Week 7A: Growth and Development - Young to Middle Adulthood

Week 7A: Growth and Development - Young to Middle Adulthood (February 26) Concepts: ● Growth and Development: Young Adulthood (Ages 20-35) to Middle Adulthood (Ages 36-65) Learning Objectives: 1. Discuss the major life events and developmental tasks of young and middleaged adults. ★ Young Adults Changes: ○ Major Life Events: ■ Career? ■ Sexuality? ■ Singlehood? ■ Marriage? ■ Child-bearing Cycle? ■ Parenthood? ○ Physical: ■ Height, muscle mass, internal/reproductive organs; brain continues to develop into mid-20s ■ Few physical illnesses occur (peak of health) ○ Cognitive: ■ Full range of cognitive skills (Formal Operations ready-to-go) to put to use ■ Honing & building – person’s adaptation to their living/learning environment ○ Psychosocial: ■ Lifestyle choices have been made. ■ Career has often been chosen – specialized vocabulary/technology communication ■ Love, friendship, and community (erikson: intimacy versus isolation) ■ Grappling with and responding to external societal and cultural forces ★ Middle Adults Changes: ○ Major Life Events: ■ Height of Career ■ Parenting Challenges ■ Marital Changes/Divorce ■ Financial Issues/Debt ○ Physical: ■ Age-related changes in appearance: acceptance of aging (body image? self-esteem?) ■ Menopause: permanent cessation of menses (late 40s & 50s); hormones (estrogen and progesterone) not produced by ovaries ■ Chronic illness ○ Cognitive: ■ Illness or trauma ■ Mental stresses ○ Psychosocial: ■ Sandwich generation: adult children, parents, workplace ■ Career transitions: own choice? economy? ■ *Sexuality: dryness, painful intercourse; erectile changes; multiple pressures on couple & libido ■ Family types: singles? adult children leaving home? divorce? ■ Erikson: Generativity vs. stagnation (helping to guide younger generations vs. unproductive member of society) 2. Describe the normal physiological changes in young and middle-adulthood. ★ Young Adulthood Physiological Changes: ○ In the first decade of young adulthood, physical development peaks with maximum height, muscle mass, and reproductive function. Internal organs function optimally, and the brain continues development until the mid-20s. Around age 30, signs of aging emerge, including spinal disk compression, height loss, increased body fat, and declines in cardiac output, muscle strength, and neurological reaction time. Perception of health vulnerability may arise by the end of the young adult period. ★ Middle Adulthood Physiological Changes: ○ Middle adulthood typically begins with most individuals in good physical shape, and physical changes occur gradually. Factors like genetics, lifestyle, and environment influence the degree and pace of changes. Expected changes include muscle loss, slower tissue regeneration, reduced gastrointestinal motility, and kidney function decline. Skin shows signs of aging, with sagging, wrinkles, and age spots. Hair thins and grays, and presbyopia affects near vision. Women experience menopause, with symptoms like hot flashes, palpitations, and mood swings, while men undergo a gradual decline in androgen levels affecting sexual function. 3. Discuss the cognitive and psychosocial changes that appear during the adult years. ★ Young Adulthood Cognitive Changes: ○ In the cognitive stage of formal operations, attained during adolescence, young adults acquire a comprehensive set of cognitive skills. They enhance their ability to address practical concerns and navigate the challenges of a dynamic world. With accumulating knowledge and experience, they can grasp intricate concepts, delve into human relationships, and explore ethical dilemmas. According to Piaget, specialization in thinking occurs, influenced by individual aptitudes and interests. ★ Young Adulthood Psychosocial Changes: ○ In the young adult stage, individuals strive for intimacy, forming trusting relationships and making decisions about partnerships, marriage, parenting, and careers. Erikson's task emphasizes establishing mature connections, which may be expressed in various relationships. Pursuing education and economic factors can influence the timing of leaving the parental home. Boomeranging, or returning home, is common, but by the period's end, young adults ideally establish a career, relationship, and long-term plans. Factors like social and financial pressures impact decisions like remaining at home (failure to launch). –★ Middle Adulthood Cognitive Changes: ○ In middle adulthood, cognitive functions like abstract thinking, problemsolving, learning, and memory remain intact. While reaction time may slow and hand–eye coordination decline slightly, cognitive abilities related to career pursuits stay strong. Middle-aged adults are highly motivated to learn when information is personally relevant. ★ Middle Adulthood Psychosocial Changes: ○ In middle adulthood, individuals engage in Erikson's generativity task, finding satisfaction in nurturing the next generation or contributing to society creatively. The experience varies between men and women, with women gaining assertiveness post-launch of adult children, while men may shift focus to relationships with retirement in sight. Life events shape the diversity in social roles during this period, such as career changes, educational pursuits, or being part