability to reason logically) 4. Absence of internal or external coercive influences 5. Ability to appreciate risks and benefits of alternative choices g. Informed consent i. Process of ensuring that a person has all appropriate info necessary to reach decision about participation that facilitates autonomous action ii. Intentionally authorize professional to intervene on behalf iii. Have right to rescind consent iv. Competency to consent: 1. No physical or mental impairments that hinder understanding 2. Made aware of important details of proposed intervention 3. Understand alternatives 4. No subtle or overt coercion of professionals h. Exceptions to autonomous decision-making i. Sometimes proxy decision-making is required ii. Alzheimer’s, not all are incapable iii. Incarcerated people are restricted in choices iv. Children are less than fully autonomous v. Certain mental illnesses like bi-polar could change decisions vi. Have to have: 1. Possession of set of values and goals 2. Ability to communicate and understand info 3. Ability to reason and deliberation about choice i. Confidentiality i. Ability to maintain privacy in one’s life ii. Expression of autonomy because have right to decide who can have access to info about them iii. Sometimes might have duty to warn others who are unknowingly endangered or if going to harm self iv. Privacy rule: 1. Developed as result of Health Insurance Portability and Accountability Act 2. Ensure individual’s health info is properly protected, while allowing flow of info needed to provide and promote high quality care and to protect public’s health and well-being 3. Limit use of medical info 4. Nurses responsible for using judgment in deciding what level of detail to share 5. Rights: a. Access own info b. Limit who may receive info c. Request corrections d. Receive accounting of how info has been used e. Request confidential reportin of info f. Pursue complaints with Department of Health and Human Services Office for Civil Rights v. Adolescents: Special Considerations of Confidentiality 1. Have to maintain and facilitate adolescent’s emerging autonomy and confidentiality needs, while mediating between peer and parental figures who feel have right to info 2. Mandatory reporting laws exist (abuse) vi. Veracity 1. Devotion to truth 2. Individual is reliant on person who possesses knowledge and skills 3. Some cultures don’t tell truth with terminal illness 4. Goes against exaggerating, withholding, etc. vii. Nonmaleficence 1. Enjoins people not to harm other people 2. Constrains people from autonomous actions that are likely to harm others 3. Possible harms must be anticipated and minimized viii. Beneficence 1. Quality or state of doing or producing good 2. Duty to max benefits of actions while minimizing harms 3. Rules designed to protect people against negative effects of own actions, but should be carried out according to person’s own will or values, and respecting person’s autonomy 4. Conflict with autonomy: a. Paternalism- rules designed to protect people; override person’s autonomy to disobey them b. Can override decision if can’t use rational decision-making c. When a decision cannot be said to be informed, the principle of beneficence directs us to decide treatment based on the person’s best interests ix. Social justice 1. Includes formal or informal systems within society that are concerned with disparities in socioeconomic conditions leading to poor health and fairness in distribution of goods such as health, education, food, and shelter 2. 2 perspectives: a. Those who contribute more are deserving of better social benefits (merit; for scarce resources: organ transplant) b. Equalizing benefits across society, regardless of merit (fairness) 7. Strategies for ethical decision-making a. Locating source and levels of ethical problems i. Tensions between societal and individual perspectives require mediation and may force health promoter to decide which problem must be addressed first ii. Understanding personal philosophy, biases, and values permits one to control for these in sense of being aware of influences they have on interactions b. Values clarification and reflection i. Guide to recognizing and addressing ethical issues: 1. Examine beliefs and values a. Relate to human condition, justice and responsibility b. Be willing to revise beliefs in line with professional knowledge base, experiences, or current research findings 2. Reflection on influence of personal beliefs and values 3. Reflect on practice 4. Decision-making considerations 5. Identify main problem or issue 6. Determine who or what created the problem 7. Determine prevalent values 8. Identify information gaps 9. Formulate possible courses of action and probable consequences 10. Initiate selected course of action and evaluate the outcome 11. Engage in self-reflection and peer or expert group reflection 8. Ethics of health promotion: cases a. Case 1: addressing health care system- Elissa Needs Help Elissa is 38 years old. She recently moved 200 miles from her home to a small town (population 6000) and separated from her abusive husband to escape his continuing threats and to be near her childhood friend. She suffers from chronic, sometimes incapacitating, depression for which she has in the past received antidepressant medications and counseling, with temporary relief. She has been unable to work and has no private health insurance. She is eligible for the state’s Medicaid program, however, and has recently discovered that Medicaid will cover her health care needs. Her friend refers her to the only primary care center in the area, where she is seen by Jill, one of the two nurse practitioners. As part of her evaluation, Jill discovers that Elissa was also abused as a child and has very poor self-esteem. Elissa affirms that her childhood friend is very supportive. Jill believes that longer term psychological counseling would benefit Elissa and facilitate her well-being, but she also knows that none of the counseling services within a 50-mile radius accepts Medicaid payment. Elissa