Health Promotion I

Session 1: Canadian Fundamentals (Chapters 1 )

Key Concepts :
• Nursing has responded to the healthcare needs of society, influenced over time by economic,
social, and cultural factors.
• Nursing in Canada is rooted in the traditions of nursing that developed in New France.
• Florence Nightingale revolutionized nursing as an acceptable profession for women as lay
nurses in the late 1800s and early 1900s.
• The development of a system of nursing education in Canada emerged from the early nursing
sisterhoods and from schools of nursing associated with hospitals.
• Baccalaureate entry-to-practice was fully implemented in English-speaking Canada.
• Basic nursing education is acquired in college, collaborative college-university, or university
programs.
• The ranks of the profession are moving toward gender balance and increased diversity that
reflects the Canadian population.

End of the chapter questions:

1. The founder of modern nursing is

1. Hippocrates

2. Florence Nightingale

3. Jeanne Mance

4. Mary Agnes Snively

2. The earliest role of nurses involved

1. Caring for the sick at home

2. Using herbal remedies to relieve symptoms

3. Caring for the sick in hospitals

4. Supervising nursing students

3. The religious roots of nursing in Canada can be seen in the development of:
1. The ICN

2. The VON

3. The code of ethics

4. BETP

4. The following characteristic of nursing in Canada today can be traced back to

Nightingale:

1. The high percentage of men in nursing

2. The apprenticeship model

3. Public health education

4. Nursing as a highly regarded profession

5. Minimum standards for nursing education are set by:

1. The nursing school

2. The provincial regulators and associations

3. The Canadian Nurses Association

4. The Canadian Nurses Federation

Answers:
1. 2
2. 2
3. 3
4. 4
5. 2

Chapter 2

Facts About Nursing in Canada, 2016

• For RNs, 63.3% practised in the hospital sector; 8.1% in long-term care; 15.7% in community
and home care; and 13% in other settings.
• For LPNs, 47.2% practised in hospitals; 12.8% in the community; 31.9% in long-term care; and
8.1% in other settings.
• For RPNs, 44.7% worked in the hospital; 30.7% in the community; and 13.5% in nursing
homes and long-term care.
• For RNs, in 2015, 48% were degree prepared.
• Foreign-graduate representation in the regulated nursing workforce included 8.9% of RNs,
5.1% of LPNs, and 7.2% of RPNs.
• 17 947 RNs obtained CNA certification in 1 of 20 specialty areas.
• In 2015, the ratio of regulated nurses employed in Canada was one RN for every 119 persons
and one LPN for every 347 persons.
• The ratio of NPs employed in Canada was one NP for every 1 020 433 persons (9.8 per 100
000).
• By gender, for RNs and NPs, 92.4% were female and 7.6% were male; for LPNs, 91% were
female and 9% were male.
• Average age of RNs was 44.6 years; for LPNs, it was 41, and for RPNs, it was 46.
• For RNs, 25.5% were aged 55 years or older, 13.5% were aged 60 years or older, and 1.2%
were aged 65 years or older. For LPNs, 17.1% were aged 55 or older, and 7.9% were aged 60
or older.
• 9 out of 10 Canadian graduates either remain in or return to the jurisdiction of graduation to
practise, a continuous pattern since 2006.

Key Concepts:

• Medicare is a key component of Canada's social safety net.

• All levels of government play a major role in co-funding national health insurance and setting
health care policies in accordance with the Canada Health Act.
• The Canada Health Act forbids extra-billing and user fees while articulating the five principles
of public administration, comprehensiveness, universality, portability, and accessibility.
• Health care services are provided in institutional, community, and home settings; across all
age groups; and for individual, family, group, and community populations.
• Five levels of health care are promotive, preventive, curative, rehabilitative, and supportive.
• Escalating costs, technological innovations, and consumer expectations challenge the
healthcare system in efforts to deliver innovative, efficient, and quality care.
• Equality, equity, access, interdisciplinary approaches, communication, and continuity of care
challenge the healthcare system.
• The primacy of PHC and home care align with the reforming health care environment and
cost-effectiveness.
• Successful health promotion and disease prevention programs help patients acquire healthier
lifestyles and achieve an optimal quality of life.
• Sufficient, diverse, and qualified human health resources are essential for a culturally
competent workforce attending to a culturally safe Canadian healthcare system.
• Enhancing the health of Canada's Indigenous peoples is a significant challenge to society and
to the health care system.
• Nurses must continually seek out information and evidence to remain responsive to providing
quality, culturally competent, and safe care.
End of the chapter questions:

1. A nurse working in a new position in policy development has been asked to identify
agencies in Canada that have undertaken an effort to reduce wait times, reduce
duplication of tests, and support coordination of care. Which of the following agencies
would you expect to be on the list? (Select all that apply.)

1. Canada eHealth

2. Canadian Institute for Health Information

3. Canada Health Infoway

4. Canadian Institutes for Health Research

5. Consumer Association of Canada

2. Which of the following people fall outside the Canada Health Act? (Select all that
apply.)

1. Indigenous peoples

2. RCMP members

3. Recently arrived newcomers

4. Members of military services

5. Persons in transit between provinces

3. A nursing student is discussing public health with her preceptor and asks about the
main focus of public health. The mentor responds that public health primarily focuses
on:

1. Reporting

2. Promotion

3. Intervention

4. Institutionalization

5. Immunization
4. The Canada Health Act embraces which of the following five principles:

1. Social justice, equity, acceptability, efficiency, effectiveness

2. Accountability, equality, economy, collaboration, coordination

3. Insured health services, provider compensation, hospital services, community care, and
pharmaceuticals

4. Public administration, comprehensiveness, universality, portability, accessibility

5. At the clinic, the nurse sees a middle-aged woman who is nearing exhaustion caring
for her aging mother, who is experiencing dementia. As the nurse opens the dialogue on
potential placements for her mother, it is obvious that there is a lack of understanding
about the existence of community agencies such as _____________________, which
might provide an alternative for this family.

1. Home care

2. Palliative care

3. Hospital care

4. Ambulatory care

5. Adult day support

6. A nurse practitioner is establishing an interprofessional team to work with pregnant

newcomer women, focusing on nutrition. In addition to the nurse, the three most critical
members of the team at this early stage will include: (Select all that apply.)

1. Obstetrics specialist

2. Dietitian

3. Pharmacist

4. Social worker

5. Translator
7. A nurse practitioner who is working in a northern remote community notes a trend
toward depression and anxiety among a subset of the population in the 40–60 age group
who were residential school survivors. A culturally competent strategy to work with this
group might be to:

1. Provide individual counselling on a case-by-case basis to protect confidentiality.

2. Offer a weekly peer support program.

3. Work with the elder and chief of the community to determine a way forward.

4. Consult with a psychologist or psychiatrist before undertaking any programming to affirm risks
and potential barriers.

8. Management has requested a brief report from the nurse manager on a human
resources plan for the next 5 years. Which of the following statements best represents
the factors that should be mentioned?

1. We should be working with our aging nurses to transition out of full-time work and let younger
nurses be mentored into their vacated positions.

2. With all the workplace injuries, we should be hiring an occupational therapist or there will
soon be no nurses working.

3. We will soon be able to replace nurses with robots and technology, so that is where we
should be investing.

4. We are not educating enough nurses, so we may have to recruit from international pools to fill
positions.

5. There are too many variables to be able to predict what will be needed in 5 years, so the best
we can do is try to keep the nurses we have.