of the sandwich generation, juggling responsibilities for children and aging parents. Grandparenting becomes a new role for many. 4. Describe health concerns of young and middle-aged adults. ★ Young Adults Health Concerns: ○ Leading cause of death in this age group is accidental death & injury, followed by self harm/suicide, Cancer, Heart disease, Liver disease, Sexual abuse/violence/assault, and Covid 19 ■ Lifestyle? ■ Family history? ■ Substance abuse? ■ Unplanned pregnancies? ■ STIs? ■ Environmental/Occupational factors? ■ Infertility? ■ Exercise/Nutrition? ■ Routine health screening? ■ Job stress? ■ Family stress? ■ Pregnancy? ★ Middle Adults Health Concerns: ○ Health Screening becomes very important! ○ Health Promotion! ■ Education ■ Early Detection ■ Prevention ○ Chronic Stress? ○ Obesity? ○ Personal Health Habits? ○ Potential chronic physical illnesses? ○ Depression/Anxiety? Week 8A: Growth and Development - Older Adults and Ageism (March 4) Concepts: ● Growth and Development ● Ageism Learning Objectives: 1. Identify common myths and stereotypes about older adults ★ Common Myths/Stereotypes Include: ○ Older people are not active → false ○ Pain is a part of normal aging → false ○ Incontinence is a normal part of aging → false ○ Older people have trouble eating a regular diet → false ○ Older people don’t have sex → false ○ Forgetfulness and confusion are a normal part of aging → false ○ Older people cannot understand normal speech → false ○ Older people are not competent with technology → false ★ Harm of Myths/Stereotypes? → Can lead to ‘self-fulfilling prophecy’ ○ Patient believes that something will happen which inadvertently causes it to happen ○ Ex. Patient believes their hearing will worsen due to age → (does minimal care to prevent hearing loss) → patient’s hearing gets worse as they age 2. Discuss common developmental tasks of older adults ★ Erikson’s Model - Stage: Integrity versus Despair ○ Adjusting to retirement & death of loved ones ○ *Adjusting to decreasing health and physical strength ○ Finding ways to maintain quality of life: meaningful activities ○ Redefining relationships with adult children ○ Accepting oneself as an aging person – facing life’s end ★ Life Review as Self-Reflection: Has my life been worthwhile? ○ Sense of achievement and Wisdom Erikson: Integrity involves the ability to come to terms with one’s life, to face the end of life, and to find meaning. Despair is a sense of disappointment with one’s life in the face of the losses experienced with aging 3. Describe normal physiological changes associated with aging ★ Older Adulthood Physiological Changes: ○ The older adult stage is marked by gradual physical decline, though the extent and pace of changes vary among individuals. Common changes include loss of stature due to intervertebral disk atrophy and osteoporosis, leading to a stooped posture. Muscle strength decreases, joints stiffen, and reaction time slows, increasing fall risk. Sensory changes include reduced visual acuity, taste, smell, and hearing, with men more prone to deafness. Reduced skin sensitivity raises burn risk, while organ systems experience diminished function, including decreased pulmonary and cardiovascular efficiency, gastrointestinal issues, and urinary problems. The immune system weakens, heightening susceptibility to infections like influenza and pneumonia. 4. Describe selected health concerns of older adults ★ Cognitive “Impairment”: ○ Delirium: A medical emergency which is characterized by acute and fluctuating onset of confusion, disturbances in attention, disorganized thinking and/or decline in level of consciousness. ○ Depression: A cluster of depressive symptoms (as identified on the SIG E CAPS depression criteria) is present on most days, for most of the time, for at least 2 weeks and when the symptoms are of such intensity that they are out of the ordinary for that individual. ○ Dementia: A gradual and progressive decline in mental processing ability that affects short-term memory, communication, language, judgement, reasoning, and abstract thinking Week 10A: Ethics and Professional Identity (March 19) Concepts: ● Ethics ● Professional Identity Learning Objectives: 1. Define and discuss how values are developed and shape our perspectives ★ Kohlberg’s Theory on Moral Development: ○ Level I: Preconventional Level: Based on personal gain. The person's moral reason for acting, the “why,” relates to the consequences that the person believes will occur. These consequences can occur in the form of punishment or reward. Therefore, children may view illness as a punishment for fighting with their siblings or disobeying their parents. ■ What will I gain/lose from this? ○ Level II: Conventional Level: Personal internalization of societal and others' expectations. A person wants to fulfill the expectations of the family, group, or nation; develop loyalty to the dominant order; and actively maintain, support, and justify the order. Shift from “What's in it for me?” to: ■ How will this affect my relationships with others? ○ Level III: Postconventional Level: Balance between basic human rights and obligations and societal rules and regulations. Individuals reject moral decisions based on authority or conformity to groups in favour of defining their own moral values and principles. Individuals