PN Nursing Exam

Sociological imagination: Understanding the social world we live in and looking at familiar routines and social forces from different perspectives nd how these impact people’s lives and personal circumstances. Cultural: things in our culture that impact on our lives, defines our behaviour. Historical: the past that has influenced the present. Structural: how particular forms of social organisation shape our lives. Sociological perspectives: a viewpoint, seeing things through theoretical perspectives to see function and changes of humans. Conflict: (Marxism): conflict + strife are basic elements of society; conflict occurs between 2 social classes in society + unequal power results in inequity, structure/power. Symbolic interactionism: structures created through human interaction (verbal and non-verbal). Symbols and communication shape our perception for language and behaviour. Functionalism: organic system that functions well for balance and harmony. Shared values + need moral consensus for society to function. Feminism: gender issues are the cause of social inequality. Legal health/educational systems reflect sexist values and support males. Social structure: interrelationships and interactions of the population produce recurring patterns of behaviour and social structure. Social roles: society is a population which are groups which have individuals with status or position in society Socialisation: people learning to conform to society’s norms, values, and roles because society expects people to behave according to the norms of culture. Primary, secondary, and adult socialisation. People are socialised by direct instruction/modelling of behaviours. Agencies of socialisation: groups of people who influence a person’s social development throughout their life. Family, schools, peer groups, mass media and religion. Social institutions: groups with statuses and roles designed to perform major social functions are termed institutions. Are devoted to meeting the basic needs of people in society and let us explore the NZ health system. NZ health system: Ministry of Health is a government organisation for the health and disability system that is going to improve health and well-being. Te Whatu Ora/Health NZ: weaving of wellness, combing people, resources and organisations together for better wellbeing. New fresh perspective. All healthcare and community services. Te Aka Whai Ora: Maori Health Authority: leading change in health/wellbeing for Maori, works with MOH and Te Whatu Ora, health needs, policies/strategies, reducing health inequity. Maori Health strategy: whaka maua Maori health action (2020-2025) guides ministry and health in disability systems when implementing health related actions. He Korowai Oranga, government’s vision for Maori health is pae ora (health futures), mauri ora (healthy individuals), whanau ora (healthy families) and wai ora, (healthy environment). Effective/appropriate stewardship, enabling rights, Maori philosophies and terms, equity in health and disability outcomes, Maori customs, and practices. Hauora Report: 2019: It addressed 2 claims concerning administration, funding and monitoring of the PHO. It had breached the Treaty by failing to address inequities and upholding Treaty obligations. It made recommendations to explore Maori Health Authority, methology, review and redesign of PHO. Levels of care: 1. Primary: community based, first point of contact: gp, nurse, doctor. 2. Secondary: referred to another health professional: doctor referring client to see a cardiologist. 3. Tertiary: in patient/specialty section: client having a burn and in the burns unit. Health promotion: Ottawa charter: international health promotion document. Prerequisites are peace, shelter, education, food, income, a stable ecosystem, social justice, and equity. 5 key action strategies are to build healthy public policy, create supportive environments, strengthen community action, develop personal skills and reorient health services. Health promotion: becoming aware of problems in other countries and making sure health issues are understood/publicised. Local community planning activities, assessment, working together with groups and agencies to lobby the government for better services. Providing health education to people in local communities. Enables people to thrive and build resilience rather than just surviving. Support systems in place to enable people to achieve high levels of health preventing ill health or injury and successfully recover from illness. Focus on community’s assets and strengths rather than weaknesses. Requires cooperation and collaboration including education, housing, transport, environmental protection, and employment sectors. A process of working at many levels from government to personal lives and this enables people to increase control over their health and improve health outcomes. PHC and health promotion: two guiding documents for health promotion are the Tiriti o Waitangi and the Ottawa charter. PHC: culture embeds customs, beliefs, and traditional practices. Person and whanau centred health care, incorporates delivery of healthcare for gender specific services, appropriate workforce, and environment. Benefits the indigenous PHC model enabling communities to thrive, ensuring culturally appropriate, holistic, accessible care. It provides a platform for people, who can self-determine their health. Guidelines/policies reflect cultural values, beliefs, and practices. Community and workforce work in partnership. Social justice: redressing politically, socially, and economically unacceptable health inequalities in all countries. Equity: the fair distribution of society’s benefits and resources according to the: community services card. Equality: the fair distribution of society’s benefits and resources. It is about distribution of resources