has no transportation. i. What are Jill’s options? Responsibilities? ii. What actions might Jill pursue both on a local level and on a political level? What are her resources? iii. What is the responsibility of the health-promotion disciplines in cases like this? b. Case 2: she’s my client! Lilly and “Jake” (AKA Paul) Shirley, a nurse practitioner, is at a conference when a physician colleague discusses a difficult case. One of his clients, “Jake,” is HIV positive but refuses any treatment. The physician explains that Jake fears that his wife will discover and recognize the names of the medications, because he knows “these drug names are discussed on television all the time.” Jake has not told, nor does he ever intend to disclose, his wife that he is HIV positive. Jake firmly believes his condition is his private information and, for now, the couple uses condoms for birth control. The physician is concerned that Jake will not tell his wife. The physician is presenting this case to colleagues to highlight the public awareness campaigns that, to some extent, have affected client privacy. He argues, “Listen to how they call out your name and the drugs at the pharmacy counter.” Shirley recognizes bits and pieces of information and comes to the painful realization that Jake is really Paul, and Paul is the husband of one of her clients, Lilly. Lilly has begun to discuss with Shirley that she wants to get pregnant soon. The town is too small for Shirley to be mistaken. Or is it? Is it ethical for the nurse practitioner to ask the physician if Jake is Paul? i. Is it ethical for Shirley to tell Lilly she suspects Paul is HIV positive? ii. Should this information change how Shirley counsels Lilly about a pregnancy? iii. What is in Lilly’s best interests? iv. What resources are available? c. Case 3: Don’t touch my things! Mrs. Smyth and autonomy Mrs. Smyth, 78, had lived in the same home for 30 years. Never married, she cared for her disabled mother for 15 years. After her mother died, she lived alone on a small pension. She appeared to be well groomed and appropriately dressed when she left her house. Mrs. Smyth was hospitalized for a bowel obstruction and Joe, a community health nurse, made a follow-up visit after discharge to her home. When Joe arrived at the house, he was overcome with the smell of rotting garbage, urine, and feces. Five small dogs ran back and forth among piles of garbage and magazines, overturned furniture, and discarded appliances. There was no running water and the bathroom was not functional. Joe told Mrs. Smyth that her living conditions were unhealthy and that he would contact a community agency to help her clean her house. Mrs. Smyth became very angry and said no one had the right to take her things away. i. Is it ethical for Joe to overrule Mrs. Smyth’s autonomy in decision-making? ii. What action is in Mrs. Smyth’s best interests? iii. What action is in the community’s best interests? iv. What ethical issues are involved in caring for a client with a hoarding disorder, such as that seen in Mrs. Smyth’s disorder? Edelman: Chp 25 1. Malnutrition a. WHO defines as bad nourishment that can be associated with either too much or too little food intake and is not limited to wrong types of food b. Characterized by inadequate or excess intake of protein, energy, and micronutrients, such as vitamins c. 3 categories: i. Protein-energy malnutrition ii. Micronutrient deficiencies iii. Obesity 2. Protein-energy malnutrition (PEM) a. Lack of calories and protein b. Widespread in low-income countries c. Most lethal form of malnutrition d. Harmful to mental and physical development of individuals, especially under age of 5 e. Children born to undernourished mothers: high risk for low birth weight, birth defects, low immunity levels and infection susceptibility, growth retardation, learning disabilities, mental retardation, blindness, and, most severely, premature death f. Worldwide, one out of two deaths among children younger than 5 years old stems from protein-energy malnutrition, One out of four children is underweight and one out of three is stunted g. Severe acute malnutrition i. Can be lethal ii. Presence of 1. serious wasting a. weight of a child being less than 70% of median weight-for-height b. caused by loss of subcutaneous fat and skeletal muscle c. highly noticed because of underdeveloped buttocks, thighs, upper arms, sunken eyes, visible ribs, and protruding shoulder blades d. irritable, anxious, and cry easily (may not be able to produce tears) 2. a/o edema a. caused by leaking of potassium from cells, leading to electrolyte imbalance and fluid retention in feet, lower legs, arms, and face b. skin is abnormally dark with peeling patches and sensitive iii. Require immediate treatment: 1. Providing special therapeutic, milk-based foods called Ready-to-Use Therapeutic Foods 2. When have a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, a/o infections), use RUTFs 3. When don’t have appetite a/o have medical conditions, needs to receive facility-based care 3. Addressing Malnutrition at global level a. CDC, WHO, UNICEF, and United Nations b. Baby Friendly Hospital Initiative i. Goal to promote exclusive breastfeeding during first 4 months of life c. Manage nutrition during emergencies d. Global nutrition data banks e. Global network of collaborating centers in nutrition f. International Micronutrient Malnutrition Prevention and Control i. Eradicate vitamin and mineral deficiencies around globe 4. Emerging infections a. Methicillin-resistant Staphylococcus aureus (MRSA) i. Causes skin/soft tissue infections ii. Resistant to beta-lactams (penicillin, etc) b. Community-associated methicillin resistant S. aureus (CA-MRSA) i. Causes dermatitis, soft tissue infections, and fatal infections in lungs ii. Spreads more easily iii. Higher recurrence rates iv. (HA-MRSA found in hospital settings) v. Take oral antibiotics for skin-isolated, incision and drainage, and wash hands c. HIV/AIDS i. 40 million worldwide, most in sub-Saharan Africa (life expectancy- 20 yr) ii. More