at this stage start to envision an ideal society. Focus not only on your individual practice but also on social determinants that affect the well-being of a community, such as poverty and homelessness. ■ What can this do for society? (← Most people don’t reach this stage) 2. Discuss the role of values in relation to the study of ethics ★ Ethics: The branch of philosophy that helps us organize our thinking and reasoning about what we consider to be right and wrong, particularly in the social context (academic) ★ Value: our idea of what is good and what is most desirable 3. Define and describe some basic ethical philosophies relevant to healthcare ★ Principlism: Offers a framework in an attempt to make academic philosophical principles more accessible to solve real-world ethical and complex dilemmas in health care. It consists of four guiding principles: respect for autonomy, beneficence, nonmaleficence, and justice. ○ Respect for autonomy: This principle emphasizes an individual's right to govern their own decisions and processes concerning their life and health. Healthcare professionals are expected to uphold and respect patients' autonomy by involving them in decision-making processes. ○ Beneficence: Healthcare professionals are obligated to act in the best interests of their patients and to advocate for their well-being. This principle underscores the importance of promoting positive outcomes and providing beneficial interventions. ○ Nonmaleficence: This principle requires healthcare professionals to avoid (especially knowingly) causing harm or acting maliciously toward patients. It emphasizes the importance of preventing harm and minimizing risks associated with medical interventions. ○ Justice: Justice entails fairness in the distribution of resources, benefits, risks, and procedures in healthcare settings. It involves ensuring equitable access to healthcare services and treating patients and colleagues impartially. ★ While ethical theories provide frameworks for understanding what should be done and what is morally right, they do not offer easy answers. Instead, they help guide decision-making by providing clear rationales for difficult choices. Ethical theories help prioritize values and considerations in resolving ethical dilemmas faced in healthcare. 4. Explain the relationship between ethics and professional nursing practice ★ Professional Ethics: ○ Safety at Work: The 5 C’s, SOP, COE ○ Client Autonomy and Informed Consent: Involves respecting patients' decisions even if they differ from what healthcare professionals recommend. Informed consent is a critical aspect of respecting autonomy, ensuring that clients have access to relevant and understandable information to make decisions about their care. It involves two key aspects: cognitive understanding and voluntary choice. Nurses play a crucial role in facilitating informed consent by providing clear and relevant information to clients in a manner that they can comprehend. ○ Truth-Telling, Deception, and Withholding Knowledge: Trusting relationships are crucial in nursing, built on honesty and fairness. While in daily life, people may withhold truth to spare feelings or avoid conflict, nurses have a fiduciary duty to prioritize their clients' best interests, requiring honesty and disclosure. The nursing code of ethics underscores the importance of truth-telling in all interactions, not just in delivering difficult news. Deception, often justified to protect clients, can erode trust and cause harm. Clients prefer truthfulness, even when facing tough information. Promoting honesty strengthens nurse-client relationships, providing comfort in challenging times. Nurses play a key role in providing complete information, educating clients, and advocating for truthfulness, recognizing their position as holders of knowledge and the importance of integrity in their interactions. ○ Care at the End of Life: Nurses play a significant role in providing care and support to dying patients across various settings, often being deeply involved in difficult conversations, decision-making, and direct care. Ethical dilemmas arise as technology prolongs life, shifting control to specialists. Davis and Aroskar identified three types of ethical dilemmas in death and dying: medical interventions, decisions involving close individuals, and those made by the patient themselves. These dilemmas encompass issues like resuscitation, withdrawal of life support, determining futility, advance directives, and refusal of interventions. Eligibility: ■ Over 18 ■ Must be mentally capable of making the decision ■ Pt.’s fully autonomous decision/NO COERCION ■ Need to receive informed consent (know all their choices, methods, possibilities, and alternatives) ■ Suffering from Non-remedial illness/no cure ■ IF they don’t die they will suffer indescribably + no acceptable ways to alleviate pain ■ Will die soon ■ Must wait minimum 10 days after form is signed to have the procedure ○ Medical Interventions: Medical interventions at the end of life, such as CPR, ventilation, and medications, are commonly used to prolong life and improve functioning. While often necessary, these interventions can sometimes be too invasive or prolong suffering. Do not resuscitate (DNR) orders may be appropriate in cases where further intervention is deemed