according to need/ex community services card. Health literacy: being able to obtain, understand and use basic health information to navigate health services and make appropriate health decisions. Communication and understanding in the health context. Level 1: poor literacy skills. People are unable to determine a package label the correct amount of medicine to give a child. Level 2: a capacity to deal only with simple, clear material involving uncomplicated tasks. People develop everyday coping skills, but poor literacy makes it hard to conquer challenges. Level 3: adequate to cope with the demands of everyday life and work in an advanced society and this denotes the skill level required for successful secondary school completion into tertiary education entry. Level 4/5: strong skills and a person at these levels can process information of a complex and demanding nature. Barriers to health literacy: age, culture, education, lower socio-economic groups, technology, people with disabilities: vision, hearing.Health literacy strategies: accessible and appropriate written, oral, and visual communication. Provide easy to understand information, make it relevant for the individual and inclusion of culture and language. Rationale (reasons for instructions), nurture/engage in partnership, protection, and participation. Ensuring patient has understood, use the teach back method, ask me 3 questions (diagnosis, treatment, context), use models, cultural language, images, 3 steps to improve health literacy: 1. Find out what people know 2. Build health literacy skills and knowledge 3. Check you were clear. Evaluating written information: Simple, clear, no jargon. Definitions and patterns of health: a balance in all areas of life, being active, health includes physical, social, and mental wellbeing and not merely the absence of disease or infirmity. Health model: a pattern or framework that helps us to understand a definition concept or issue. Biochemical model: diagnosis – identification of a disease or illness through a doctor’s observation or using specific diagnostic tests/intervention/treatment – refers to action taken to improve health: x-rays, scans, blood test, ultrasound, mammograms, pap smear tests, surgery, and hospitalisation. Problem: doesn’t take into account external factors. Socio-ecological: acknowledges the influences of; political, economic, and cultural conditions impacting on health and community. Holistic health is a social and ecological phenomenon, ecological is the idea that everything is connected, dynamic and constantly changing. Health models: social psychological health behaviour change model to explain and predict health behaviour, particularly regarding uptake of health services. Complementary and alternative health care: healing resources or methods that are alternative. Differs from the dominant health system of the society, each has its own belief/philosophy, only a few are regulated. Complementary medicine (alternative health care), Tai Chi (energy therapy), homoeopathy (body cures itself), Te whare tapa whā (health is maintained through balance of physical, family, spiritual and mental wellbeing), traditional Chinese medicine (harmony from yin and yang), fonofale (cultural values and beliefs are roof or shelter for life and wellbeing). Fonofale: helping people to learn and grow as themselves. Benefits: holistic, focusses on widening mental health other than the physical and on Pacifica. Invented by Fuimanono Karl Pulotu-Endermann in 1984. Supports health and wellbeing by focussing on resilience, people as a whole, moral wellbeing, embrances Pacific perspective, instills cultural safety. Designed for Samoan’s, Cook Islander’s, Tongan’s, Niuean’s, Tokelaun’s, Fijian’s. Family is the base, physical, spiritual, mental, and other are supporting frameworks of the house. Environment, time and context are inside the house and culture is the roof above all else. Te whare tapa whā: One of four dimensions a person may become unbalanced or unwell 1. Taha tinana (physical health): physical growth and development. Good physical health required for optimal development and our physical being supports our essence and shelters us from the external environment 2. Taha wairua (spiritual health): faith and wider communication. Health is related to unseen and unspoken energies. The spiritual essence of a person is their life force. Determines us as individuals and as a collective, who and what we are, where we have come from and where we are going 3. Te whanau (family health): the capacity to belong, to care and to share where individuals are part of wider social systems. Whanau provides us with the strength to be who we are. This links us to our ancestors, our ties with the past, present, and future 4. Taha hinengaro (mental health): the capacity to communicate, to think and to feel mind and body are inseparable. Thoughts, feelings, and emotions are integral components of the body and soul. Population health profile: Morbidity:measures the disease rate and the susceptibility of a population to a disease. The number of people diagnosed with the disease. Mortality: measures the death rate. The number of deaths per year from a certain disease or condition. Health disparities: differences in health between groups of people – considered to be unfair or unjust and are often linked to economic, social, historical, cultural, or environmental disadvantage. Health inequalities:differences in health status of different groups. May be expected and may be avoidable so disparities and inequalities can be used to mean the same thing. Health equities: try to eliminate the health disparities/inequalities linked to social disadvantage and strive for a high standard of health for all people – special attention to social conditions, such as housing, economics, education, employment, culture.

