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Pup 4001 Sustaining Health

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Pup 4001 Sustaining Health

  1. 1. SUSTAINING HEALTH AND WELL-BEING Determining Care through Ideologies, Policy and Practice in order to sustain health and well being
  2. 2. The Role of the Nurse • To identify a client's health status, actual or potential health care problems or needs • To establish plans to meet the identified needs, • To deliver specific nursing interventions to meet those needs. • The role of the Nurse is currently shaped by the NMC competencies demanding professional behaviour to safeguard patients with the aim to deliver care that promotes health and wellbeing • The first stage of any care is based on Assessment • Scenario Therefore what does the role of the nurse require to carry out a comprehensive assessment?
  3. 3. Revealing through critical analysis the role of the nurse and the profession • Thus we are interested in how nursing relate to the philosophical understanding of scientific method, epistemology and the search for truth…….therefore encouraging you to ask searching questions about the development of practices such as how far they provide more adequate truths or epistomologies as a means to improve health….
  4. 4. Nurse Assessment • The nursing process is a series of organized steps designed for nurses to provide excellent care. • The five phases, include assessing, diagnosing, planning, implementing, and evaluating. • Purpose of Nursing Process is to determine the potential, actual and percieved problems • Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status.
  5. 5. Nursing Process • Is the systematic and continuous collection, organisation, validation and documentation of information • Cornerstone for individualised care • Provides a baseline of the “Normal”
  6. 6. RCN (2015) • “The nursing process is described as being cyclical, made up of four interconnecting elements and having a dynamic nature (Pearson et al, 1996). It has long been a feature of nursing care in the UK and when used in conjunction with a nursing model it facilitates consistent, evidenced-based nursing care, and necessitates accurate, up-to-date care documentation. The nursing process consists of four distinct phases, each having a discreet role in the process, whilst also being interdependent upon each other. The phases of the process are” (RCN 2015) • http://www2.rcn.org.uk/development/learning/transcultural_heal th/transcultural/adulthealth/sectionthree •
  7. 7. Assessment • To determine the needs of the patients through determining the Health Status/Position of the patient. • Deficit Model • Determine the Health Need • Health needs (Wright et al 1998) • incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education, employment. This wider definition allows us to look beyond the confines of the medical model based on health services, to the wider influences on health (box). •
  8. 8. Previous LO1 • Biomedicine: Dominant Paradigm • Coined by R.D. Laing (1971) • So illness is due to dysfunction in the individual • Cartesian Dualism (Body Mind split) • Its critique Ivan Illich 1974 • Medical Iatrogenisis • Therapeutic Nihilism
  9. 9. Andrews and Boyle (2008) • The first is determinism which states that a cause and effect relationships exists for all natural phenomena • The second relates to life to the structure and function of machines which is possible to control life processes through mechanical, genetic and other engineered interventions. • The third is reductionism according to which all life can be reduced or divided into smaller parts; study of these isolated parts is thought to reveal aspects/properties of the whole
  10. 10. Biomedical Model • Biomedical model guides nurses to perceive an individual as a physicochemical machine or a disease diagnosis where emphasis is on body’s structure and malfunction. • Mind and body separation was not suitable with holistic nursing philosophy. • As a result, nurses ignored patient’s individual characteristics and needs and limited themselves in the frame of treatment. • Practicing with biomedical model leaded nurses to uncertainty between treatment and care, where nurses would decide on whether to be dependent to physicians or be independent from physicians.
  11. 11. Biomedicine • Biomedical model, as a traditional model where the nursing practice has been based, is important for its contributions in the past. However, it is a widespread idea within the nurses that this model is not suitable to provide a base for nursing practice. For a different nursing care, existence of various alternatives is very crucial
  12. 12. Traditional: George Castledine (2005) • The difference between nursing and medicine has often been expressed as the nurse ‘cares’ and the doctor ‘cures’. • Some observers would see it as a difference between models of health care, or the way each profession approaches the patient. • The predominant model used by doctors in the UK is a biomedical one, emphasizing diagnosis and treatment based on scientific evidence. It is important to acknowledge, however, that there are those doctors who reject this approach and use a much more holistic and alternative Eastern model. • There is a great deal of evidence to suggest that the biomedical model has, and continues to be, the model on which many nurses base their practice. Research studies in nursing have frequently reported nurses viewing their patients as physical beings with medical problems to solve, rather than nursing and healing patients’ wider personal and individual problems.