not in the client's best interests. Physicians typically write DNR orders, but the entire healthcare team must understand and support the decision. Nurses play a crucial role in educating staff, families, and clients about DNR orders and maintaining open communication about end-of-life choices. ○ Facing Death: In end-of-life care, healthcare teams may face requests to ease suffering or hasten death, either explicitly or implicitly. Euthanasia, categorized as voluntary, involuntary, or nonvoluntary, aims to end or prevent suffering. Passive euthanasia involves withholding or ceasing treatment, while active euthanasia actively interferes with bodily processes. The moral distinction between these actions remains debated, reflecting varying values. Assisted suicide involves ending one's life with the help of another, while Medical Assistance in Dying (MAiD) is now legal in Canada, subject to safety and criteria. Nurses play crucial roles in supporting dying clients and families, advocating for their wishes, providing information, facilitating communication, and ensuring access to appropriate end-of-life care settings. In Canada, Nurse Practitioners (NPs) may assess eligibility for MAiD, administer medication, provide second opinions, and educate and counsel clients and families, highlighting the evolving role of nurses in end-of-life care and decisionmaking. Week 10B: Ethics and Professional Identity (March 1st) Concepts: ● Ethics ● Professional Identity Learning Objectives: 1. Discuss how values influence patient care ★ Values: Represent our understanding of what is good and desirable in life. They guide our behavior and actions, as we strive to promote and uphold what we value. These notions develop from various influences throughout our lives, initially guided by parents and guardians. As we mature, we explore alternative choices, often challenging the values imposed upon us. ★ Moral Integrity: Moral integrity is a virtue characterized by reliability, wholeness, and consistency in adhering to moral principles over time. ○ It involves trustworthiness and aligning one's convictions with their actions. Individuals with moral integrity are seen as having good moral character and may serve as moral mentors. They demonstrate commitment to a set of values and beliefs, maintaining consistency by remaining true to their embraced values. ★ Moral Distress: Arises when individuals face situations where they are unable to act in alignment with their ethical convictions due to various constraints or barriers. Factors contributing to moral distress include institutional constraints, perceived powerlessness, hierarchical structures, and lack of resources or ethical leadership. ○ Being unable to effect meaningful change in challenging ethical circumstances ★ Ethical Environments: Ethical environments are conducive settings where individuals feel supported in practicing ethical approaches to nursing and client care. In these environments, individuals feel empowered to actively engage in decision-making regarding client treatment and care. Ethical environments are fostered by strong ethical leadership, open communication, and collaborative decision-making processes. ○ Feel supported ★ Nursing #1 Rule: Provide Safe, Competent, and Ethical Care 2. Explain the relationship between ethics and professional nursing practice ★ Ethical Dilemma: Refer to situations where individuals are faced with making difficult choices between two or more morally acceptable options. These dilemmas arise when there is a conflict between different ethical principles or when the morally correct course of action is unclear. ○ Other Definitions: ■ A situation involving values and beliefs in which we find a clear course of action is not obvious and in which we find that there may be strong ethical reasons to support either option ■ Arise when there are equally compelling reasons for and against two or more possible courses of action, and where choosing one course of action means that something else is relinquished or let go. An ethical dilemma is a particular type of ethical problem ★ Ethical Inquiry: ○ 1. Gather background information. This first stage is characterized by the collection of relevant information to help you define and describe the problem. ○ 2. Identify whether the problem is an ethical one. Determine, through collecting as much information as possible, whether the problem is in fact an ethical one or whether it may instead be a practical, legal, or professional issue. There may certainly be overlap between these categories of issues, but it is most important at this point to determine whether the problem has an ethical dimension. ○ 3. Identify key stakeholders. Identify the key players, that is, anyone who might be affected by this ethical issue. Relational concepts such as responsibility, authority, professional roles, and conflicting duties may be relevant. ○ 4. Identify possible courses of action. Identify possible options and consequences. ○ 5. Reconcile the facts of the case with relevant principles. As you have already determined the relevant principles, you must now consider the outcomes along with these principles to make sure you haven’t missed an important consideration. ○ 6. Resolution. Try to achieve consensus among all those involved in resolving the issue, keeping