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Title: Unit I: Concepts in Health Care


1
Unit I Concepts in Health Care
  • Health and Wellness
  • Legal Principles in Nursing

Dr. Belal Hijji, RN, PhD January 4, 2012
2
Learning Outcomes
  • By the end of this lecture, students will be able
    to
  • Define key terms
  • Discuss models of health and illness
  • Discuss variables influencing health beliefs and
    health practices
  • Describe health promotion and illness prevention
    activities
  • Discuss the preventive levels of health care
  • Discuss four types of risk factors and the
    process of risk factor modification
  • Describe the impact of illness on the client and
    family
  • Discuss some of the legal principles and
    relationships in nursing practice
  • Discuss some of the legal issues in nursing
    practice

3
Definition of Key Terms
  • Health
  • State of complete physical, mental and social
    wellbeing, not only the absence of disease or
    infirmity. (WHO, 1947).
  • Is a state of being that people define in
    relation to their own values, personality and
    lifestyle.
  • Health status
  • Is a description of health that can be measured
    by birth rates and death rates, life expectancy,
    quality of life, morbidity from specific
    diseases, risk factors, and other factors.

4
Models of Health and Illness
  • A model is a theoretical way of understanding a
    concept.
  • Models provide various ways of approaching
    complex concepts such as health and illness.
  • Models are used to understand the relationship
    between these concepts and the clients attitudes
    toward health and health practices.

5
Health-Illness Continuum Model
  • According to this model, health is a dynamic
    state that fluctuates as a person adapts to
    changes in the internal or external environments
    to maintain a state of well-being.
  • Illness is a process in which the functioning of
    a client is diminished or impaired when compared
    with his/ her previous condition.
  • In this model, high-level wellness and severe
    illness are at opposite ends of the continuum.
  • Risk factors, including genetic and
    physiological, environmental age, and lifestyle,
    are at the centre of the model.

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7
Health Belief Model
  • Was developed in the 1950s to examine why people
    did not participate in health-screening
    programmes
  • Was later modified to address compliance to
    therapeutic regimen
  • Is built on the premise that disease prevention
    and curing regimens will eventually be successful
    and the belief that health is highly valued. Both
    premises need to be present in the model to be
    relevant in explaining health behaviour

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Revised Health Promotion Model
  • Has been primarily used in nursing
  • Describes major components and variables that
    influence health promoting behaviours
  • Emphasises actualisation of health potential and
    an increase in the level of wellbeing rather than
    avoidance of disease
  • Has three major components of individual
    characteristics and experiences,
    behaviour-specific cognition and affect, and
    behavioural outcome

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11
Variables Influencing Health Beliefs and Health
Practices
  • Internal variables
  • Developmental stage The persons concept of
    illness depends on his developmental stage. For
    example, different techniques of teaching are
    used about contraception to an adolescent and to
    an adult
  • Intellectual background Cognitive abilities
    shape the way a person thinks, including the
    ability to understand factors involved in illness
    and to apply knowledge of health and illness to
    personal health practices
  • Emotional factors A persons degree of calm or
    stress can influence health beliefs and
    practices. A very calm person may have little
    emotional response during illness, whereas a
    person unable to cope with stress may either
    overreact to illness or deny the presence of
    symptoms.

12
  • Spiritual factors Religious practices are one
    way people exercise spirituality. Nurses must
    understand clients spiritual dimensions to
    involve them in nursing care
  • External variables
  • Family practices A person raised in a family
    that values the importance of preventive care,
    e.g periodic dental checkups, is more likely to
    continue those health practices during adulthood.
  • Socioeconomic factors These factors can increase
    the risk for illness and influence the way a
    person defines and reacts to illness. A person
    with low income tend to focus on food for the
    family than to costly drugs or special diets.

13
  • Cultural background Cultural backgrounds
    influence beliefs, values, and customs. It
    influences the approach to the health care
    system, personal health practices, and the
    nurse-client relationship.

14
Health Promotion and Illness Prevention Activities
  • Health promotion strategies can be
  • Passive Clients gain from activities of others
    without acting themselves, (e.g flouridation,
    fortification of milk with vitamin D)
  • Active Clients are motivated to adopt specific
    health programmes (e.g weight reduction, smoking
    cessation)

15
Levels of Preventive Care
  • Health activities and nursing care occur at the
    following levels of prevention
  • Primary True prevention preceding disease or
    dysfunction and is targeting physically and
    emotionally healthy people (immunisation,
    personal hygiene)
  • Secondary Focuses on clients who experience
    health problems or illnesses and who are at risk
    of developing complications or worsening
    conditions (e.g early treatment, screening)
  • Tertiary Disability is permanent and
    irreversible. The aim is to minimise the effects
    of long-term disease or disability by
    intervention directed at preventing complications
    and deterioration (bed sore development).

16
Types of Risk Factors
  • A risk factor is a situation, habit,
    environmental condition, physiological condition,
    that increases the vulnerability of an individual
    to an illness or accident.
  • Risk factors can be grouped into
  • Genetic and physiological factors Diabetes,
    Pregnancy, or overweight
  • Age Increases risk of heart disease, birth
    defects when a woman is gt 45 yrs.
  • Environment Unclean, crowded dwellings increase
    the risk of infection and other disease.
  • Lifestyle Overeating, poor nutrition,
    insufficient rest or sleep, alcohol or smoking

17
  • The goal of risk factor identification is to
    assist clients in understanding those areas in
    the lives that can be modified or eliminated to
    promote wellness and prevent illness.
  • Risk factor identification is the first step in
    health promotion, wellness education, and illness
    prevention.
  • Once risk factors are identified, health
    education programmes can be implemented and this
    may lead a person to change a risky health
    behaviour, such as smoking cessation, alcohol
    misuse, lack of exercise, unhealthy food.