  13. 13. Traditional • WHO (2000) states that traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures whether explicated or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
  14. 14. Changing Perspectives • The role of sociology in nursing continues to cast new light on many aspects of health and illness. • Over the last 20 years, nursing practice has seen sociological theory become a valuable clinical tool, both in the diagnosis and prognosis of a wide range of illnesses and long-term conditions. Lifestyles, Environment, Economics • Nevertheless, of these, the sociological examination of mental health problems and its impact upon nursing practitioners has received little coverage, simply because, as a discipline, mental health nursing has historically been wedded to a biomedical model, one which continues to embrace psychiatry/psychology as the driving force in the diagnosis and treatment of psychopathology.
  15. 15. Holistic Paradigm • The force of nature itself must be kept in natural balance or harmony disturbance causes imbalance • George Bateson’s double blind bind theory of schizophrenia focuses on environmental causes rather than physical brain dysfunction
  16. 16. Transcultural Concepts in Nursing Care Andrews and Boyle (2008) • Health and illness states are strongly influenced by culture • 1950’s Dr Madelerine Leininger • Florence Nightingale emphasised nursing’s control of the environment so that patients could heal naturally ( was viewed as holistic)
  17. 17. Folk Lore:Common Sense • It is defined by McClean (2010) as stories customs and beliefs in a culture that are unwritten and passed down orally from generation • Nursing: shares and preserves a common body of stories, practices and beliefs and rights of passage that are not shared or known by non nurses • Traditions, Rituals, Practices handed down from previous generations of nursing (Field) Customs of Nursing Practice • Can become “Common sense” views that are based upon understandings within an expert nurse paradigm
  18. 18. Bio-psycholosocial Nassir Ghaemi (2009) • Attributes disease causation or disease outcome to the interaction of biological factors, genetics, biochemistry, social and psychological factors • Conceptual status quo devolved into mere eclecticism
  19. 19. Conclusion • “We have made incredible advances in nursing science. However, many of our practice remain focused on procedures, principles underlying our procedures, and medical science.” • We have built care on nursing conceptual frameworks/theories, only to return to medical models that match the medically dominated clinical environments. • But, is there a major shift is underway?
  20. 20. Consider • Nursing is a microcosm of society it mirrors the biases and prejudices found in the larger social order • Is it realistic to expect respecting socio political economic factors can reverse all inequalities • It is realistic to expect more definitional conceptual and theoretical clarity as well as expect nursing to become increasingly active in influencing the political economic and social policy agenda at various levels
  21. 21. Learning Outcome 4 • Relating to your field of practice construct a critical evaluation of the current socio political and cultural context of public health and social policy…. • 30mins to list as many policies that shape your practice in order to shape the health of your patient (Scenario)
  22. 22. Public Health • The concept that nurses care for the sick and infirm is contested as the focus is on sustaining health and well being • Bio medical model– the absence of illness and disease • WHO aim is to improve global health (using health determinants and health indicators)
  23. 23. Sustaining Health or Curing Disease? • Introducing Prevention • Epidemiology John Snow • Broad Street Pump • 1999 Project 2000 was introduced • 16 Years of learning how to sustain health • Public Health and Health Promotion 20 years young!
  24. 24. Helping people make healthy choices! • Ottowa Charter - a process of enabling people to exert control over, and to improve their health. • Done with and for not on or to people • Changing and improving health status • Empowering
  25. 25. Lalonde Report (1974) • “Health is maintained and improved not only through the advancement and application of health science but also through the efforts and intelligent lifestyle choices of the individual and society”
  26. 26. Yet another role added….. • Lifestyle behaviours causes illness and disease • Public Domain v Private Domain • Assessment to determine health risks • Preventing disease • Advising educating to enable self control!! • Modifying behaviours
  27. 27. Scenario: • Review the scenario • Sustaining the health of the Evie/Julie/Jacob/ • Self Imposed risk behaviours • What is she/he entitled to? Support • How is she/he protected? Law • Family centred care? Others
  28. 28. Feedback • Core policy: Inequalities addressed • MH • LD • Adult • Child

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