in mind that there may be constraints such as professional obligations or legal restrictions that may affect realization of the chosen alternative. ★ Relational Ethics: ○ Can you live with this option? ○ Would you be comfortable telling others about it? Living by it? ○ (deontology – would this be okay to do in similar situations) 3. Apply a method of ethical inquiry to a patient situation (meet Mary) ★ “You have received into care a 35-year-old female who has been in a coma since her MVA (motor vehicle accident) 4 hours ago. ‘Mary’ has an abdominal bleed and requires surgery. She is married. Her husband does not share her religious beliefs. No GOC (goal of care) Designation is in place. You have been informed by him that her religious beliefs state she cannot receive any blood products. Due to the loss of blood your patient has experienced thus far she may require the administration of blood products during or after surgery. While witnessing the physician trying to obtain informed consent from the husband to proceed with the surgery, the husband turns to you and says; “What would you do in my position?” Week 11A: Patient Education Part 1 and Educative Nursing Practice (March 25) Concepts: ● Patient Education ● Educative Nursing Practice Learning Objectives: 1. Discuss Educative Nursing Practice: linking knowing with making decisions around patient education ★ Drawing on: Theory and Evidence → What you bring → Context at play → ★ Encounters in clinical → Reciprocity (learn from each other) → Listening, assessments, authentic engagement, application of principles of teaching/learning, organized care → Reflection (knowing, evaluating) 2. Describe major theories influencing educative nursing practice ★ Behaviorism: ○ Behaviorism posits that learning occurs through reinforcement of desired behaviors by teachers. It breaks down learning into observable, measurable steps, focusing on rewards or removal of negative stimuli. Critics note its one-size-fits-all approach and its overlook of individual needs. ■ Change behavior in small steps ■ Learning brings rewards/give rewards ■ Using already prepared materials/checklists ★ Cognitivism: ○ Cognitivism views learning as derived from brain processes akin to a computer. Learners construct mental structures to process information logically. Unlike behaviorism, it emphasizes comprehension, problemsolving, and memory functions. While influential in nursing, critics note its limitations in explaining emotional and linguistic aspects of learning. ■ Learning is best facilitated when the learner is active (i.e., doing) rather than passive (listening). ■ Instruction that is organized is easier to learn and remember than teaching that is scattered and unorganized. ■ Brain work ★ Humanism: ○ Humanism prioritizes human dignity and autonomy, viewing learners as unique individuals capable of self-actualization. Teaching is clientcentered, emphasizing their needs and fostering a facilitative relationship. While influential in nursing, criticism exists regarding assumptions about learners' autonomy and preferences, and challenges with group learning. ■ What does the client need and want to learn? ■ Client-specific learning plans (doing what…) ■ Clients are self-motivated ★ Constructivism: ○ Constructivism posits that individuals construct knowledge through reflection on experiences, developing personal mental models. Learning is adapting these models to new experiences, with teaching involving facilitating discovery. Social constructivism emphasizes learning in social interactions. Critics note challenges with structure for novice learners but praise client-centeredness. ■ More advanced than Humanism ■ Learning by doing things ■ Apply prior learning in here-and-now real- life situations (building/ reflecting) ■ Solving real world problems is meaningful work – client learns by discovery ■ Draw on your real-life experiences to help clients learn ★ Andragogy (Malcolm Knowles): ○ Andragogy, coined by Malcolm Knowles, focuses on adult learning, distinguishing it from pedagogy. It emphasizes the process of learning over content and draws from humanistic theories. While debated, it acknowledges adult learners' autonomy and readiness, influencing nurses to tailor education to individual needs and contexts. ■ Clients learn as they experience things, even when making mistakes ■ Clients are interested in learning things relevant to work & life ■ Clients help plan & implement ■ Clients are more interested in solving real-world problems ■ Clients take responsibility for their own learning ■ Clients learn when they are ready to learn 3. Discuss tips and tools for educative nursing practice ★ Tips: ○ Acting in accordance with: ■ Entry to Practice Standards & Standards of Practice Skills ■ Roles of Graduate and Registered Nurses ■ Code of Ethics ■ Knowing you as a professional (Experience → Strengths? Limits? Your assumptions?) ○ Others: ■ Readiness to learn? ■ Timing (when to teach?) ■ Assessing outcomes ■ Organization ■ Information (esp. what they want to know) ■ Communication ★ Tools: ★ Nursing Process vs. Teaching Process → There is a relationship between the two but they are not the same ○ Nursing process: Assessment of all data → broader ○ Teaching process: Patientʼs learning needs/ability to learn (translating the nursing process into