9. A nurse organizes a blood pressure screening program as a ______________ strategy.

1. Primary level

2. Secondary level

3. Tertiary level

4. Rehabilitative level
10. Primary care can only be provided by a physician or in a hospital setting.

1. True

2. False

Answers:
1. 2, 3, 4
2. 1, 2
3. 2
4. 4
5. 5
6. 2, 4, 5
7. 3
8. 1
9. 2
10. 2

Health Promotion Chapter 1: (Summary)

● The ways individuals define health and health problems are important because
definitions influence attempts to improve health and care delivery. In the case study,
Frank Thompson’s health was affected by obvious, immediate, and personal factors,
such as his diet and employment pressures. Nevertheless, his problems had their roots
in the social and economic conditions of his parents; in his own early history of illness,
education, and work; and in his and his family’s hopes and aspirations. His physician
defined Frank’s problem in immediate biomedical terms. Public health planners, who
saw Frank’s problem on a longer-term population basis, sought policy solutions to the
problem of preventing cardiovascular disease.
● The view taken in this text is that a broad and longer-term perspective of health is the
best guide to promoting health more effectively, even as nurses deal with individual
problems on a daily basis. Health is a sustainable balance between internal and external
forces. Health allows people to move through life free from the constraints of illness and
promotes healing.

● Illness represents an imbalance that human choices (inter- twined social, political,
spiritual, professional, and personal choices) create. In the United States, communities
may still have time to reduce the onslaught of chronic disability and shift the direction,
slow the pace, and humanize the scope of economic and social life.
● Shifting directions in today’s health care patterns may be possible only when nurses and
other health professionals do what is expected of them as leaders in the care of health:
to work with others through open processes; to provide leadership in finding the vision
and the path; and to inform, educate, and reeducate themselves, their colleagues, the
 media, and the general public using research findings and evidence-based practice
methods.
● The responsibility of nurses as health professionals today is to see the health problem in
new ways and help others to do the same. Responsibility means developing new roles
and examining the problem through others’ viewpoints, including those of individuals, the
public, other professionals, and other nations. Responsibility also means evaluating the
social and individual consequences, the long-term and short-term effects, and the public
and private interests that are involved when one is deciding on the set of tools to use in
the care of health.

Sessions 2 & 3

Unit 5:

● Growth is the quantitative, or measurable, aspect of an individual's increase in physical

measurements.
● Development is a progressive and continuous process of change leading to increased
skill and capacity to function.

Factors Influencing Growth and Development:

● Heredity
● Temperament
● Family
● Peer Group
● Health Environment
● Nutrition
● Rest, sleep and exercise
● Living Environment
● Political and Policy Environment
● Life experiences
● Prenatal Health
● State of health

A theory is an organized, often observable, logical set of statements about a subject.

Mechanisms of development are the explanatory components of each theory, or the means by
which the developmental tasks are achieved.

Organicism refers to a theoretical focus on the organism itself.

Biophysical developmental theories describe and explain how the physical body grows and
changes.
Maturation is the biological internal regulatory mechanism that governs the emergence of all
new skills and abilities that appear with advancing age (Crandell et al., 2012).

Differentiation is the process by which cells and structures become modified and refine their
characteristics.

Temperament is a physical and emotional response style that affects a child's interactions with
others (Hockenberry & Wilson, 2015).

The easy child is easygoing and even-tempered, regular and predictable in his or her habits,
and open-minded, flexible and adaptable to change. Mood expressions are mild to moderately
intense and typically positive.

The difficult child is highly active, irritable, and irregular in habits. Negativity in interactions
and withdrawal from other people is typical, and the child requires a highly structured
environment. He or she adapts slowly to new routines, new people, or new situations. Mood
expressions are usually intense and primarily negative.

The slow-to-warm-up child typically reacts negatively and with mild intensity to new stimuli. He
or she adapts slowly with repeated contact unless pressured and responds with mild but
passive resistance to novelty or changes in routine.

Cognitive developmental theories focus on reasoning and thinking processes, including the
changes in how people perform intellectual operations. These operations are related to the
ways people learn to understand the world in which they live. Mental processes, including
perceiving, reasoning, remembering, and believing, affect certain types of emotional behaviour.
For example, a typical child will have a different emotional reaction to the death of a
grandparent than to the death of an older sibling or a parent.

Piaget’s theory of cognitive development:

Piaget's theory of cognitive development addresses the development of children's intellectual

organization and how they think, reason, perceive, and make meaning of the physical world.