Stratification: is the way a society is arranged in layers including wealth, income, ethnicity, gender, religion. It’s often about power and money or people with no money. Status of people is determined by their stratification and can cause problems in society such as racism, discrimination, prejudice, patriarchy, sexism, ageism, hegemony, and assimilation. Types of stratification:Closed stratification system: rigid boundaries allow no movement between social layers. Open stratification system: individuals, families and even communities can move from one social layer to another.  Stratification and health inequalities: the place in society’s stratification system into which you are born has an enormous impact on what you will do or become throughout life. What oppotunities or lack of opportunities determines your place in society. Racism: discrimination against a person based on their racial or ethnic group. Discrimination: treating people unfairly based on the group they belong to: age, sex, race. Prejudice/Stereotypes: preconceived opinions about somebody based on their perception. Patriarchy: a male dominated society. Sexism:prejudice and discrimination based on sex. Ageism: prejudice and discrimination based on age. Hegemony: power related leadership or dominance over another group. Assimilation: being more like another dominant group, conforming. Life Chances: the ability and opportunity each individual has to change their life in social positioning. Social determinants: factors that promote and affect health and wellness in individuals, families, and communities, including social, political, and economic factors. Health determinants: income, employment, education, housing, culture, and ethnicity, population-based services and facilities, social cohesion.People powered:provides people with info to be able to fully understand issues to do with health and wellness: how to be healthy, access health services, manage their own health, communicate, and make choices. NZ health strategy: benefits everyone. Creates a space to meaningfully address racism and discrimination, Treaty of Waitangi, oragnisations promoting equity, leaders take responsibility for addressing equality, decisions are inclusive, actions addressed are effective, timely, pragmatic and evidence based. Whanau Ora: benefits whanau as a group. It is an indigenous health initative driven by Maori cultural values. Main principles: building whanau capability, putting whanau needs and aspirations at the centre, building trusting relationships, developing culturally competent and skilled workforce.Goal: postive changes in education, health, employment, living, housing and cultural identity by building on whanau strengths. Whanau are supported to realise their confidence, mana and self belief. They work with non-governement agencies to ensure it is community based, Ideas of strategy: for Maori to be able to self-manage, live healthy lifestyles, participate fully in society, participate in the Maori language, economically secure, stewards of the natural and living environment, engage in collaboration, and build strengths. Poverty: caused by economic, political, and social distortions or discrimination, link between power and wealth, poor people lack power and influence in political system. Absolute poverty: where a person does not have sufficient resources to even meet basic needs from day to day – it is about lack of the essentials such as food and water but there are also problems with housing, land, and healthcare. Lack of these can lead to hunger and physical deprivation. Relative poverty: within a nation is calculated as the proportion of the population with an income below a certain fraction of the median income. In NZ it is less than 60% of yearly median income. It is about household resources being too low to meet basic needs, and material hardship. Poverty reduction:increase income, reduce inequalities between rich and poor. Effects of Poverty:can impact health, development education, nutrition, crime, isolation, fear, anxiety, rejection, marginalised, opression. Living wage:$23.75 an hour. For a worker to survive and participate in society. Reflects basic expenses of workers and their families such as food, transportation, housing, and childcare. Nurses helping people in poverty: advocate for clients, think about income and options when planning care, help clients be empowered, enable choices and engage in decision making. Labelling:failure to conform results not just from actions of the behaviour/social forces but also from responses of others, affects the way we treat people, exclusion, assumptions about people: fat, alcoholic, crippled, poor. Stigma:disapproval or discrimination from percieved characteristics. Exclusion:people are cut off from having the same access to opportunities in society economically, social, political, cultural. Inclusion:people are involved in society and have the same opportunities as others. Power: being able to influence the actions of others, a person able to carry out their own will despite resistance, getting your own way, intertwined with knowledge. Medicalisation: the process by which non-medical problems (behaviours, activities, conditions) come to be defined and treated as if they were medical issues: sleeplessness, menopause, childbirth. Forms of Power: legitimate: belief of the right to demands and others to be compliant and obedient. Reward: compensation for compliance. Expert: high levels of skill and knowledge. Referent: perceived attractiveness, worthiness, right to others respect. Coercive: punishment for noncompliance. Informational: ability to control the information others need to control something. Pharmac: a NZ crown entity. Role: decides on behalf of the DHBs, which medicines and pharmaceutical products are subsidised for the community and public hospitals. Commercialization: in health care the increasing provision of health care services where users pay, associated investment in and production of health services for the purpose of cash income or profit, an increasing number of systems being based on individual payment or private insurance creating inequality and exclusion. Power in healthcare system: Medicalisation, government, commercialization. Family violence: abuse of