a teachable content to educate the patient) (NPP Approach~) ★ Assessment: ○ Stop, look, listen with intention (client) ■ Ability to learn? Motivation to learn? Past teaching? ○ Stop, look, listen with intention (person) ■ Health interferences [*physical? G & D?] ■ Needs/wants re: learning preferences? ■ Fears/*Emotional? Cultural values/beliefs? ■ Supports available? Health literacy [*intellectual]? ○ Cues: Doctor’s order, client request, nurse’s assessment, someone else’s inkling ■ Observations & Statements ■ Laboratory & Assessment data ○ Knowing the case ■ Intuiting from past: what typically goes on? ★ Clinical Judgment (Diagnosis): ○ What learning needs to occur? ○ Forming a diagnosis from the three domains: cognitive, assertive, psychomotor → ★ Formula: Person + action word + conditions + time frame [SMART Goals] ★ ‘Domains’ of learning to ‘Focus’ ‘on: ○ Cognitive: All intellectual behaviors and requires thinking (ex. memory, recall, understanding, knowledge, comprehension, decision-making, application, problem-solving, etc.) ■ Ex. At the end of today’s education session, Mr. Salvador will name 5 common side effects of his new BP medication ■ Ex. Mr. Poebles will plan and write out a 7-day low salt menu for bkfst., lunch, and dinner by discharge ○ Affective: Expressions of feelings and acceptance of attitudes, opinions, and values (Pathos/emotion; acknowledgement) ■ Ex. Mrs. Romerez will verbalize feelings and fears about changing diet 2 days before discharge ○ Psychomotor: Acquiring skills through the integration of mental and muscular activity (kinetics; physical; demonstration) ■ Ex. Within the next 48 hours, Mrs. Anderson will walk from her armchair to the bathroom, using crutches ★ *Cognitive Teaching Methods: ○ Discussion (One-on-One or Group) ○ Storytelling ○ Lecture ○ Question-and-Answer Session ○ Role Play and Discovery ○ Independent Projects (e.g., Computer-Assisted Instruction) and Field Experience ■ → Assists patient to assume responsibility for learning at own pace; Promotes analysis, synthesis, and evaluation of new information/skills ★ Affective Teaching Methods: ○ Role Play ■ Encourages expression of values, feelings, and attitudes ○ Discussion (Group) ■ Enables patient to acquire support from other people in group; Encourages patient to learn from other people's experiences; Promotes responding, valuing, and organizing ○ Discussion (One-on-One) ■ Facilitates discussion of personal, sensitive topics of interest or concern ★ Psychomotor Teaching Methods: ○ Demonstration ■ Provides presentation of procedures or skills by nurse; Encourages patient to model nurse's behaviour ■ Allows nurse to control questioning during demonstration ○ Practice ■ Enables patient to perform skills by using equipment in a controlled setting; Allows repetition ○ Return Demonstrations ■ Enables patient to perform skill as nurse observes; Provides excellent source of feedback and reinforcement ○ Independent Projects and Games ■ Require teaching method that promotes adaptation and initiation of psychomotor learning; Enable learner to use new skills ★ Teaching w/ G&D: ★ ★ ★ ★ More Tips: Having a Plan B when your initial education plan doesn’t work Learning requires the individual to: Think, feel, and do Get the client involved in goal setting (SMART goals) 4. Understand common features of learning ★ Impostor Syndrome: Individuals feeling inadequate in new learning environments. ○ “everyone else is smarter” → sol. reassure them it’s temporary ★ Emotionality: Emotional engagement is intrinsic to learning experiences, often marked by feelings of anxiety, relief, or grief, particularly when learning is perceived as threatening. Nurses should acknowledge and address these emotions to facilitate effective learning. ○ angry and frustrated → sol. spend time ★ Incremental Fluctuation: Natural in complex learning processes, where learners may momentarily regress before progressing. Recognizing and accepting this pattern can alleviate anxiety and frustration in both learners and educators. ○ overwhelmed → sol. reassure them that it’s natural ★ (bonus) Learning Climate: The contextual atmosphere impacting learning, including physical and psychosocial factors such as temperature, noise levels, equipment functionality, trust, and emotional safety. ★ What you teach the patient is a clinical judgment ★ Paying attention to the client as person ○ Are they motivated? ○ How much do they already know? ○ Are they able to learn? Barriers? ■ Hearing, language, cognitive? ○ Cognitive level? (growth and developments) ○ What do they WANT to learn? (needs and wants) ★ What are some topics that patients are interested in learning? ○ Health Maintenance and Promotion and Illness Prevention ○ Restoration of Health ○ Optimizing Quality of Life When Functions Are Impaired 5. Apply what you learn to a real-life case study ★ Slides >> https://eclass.srv.ualberta.ca/pluginfile.php/10554970/mod_resource/content/2/ Week%2011A%20%28MAR%2025%29%20Class%20slides.pdf Week 12A: Patient Education Part 2 and Educative Nursing Practice (April 5) Concepts: ● Patient Education ● Educative Nursing Practice Learning Objectives: 1. Develop learning objectives addressing the domains of learning ★ Domains of Learning: ○ Cognitive: All intellectual behaviors and requires thinking (patients with diabetes must