Includes 4 theories:

Period 1: Sensorimotor (birth to 2 years of age):

The infant develops the schema or action pattern for dealing with the environment (Berk, 2013;
Piaget, 2000). These schemas may include mouthing, looking, vocalizing, grasping, or hitting
(Figure 21-1). Schemas become self-initiated activities; for example, the infant who learns that
mouthing or sucking achieves a pleasing result generalizes the action to suck fingers, blanket,
or clothing. Successful achievement leads to greater exploration. In the second year, children
are able to form primitive mental images as they acquire object permanence. Before this, they
do not realize that objects out of sight exist. When a 6-month-old is shown a toy before it is
hidden, he or she will not search for it. At 18 months, the child can understand that even if it
cannot be seen, it still exists and will search for it.

Period 2: Preoperational (2 to 7 years of age)

Children learn to think with the use of symbols and mental images. Still egocentric, the child
sees objects and people from only one point of view: the child's own. Play is the initial method of
nonlanguage use of symbols. This is a time of parallel play. Parallel play can be observed as
children engage in activities side by side without a common goal. Imitation and make-believe
play are ways to represent experience (Berk, 2013; Piaget, 2000). Later, language develops and
broadens possibilities for thinking about the past or the future. Children can now communicate
about events with others. As the language fits into a logical form, it mirrors the thinking process
at the time.

Period 3: Concrete operations (7 to 11 years of age)

Children achieve the ability to perform mental operations. For example, the child can think about
an action that before was performed physically. At the earlier stage, the child could count to 10,
but at this stage, he or she can count and understand what each number represents. Children
can describe a process without actually performing it. At this stage, they are able to coordinate
two perspectives. In other words, they can appreciate the difference between their perspective
and that of a friend. Reversibility is the primary characteristic of concrete operational thought.
Children can mentally reverse the direction of their thoughts. Children can mentally classify
objects according to their quantitative dimensions, known as seriation. Another major
accomplishment of this stage is conservation, or the ability to see objects or quantities as
remaining the same despite a change in their physical appearance (Berk, 2013; Piaget, 2000).
Children can begin to cooperate and share with new information about the acts they perform.

Period 4: Formal operations (11 years to adulthood)

The individual's thinking moves to abstract and theoretical subjects. Thinking can venture into
such subjects as achieving world peace, finding justice, and seeking meaning in life.
Adolescents can organize their thoughts in their minds. They have the capacity to reason with
regard to possibilities. New cognitive powers allow the adolescent to achieve more far-reaching
problem-solving. This thinking matures, and the depth of understanding increases with
experience.

Piaget's theory of moral development presents three stages of morality:

● The premoral stage: The child feels no obligation to follow rules.
● The conventional stage: children follow the rules set up by people in authority, such as
their parents, teachers, clergy, or police.
● The autonomous stage: moral judgements are based on mutual respect for the rules.
******Piaget believed that children initially follow the rules without understanding them. Children
see these rules as fixed and handed down by adults or by a higher authority (e.g., God) and
therefore think they cannot change them.

Assimilation is the process of making sense of new information in comparison with what is
already known.

Accommodation is the process of adapting ways of thinking to a new experience or new

information. Together, these processes reflect adaptation to new information or experience.

Moral developmental theories are a subset of cognitive theory and describe the development
of moral reasoning.

Moral reasoning is how people think about the rules of ethical or moral conduct, but it does not
predict what a person would actually do in a given situation.

Moral development is the ability of an individual to distinguish right from wrong and to develop
ethical values on which to base his or her actions.

Kohlberg’s Theory of moral development:

Kohlberg found a link between moral development and Piaget's cognitive development theory.
He theorized that a child's moral development does not advance if the child's cognitive
development does not also mature.

In this way, Kohlberg's theory of moral development follows Piaget's cognitive developmental
theory. According to Kohlberg, levels and stages do not occur at specific ages, and people attain
different levels of moral development.

Level I: Preconventional level

The person reflects on moral reasoning 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.

Stage 1: Punishment and obedience orientation

Response to a moral dilemma is in terms of absolute obedience to authority and rules.