prevalent in low-income iii. Cultural beliefs can effect: 1. Wife inheritance a. Among Kenyans b. Male family member becomes husband of new widow in family 2. Traditional sexual cleansing a. In sub-Saharan Africa (Kenya, Zambia adapted away) b. Undertaken after the spouse of a survivor has died, widow or widower is required to have penetrative sex with a cleanser (person) to avoid misfortune and to chase away the spirit of the dead from the self and the community 3. Virgin cleansing a. Healers advise HIV+ men to have sex with a virgin female under 12 to cure 4. Mila potofu a. Taboo of talking about sex, wife inheritance, and sexual cleansing 5. Violence a. Among leading causes of physical, sexual, reproductive, and mental health problems worldwide b. Loss of 1.6million lives c. Who defined as intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation d. Steps: i. Defining the problem 1. Police reports, medical examiner files, vital records, medical charts, population-based surveys, and research results ii. Identifying the risks and protective factors 1. Risk factor- characteristic that increases likelihood of person becoming victim or perpetrator of violence 2. Protective factor- characteristic that decreases likelihood of person becoming victim or perpetrator of violence 3. Helps estimate violence magnitudes and devise appropriate prevention measures iii. Devising and testing means of dealing with violence 1. Data on violence from sources are extrapolated and assessed 2. Then plan interventions, Then implement, Then evaluate iv. Applying successful means on large scale 1. communities are encouraged to adopt a program tailored to their own problems and needs e. 3 categories: i. Interpersonal 1. Violence committed by individual or small group in wide range of acts and behaviors ii. Self-directed 1. Violence in which perpetrator and victim are same individual and is subdivided into self-abuse and suicide iii. Collective 1. Instrumental use of violence by particular group of people for specific political, economic, or social objectives 2. Armed conflicts within or between states or nations, genocide, terrorism, repression, and other abuses of human rights 6. Terrorism a. Creates unique brand of fear among individuals and communities b. International Council for Nurses (ICN) describes its position on the role of nursing concerning disaster preparedness to include risk assessment as well as management strategies bridging multiple disciplines and system levels c. Nursing plays key role in responding to short-, medium-, and long-term requirements of populations stricken by disaster 7. Bioterrorism a. Deliberate release of viruses, bacteria, or other germs used to cause illness or death in people, animals, or plants b. Can be changed to increase ability to cause disease, make resistant, or increase ability to be spread into environment c. Category A diseases/agents i. not normally in US ii. highest risk iii. Anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers d. Category B i. Second highest risk ii. Brucellosis; food safety threats (Salmonella, E. coli, Shigella); glanders; meliodosis; psittacosis; Q fever; ricin toxin, staphylococcal enterotoxin B; typhus fever; viral encephalitis; and water safety threats (Vibrio cholera, Cryptosporidium parvum) e. Category C i. Emerging pathogens that could be reproduced for mass dissemination ii. Nipah virus and hantavirus 8. Epidemic and pandemic alert and response (EPR) a. CDC created public health emergency response guide to help public health professionals at state, local, and tribal levels respond to emergency in first 24 hrs b. Health care providers should be alerted to any unusual symptoms indicative of infectious outbreak related to bioterrorism, and report if suspect one c. Indications of bioterrorism: i. Unusual temporal or geographic clustering of illness ii. Individuals presenting clinical signs and symptoms that suggest outbreak iii. Unusual age distribution for common diseases iv. Large number of cases of acute flaccid paralysis with prominent bulbar palsies d. WHO works to gather reports in countries regarding bioterrorism e. Global Public Health Intelligence Network is a significant source of informal info; constantly searching data over internet to identify info about outbreaks 9. Natural Disasters a. Phenomena that occur through natural forces involving land, air, or water, and have large-scale negative impacts on humans who live in affected areas b. Tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter weather,etc c. More harm in developing countries because of deforestation and inadequate warning 10. Implications a. Essential public health services i. Monitoring the health status of individuals and communities in order to address identified health problems ii. Diagnosing and investigating health problems and health hazards among individuals in the community iii. Informing, educating, and empowering people about health problems and various ways to address problems, including applying strengths found in the community iv. Mobilizing community partnerships and community actions so that health problems can be identified and addressed v. Developing policies and plans that will assist individuals and their communities to address identified problems vi. Enforcing laws and regulations to provide and protect the safety and health of individuals and communities vii. Linking people to appropriate health services to ensure accessible health care viii. Ensuring proficient personal and public health care workforces ix. Evaluating the accessibility, effectiveness, and quality of health services x. Searching for innovative ideas and solutions to identified health problems b. awareness of human rights, empowerment, cultural diversity, and cultural competence can help health care professionals effectively deliver care to individuals and communities c. need more advanced practice nurses d. introduce health promotion and disease prevention with emphasis on evidence-based practice, human rights, cultural diversity, and cultural competency e.