learn how diabetes affects their bodies & how to control blood sugar for better health) ■ Focus: Deficient knowledge related to controlling blood sugar ■ Focus: Lack of recall and exposure to information related to how diabetes affects your physical health ○ Affective: expressions of feelings and acceptance of attitudes, opinions, and values (patients with diabetes must learn to accept the chronic nature of diabetes by learning positive coping mechanisms) ■ Focus: Anxiety related to having to administer multiple insulin injections ■ Focus: Fear related to remembering when to and how to give insulin injections ○ Psychomotor: acquiring skills through the integration of mental and muscular activity (patients with diabetes must learn to test their blood sugar at home) ■ Focus: At risk for ineffective therapeutic regimen management [twice daily insulin injections] related to not knowing how to inject medications ■ Focus: Ineffective therapeutic regimen management [twice daily insulin injections] related to fatigue and pain 2. Reflect on strategies to facilitate learning outcomes ★ Teach-back is an evidence-based approach used to ask patients to repeat in their own words what they need to know or do using a non-shaming approach ○ This approach ensures better adherence to self-care activities such as medication administration, diet modification, lifestyle changes, and management of clinical appointments ○ Allows clinicians to evaluate whether learning has occurred effectively ○ Minimizes the risk of patients misunderstanding critical information in the clinical setting ★ The Power of 3 uses adult learning theory concepts that encourage self directed learning, allowing patients to review the information when they are ready and at their own pace ○ Nurses initiate patient teaching using the Power of 3 tool upon admission, providing concise and consistent education throughout the hospitalization process without requiring additional time. This approach addresses common obstacles to effective patient teaching such as health literacy and language barriers ○ It employs a simple mnemonic alliteration with associated pictures to aid memory retention. The mnemonic alliterations are tailored to the patient's diagnosis and common reasons for readmission, helping patients remember key information related to their condition and treatment plan ■ For example, for patients undergoing open-heart surgery, the mnemonic focuses on preventing infection and heart failure with the actions "wash, weigh, walk," while for joint replacement patients, it emphasizes monitoring for signs of infection and venous thromboembolism with "monitor, medicine, mobility." ○ 3. Develop a teaching intervention for a specific client or group and incorporate appropriate teaching strategies (meet Mrs. S) 4. Explain the process of evaluation as demonstrated by the outcomes achieved by the learner (meet Mrs. S) Week 13A: Health Law (April 8) Concepts: ● Health Law Learning Objectives: 1. Describe the basic structure of the Canadian Legal System ★ Common Law [our focus]: A legal system used across Canada (except Quebec) based on judge-made law where cases are decided on precedents (prior court decisions with similar facts) ○ Common law evolves as decisions do … precedents (case law) ○ Courts apply laws passed by Parliament or provincial legislation (legislation > case law) ○ The common law is law that is not written down as legislation. Common law evolved into a system of rules based on precedent. This is a rule that guides judges in making later deci- sions in similar cases. The common law cannot be found in any code or body of legislation, but only in past decisions. At the same time, it is flexible. It adapts to changing circumstanc- es because judges can announce new legal doctrines or change old ones. ★ Superior Court (provincial) judges hear evidence from witnesses and make factual findings to apply laws. Jury trials are rare. Decision appeals? Must follow appellate court decisions* ★ Supreme Court of Canada judges ○ (a) hear appeals from provincial appellate courts* ○ (b) decide on gray areas & issues of national relevance [MAID Bill C14] 2. List examples of laws that govern health care ★ Federal: ○ Canada Health Act: Chapter 2 pages 32-33 ○ Charter of Rights and Freedoms Section 7 ■ “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice” ○ MAID – Bill C14 passage ★ Provincial: ○ EHR Chapter 25 https://www.albertahealthservices.ca/cis/Page17573.aspx#how [Connect Care Provider Portal] ○ Informed consent: Personal Directives Act and Adult Guardianship and Trustee Act (Slide 6) ○ Mental Health Laws: Mental Health Act https://www.albertahealthservices.ca/info/mha.aspx ★ Health care professionals via provincial regulatory bodies: 3. Explain what is required for consent to be valid ★ Informed consent CNA 2017: “Promoting and Respecting Informed DecisionMaking” … ‘doing’ examples ○ Provide information and in an open, accurate, understandable and transparent manner ○ Ensure that nursing care is provided with the person’s informed consent. ○ Recognize & support a capable person’s right to refuse or withdraw consent for care or treatment at any time ○ If incapable of consent, respect the law on capacity assessment and substitute decision-making ○ Along with other HCPs and substitute decision makers , consider and respect best interests of the patient and previously known wishes or advance care planning that applies in the situation ★ Elements of Consent: Patient must give consent before any medical intervention takes place. ○ (1) voluntarily ○ (2) with capacity ○ (3) in reference to an intervention [and thus to the intervening HCP] ○ (4) informed ★ InfoLAW: Consent for the Incapable Adult (InfoLAW: Consent for the Incapable Adult - Canadian Nurses Protective Society) ○ Who decides on an adult’s capacity or incapacity? ○ When an adult is deemed incapable, who makes decisions about their care and treatment?