Avoidance of punishment or unquestioning deference to authority is characteristic behaviour.
The child will do something because an authority figure tells him or her to do it.
Stage 2: Instrumental relativist orientation
The person recognizes that more than one view may be correct. The decision to do something
morally correct is based on satisfying one's own needs and occasionally the needs of others.

Level II: Conventional level

The person sees moral reasoning based on his or her own 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. Moral decision-making at this level moves from “What's in it for me?” to “How will it affect
my relationships with others?”

Stage 3: Good boy–nice girl orientation

The individual wants to please others and win approval by “being nice,” which means having
good motives, showing concern for others, and keeping mutual relationships through trust,
loyalty, respect, and gratitude.

Stage 4: Society-maintaining orientation

Focus expands from relationships with others to societal concerns. Correct behaviour is doing
one's duty, showing respect for authority, and maintaining the social order. Adolescents in this
stage may choose not to attend a party at which drugs will be used, not because they are afraid
of getting caught but because they know that using drugs is not healthy.

Level III: Postconventional level

The person finds a 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.

Stage 5: Social contract orientation

An individual follows the laws but recognizes the possibility of changing the law to improve
society. The individual also recognizes that different social groups may have different values but
believe in basic rights, such as liberty and life.

Stage 6: Universal ethical principle orientation “Right” is defined by the decision of

conscience in accord with self-chosen ethical principles. These principles, such as the Golden
Rule, are abstract and appeal to logical comprehensiveness, universality, and consistency
(Kohlberg, 1981). Whereas stage 5 emphasizes basic rights and the democratic process, stage
6 defines the principles by which agreements will be most just.
Separation refers to the boy's recognition of biological distinctness and is based on his
emergence from a dependent relationship with his mother.

Individuation is based on the child's awareness of differences in will, viewpoint, and needs.

Theories in the psychoanalytic and psychosocial traditions describe the development of

personality, thinking, behaviour, and emotions. This development is thought to occur with
varying degrees of influence from internal biological forces and external societal and cultural
forces.

Erikson’s Theory of Eight Stages of Life:

1. Trust versus mistrust (infancy: birth to age 1 year)

The infant learns to trust others. Trust is achieved when the infant will let the caregiver out of
sight without undue distress. Key to this stage is consistent caregiving. The question answered
at this stage is “Can I trust the world?”

2. Autonomy versus a sense of shame and doubt (toddler years: ages 1–3 years)

The toddler learns to be independent and develops self-confidence.

Not learning independence creates feelings of shame and self-doubt. Independence is

accomplished through self-care activities, including walking, feeding, and toileting. Toddlers also
develop autonomy by making choices. The question answered at this stage is “Can I control my
own behaviour?”

3. Initiative versus guilt (preschool years: ages 3–6 years)

The child learns to initiate his or her activities. Accomplishing this task teaches the child to seek
challenges in later life.

Children use fantasy and imagination to explore their environment. Conflicts often arise between
the child's desire to explore and the limits placed on his or her behaviour.

These conflicts may lead to feelings of frustration and guilt. The question answered during this
stage is “Can I become independent of my parents and explore my limits?”

4. Industry versus inferiority (middle childhood: ages 6–11 years)

The child develops a sense of competence in physical, cognitive, and social areas. Not learning
new skills may lead to a sense of inadequacy and inferiority. Successfully achieving this task
leads to positive attitudes toward work in adulthood (Erikson, 1993). The question answered at
this stage is “Can I master the skills necessary to survive and adapt?”
5. Identity versus role confusion (adolescence: ages 12–18 years)

The task of adolescence is to try out several roles and form a unique identity. Dramatic
physiological changes associated with sexual maturation also mark this stage. Acquiring a
sense of identity is essential for making later adult decisions such as vocation or marriage
partner. New social demands, opportunities, and conflicts arise in relation to the emergent
identity and separation from family. The question answered at this stage is “Who am I, and what
are my beliefs, feelings, and attitudes?”

6. Intimacy versus isolation (young adulthood: ages 18–35 years)

The primary task of young adulthood is to form close, personal relationships. This is the time to
become fully active in the community. If young adults have not achieved a sense of personal
identity, they may be unable to form meaningful attachments, and they experience feelings of
isolation. The question answered during this stage is “Can I give of myself fully to another?”
Understand that during hospitalization, young adults may benefit from the support of their
partners or significant others because this support helps fulfill their need for intimacy.