any type perpetrated by one family member against another (partners, parents, siblings): controlling behaviours, commonly of a physical, sexual and/or psychological nature. Involves fear, intimidation, and emotional deprivation.3 R’s: recognize, respond, and refer. Elder abuse: a single or repeated act of lack of appropriate action/care in a relationship where there is an expectation or trust (physical, sexual, emotional, neglect). Child abuse: is the harming physically, emotionally, or sexually, ill-treatment, abuse, neglect or deprivation of any child or young person. Indications:physical – bruises or burns, behavioural – cringing or flinching if touched unexpectedly. Prevention: seeking help, learning to control triggers, finding strategies to manage triggers, changing attitudes and behaviours, not keeping quiet. Responsibilities: be supportive, open, and non-judgmental, believe them, ensure they are not to blame. Laws in NZ: family violence act 2018: prevent FV, protection, Oranga tamariki 2019: responsibility and provisions/protection, domestic violence: victims protection act 2018: safety of employees, 10 days DV leave, flexible schedule. Agencies: NZ Police, Oranga Tamariki, Child Matters. Campaigns/frameworks:Pacifica proud, Nga Vaka o Kaiga Tapu, E Tu Whanau, it’s not OK.Nursing knowledge and theories: theoretical, practical (nurse’s experiences and inquiry, achieved through personal knowledge and reflection), knowledge based in research or science. Link between nursing knowledge and theories: evidence-based knowledge, develops nursing knowledge, patient centred care, development of the nursing profession, meaning in nursing practice. 4 metaparadigms for nursing: Person: individuals, families, communities, and other groups who are participants in nursing and who receive nursing care. Environment/situation: the patient environment includes any setting and influencing factors that can alter the setting where the patient receives care (room temp, family members). Health:the patient’s state of well-being. A patient’s health is influenced by many physical and psychological factors. Nursing: nursing involves the use of the nursing process to assess, diagnose, plan, implement, and evaluate an individualised plan of care for providing patient care and education. Theorists: Peplau (1952): interpersonal relations: focuses on client. Neuman (1972): holistic nursing care – factors impacting person’s health status. Watson (1979): transpersonal caring – designed around caring process, assisting clients. Benner (1984): novice to expert. Florence nightingale: environment theory. Carper (1978) and White (1995): 5 patterns of knowing. Nightingale: founder of educated/scientific nursing, first nursing notes became the basis of nursing practice/research. Main idea: utilise patient environments to achieve desired effect. Began from her time in the war with infection control and the effect environment had on recovery later applied to hospitals: correct ventilation, sanitation of linen, sufficient food supplies was essential. Uses person centred care and environment metaparadigms.Carper/White: Patterns of Knowing: empirical: the science, A&P, OBS, nursing assessment. Ethical: moral knowledge, right v wrong, values. Personal: self-discovery, connections, communication, respect, cultural safety. Emancipatory: power balance, equality/equity, status, society. Aesethics: the art, practice, knowledge. Ethics: approaches of thinking about, understanding, and examining how best to live a moral life. Reflective activity concerned with systemic examination of living/behaving morally, reconsider actions, judgement, and justifications. Ethics of care 6 c’s: Compassion:about living in solidarity with others, simple presence, valuing others for who they are. Competence: state of having knowledge, judgement, skills, energy, experience, and motivation required to respond to demands of one’s professional responsibilities. Confidence: creates trusting and respectful relationships and communicates effectively. Nurses need to be confident/comfortable in themselves so they can be comfortable/open with clients. Conscience: moral sense of right and wrong. General sense of value, personal responsibility, and self-direction. Commitment: willingness to do something. Investing in tasks, people, relationships, choices. Comportment– professionalism: values, beliefs, and attitudes about your manner. Determines a nurse’s effectiveness in relating, communicating, and collaborating with their team. Nursing ethics: moral guidelines in the contexts in which they work, principles or values that guide nursing care. Principles of ethics NZNO: Autonomy: respecting choices and health consumers as dignified and rational autonomous choosers. Non-maleficence: above all, do no harm. Not putting anyone, including yourself in harm’s way. Beneficence: above all do good. Promotes welfare and wellbeing. Justice: fairness to all health consumers. Equal distribution of benefits and burdens. Confidentiality: respecting patient privacy at all costs. Veracity: actions, speech, and behaviour that ensure communications between individuals and/or groups are honest and truthful. Fidelity: being loyal: keeping promises. Guardianship: of the environment and its resources: the assumption that society has a responsibility to respect and protect the environment and its resources. Cultural/contextual variation in the relationship between person and environment will influence the value or guardianship. Being professional: professionalism. Maori world view: have the right to be Maori, Tikanga includes traditional values, beliefs, and practices. Te whare tapa wha supports models of health. Maori values: Rangatiratanga: self-determination. Manaakitanga: express aroha and acknowledge mana. Tika: importance of truth, correctness, justice, fairness, and rights. Whanaungatanga: establishing relationships, focus on people and connections made. Wairuatanga: understanding and believing there is spiritual existence, acknowledge, and respect the right of all to spiritual freedom. Kotahitanga: solidarity, togetherness, nurses will work in unity and harmony with each other. Kaitiakitanga: guardianship of stewardship, policies, and practices will reflect the role we have on this planet