* ○ What if emergency treatment is required? ★ Nurse’s Role with Consent: ○ Invasive medical procedures: doctor’s obtain consent ■ Answering questions that the patient may have ■ Ensuring signed form on chart ■ Alerting the person who obtained the consent of more questions/lack of clarity or understanding ○ Invasive nursing procedures (i.e. injections, intravenous or nasogastric tube insertion) ■ Explain the procedure, obtain ‘implied’ or ‘verbal’ consent, and document ○ Unable to consent (InfoLAW) ■ Supported Decision Making/Guardian/Trustee? ■ Advanced Directive in place? 4. Demonstrate knowledge of basic legal process and concepts involved in a negligence lawsuit ★ Negligence ○ (1) the defendant health professional owes the plaintiff a duty of care [p. 63 & 75-76, Chapter 4] ○ (2) the defendant breached the standard of care [p. 85] ○ (3) the plaintiff suffered an injury or loss ○ (4) the defendant’s conduct was the actual/legal cause of injury or loss ■ Can it be proved that the patient would not have died, “but for” the long wait in the emergency room? ■ Whether ’but for’ the nurse’s failure to continuously monitor the FHR, the child would not have been born with Spastic Quadriplegia? 5. Describe the required elements of a negligence claim ★ Breaching the Standard of Care - Failing to: ○ (1) communicate in a timely fashion ○ (2) maintain proper records ○ (3) follow hospital policy ○ (4) intervene when there is a clear and obvious neglect or incompetence on the part of another health professional ★ Vicarious Liability: negligent acts done during course of employment – responsibility of nurse’s employer [physician or a hospital] to compensate ★ Reasons for Negligence Claims as a Nurse: ○ #1 Medication errors that result in injury to patient ○ IV therapy errors that result in infiltration or phlebitis ○ Burns caused by equipment, bathing, spills of hot liquid and foods ○ Falls resulting in injuries to patient ○ Failure to use aseptic technique as required ○ Errors in sponge, instrument or needle counts in surgical cases ○ Failure to give a report, or giving an incomplete report, to incoming shift of health care staff ○ Failure to monitor a patient’s condition adequately ○ Failure to notify a physician of a significant change in a patient’s status ○ Failure to properly delegate or supervise 6. Describe some steps for nurses to take to minimize legal risk in practice ★ Prescriber’s orders: MD is responsible for directing medical treatments ○ Obligated to follow UNLESS you believe in error, would harm patient, violate policy ○ Assess and clarify with MD; if persists, contact supervisor ○ Do not proceed if you believe it would harm patient ○ Document events and your reasons for not following the order ○ Supervisor should help resolve and a pharmacist can be consulted ○ ‘Three’ essential channels of nursing communication? nurse/physician ■ Nurse-Patient Communication ■ Nurse-Team Communication ■ Nurse-Physician Communication ★ Further Examples ○ https://cnps.ca/article/confidentiality-of-health-information/ ○ https://cnps.ca/article/medication-errors/ ○ https://cnps.ca/article/patient-restraints/ ★ Abandonment: walking out when staffing is short (← what NOT to do) ○ Bring to the attention of your nursing supervisor ○ Fill out a workload and staffing report to document concerns about patient safety as a form of written protest ○ Following through with delegation [https://cnps.ca/article/ask-a-lawyerdelegation-and-assignment-2/] ○ Know your institutions policies and procedures and the union’s collective agreement on how to handle such circumstances before they arise ★ Telephone Advice (← what NOT to do) ○ High risk activity – diagnosing over the phone is extremely difficult ○ Improper advice, inappropriate referral, failure to refer [most common allegations] ○ Follow policies and procedures ★ Things to consider as a Nursing Student ○ You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. Perform as a professional when rendering care. ■ Letting patients know you are a student nurse ■ Not performing tasks for which you are unprepared ■ Carefully supervised by the instructor for every new skill ○ Separate your student nurse role from your work as an unregulated care provider. ■ Not performing tasks you are not prepared to complete safely as a nurse’s aide or assistant ■ Not performing tasks that are not in your job description as nurse’s aide or assistant (just cause ur doing it in school doesn’t automatically mean you can do it at ur job) ● Malpractice → aware of the consequences but still choose to not following the guidelines (actively cousin harm) ● Negligence → do not follow the guidelines but are unaware of the consequences (ignorantly causing harm)