18
Impact of Illness on Client and family
  • Emotional and behavioural changes Depend on the
    nature of illness, the clients attitude, and the
    reactions of others, to it.
  • Short-term, non-life threatening illness produce
    few behavioural changes in the clients and
    family functions (e.g cold)
  • Severe life-threatening illness can lead to more
    extensive emotional and behavioural changes such
    as shock, anxiety, denial, and withdrawal.

19
  • Some illnesses result in changes in physical
    appearance, and clients and families react
    differently to these changes.
  • Changes in body image depend on the type of
    changes (loss of a limb or an organ).
  • Illness may change the roles of the family and
    client.
  • Such changes may be subtle slight and short
    term that an individual or family can easily
    adjust to, or drastic severe and long term that
    require an adjustment process similar to grief
    ????? process. In this latter case, the client
    and family need specific counselling and guidance
    to assist them in coping with the role changes.

20
Legal Principles in Nursing
  • Legal limits of nursing
  • An understanding of the law coupled with sound
    judgment helps to ensure safe and appropriate
    nursing care.
  • Nurses must understand the legal limits that
    affect nursing practice to know their
    responsibilities and to protect clients from
    harm.
  • Sources of law Nursing practice is subject to
    statutory law, regulatory law, and common law
  • Statutory law is created by the US congress and
    state legislatures. Examples include Americans
    With Disabilities Act and the Nurse Practice Acts
    respectively

21
  • State Boards of nursing create regulatory law
    when they pass rules and regulation. An example
    of regulatory law is the duty to report
    incompetent or unethical nursing behaviour
  • Courts create the common law when individual
    legal cases are decided. Examples include
    informed consent and the clients right to refuse
    treatment
  • Statutes ????????? ?? ???????? are either
    criminal or civil
  • Criminal law is classified as a felony crime
    which is a serious offense, or a misdemeanor
    ???? which is a less serious crime.
  • Civil law protects individual rights. Violation
    of a civil law results in the payment of money to
    the injured party. A tort ??? is a civil wrong
    or injury. Torts are classified as intentional or
    unintentional. Intentional torts are willful acts
    such as assault ??????. Unintentional torts
    include negligence which is a conduct that falls
    below the standards of care.

22
Legal Relationships in Nursing Practice
  • Student nurses Students are responsible for all
    of their actions (USA) that cause harm to
    clients. When an injury occurs as a direct
    consequence to students action, the liability
    for the incorrect action may be shared by the
    student, the instructor, staff nurses, and the
    hospital.
  • Physicians prescriptions Nurses are responsible
    for carrying out medical treatment unless the
    prescription is in error, violates hospital
    policy, or would be harmful to the patient. If
    the nurse determines that the prescription is
    wrong or harmful, s(h)e needs to obtain further
    clarification.

23
  • If after clarification the physician confirms an
    order that a nurse still believes that it is
    inappropriate, the nursing supervisor needs to be
    informed.
  • The nurse should not carry out an order if there
    is a risk of harm. Otherwise, the nurse may be
    legally responsible for the harm suffered by the
    patient . All physicians prescriptions should be
    well-written, dated, and timed appropriately.
  • Consent A general signed consent is necessary
    for all routine treatments, surgery,
    chemotherapy, and participation in research. A
    special consent form is signed before specialised
    procedures may be performed.

24
  • Death and dying Nurses must know their legal
    responsibilities concerning death and dying. A
    nurse must document all events that occur when
    the dying client is in his care.
  • There are two standards for the determination of
    death
  • Cardiopulmonary standard requires irreversible
    cessation of a clients circulatory and
    respiratory functions
  • Whole brain standard requires irreversible
    cessation of all functions of the entire brain.
  • An autopsy requires consent by the client before
    his death, or a close family member at the time
    of death.
  • Nurses encounter legal issues with caring for
    terminally ill, severely debilitated, or
    persistently vegetative clients.

25
  • A competent client has the right to refuse
    medication and food.
  • A dead client has the right to be treated with
    dignity and care. Wrong handling can cause
    emotional harm to family members.
  • Organ and tissue donation A signed consent is
    required before a clients body, tissues, or
    organs can be donated for medical use.
  • At the time of death, a qualified health care
    provider can ask the clients family members to
    consider organ donation.

26
Legal Issues in Nursing Practice
  • Nurses need to be aware of changes in the laws
    that affect nursing practice and patient care.
  • Laws pertinent to narcotics administration are
    constant, while those of other issues such as
    abortion and care for clients with HIV are
    changing
  • Controlled substances May be administered by
    nurses under the direction of a licensed
    physician. These agents should be kept securely
    locked, and only authorised personnel should have
    access to them. Precise records must be kept.
    There are criminal penalties for the misuse of
    controlled substances.

27
  • HIV Nurses care for patients with HIV. Nurses
    must use the standard precautions for the control
    of transmission of the HIV. Nurses need to
    safeguard themselves and others from exposure to
    infectious material.
  • Abortion issues In the USA, the woman can decide
    to have an abortion as a fundamental right to
    privacy. This is true during the first trimester
    without state regulation. In the second
    trimester, the state may enforce regulations
    regarding the person who performs abortion and
    the facility. By the 3rd trimester, when the
    fetus becomes viable, the states interest is to
    protect the fetus by prohibiting abortion unless
    necessary.
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