7. Generativity versus self-absorption and stagnation (middle adulthood: ages 35–65

years)

The task of middle adulthood is to help younger people.

The ability to expand one's personal and social involvement is crucial for this stage of
development. Middle-aged adults should be able to see beyond their needs and
accomplishments and view the needs of society. Dissatisfaction with one's achievements often
leads to self-absorption and stagnation.

The question answered during this stage is “What can I offer succeeding generations?”

8. Integrity versus despair (old age: age 65 years and older)

Older persons reflect on their life and feel satisfaction or disappointment. By suffering physical
and social losses, such as those through retirement or illness, the person may also suffer loss of
status and function. The person may also have internal struggles, such as the search for
meaning in life. Meeting these challenges creates the potential for growth and wisdom (Figure
21-2). The question answered during this stage is “Has my life been worthwhile?”
Key Concepts:

• Nurses provide care for individuals and families throughout their lives. Developmental theories
provide a basis for nurses to assess, interpret, and understand the responses seen in their
patients.
• Development continues throughout life.
• Individuals have unique patterns of growth and development within broad limits.
• Development is not just a series of distinct linear tasks; it is also a process that varies across
and within individuals.
• Three major categories of factors influence human growth and development: (1) genetic or
natural forces within the person, (2) the environment in which the person lives, and (3) the
interaction that takes place between these two.
• Theories within the organic tradition explore how individuals develop when mostly biological
components are believed to stimulate developmental progress.
• Theories in the psychoanalytic and psychosocial tradition describe the development of the
human personality with regard to conflict resolution between the internal biological forces and
the external societal and cultural forces.
• According to the mechanistic approach, human development and behaviour are responses to
environmental forces rather than driven by internal causes such as maturation.
• Within the contextual tradition, the individual and the environment are viewed as mutually
influential, acting on one another in dynamic interaction.
• In the dialectical tradition, the complete complexity of development is acknowledged. Theorists
who work in this tradition strive to combine divergent ways of viewing human development.

End of chapter questions:

1. Children generally double their birth weight by 5 months of age. This is an example of

1. Development

2. Heredity

3. State of health

4. Physical growth

2. _________ development is the ability of an individual to distinguish right from wrong and to
develop ethical values on which to base his or her actions.

1. Moral

2. Cognitive

3. Psychosocial
4. Psychoanalytic

3. Theories in the _________ tradition hold that development is a result of biology and
adaptation.

1. Organicism

2. Psychoanalytic and psychosocial

3. Contexualism

4. Dialecticism

4. Which of the following factors is considered an environmental factor that affects human
development?

1. Family

2. Heredity

3. State of health

4. Genetics

5. The developmental theorist who believed his or her research described a sequential process
that resolved conflict between the internal life (personality) of adults and their outer world
(culture) was

1. Erikson

2. Crittenden

3. Freud

4. Havighurst

6. The zone of proximal development is

1. The space between the individual's potential and his or her actual developmental status

2. Where sensitive caregivers should operate to promote development of their young children

3. A concept described by Vygotsky

4. All of the above

7. According to Piaget's theory of cognitive development, during what stage does the individual's
moral thinking move to abstract and theoretical subjects, such as achieving world peace, finding
justice, and seeking meaning in life?

1. Formal operations

2. Concrete operations

3. Sensorimotor

4. Preoperational

8. The nurse who is working with a school committee to develop playground safety guidelines is
focusing on which level of the bioecological model?

1. Mesosystem

2. Microsystem

3. Exosystem

4. Macrosystem

9. Which of the following nursing interventions is representative of a population health

approach?

1. Parent teaching

2. Developing a clinical practice guideline

3. Participating in a community coalition to improve community housing

4. Assisting an individual in obtaining funding support for home care

10. A resilient individual is able to experience positive development despite challenging life
circumstances. For a young single mother with two young children, access to high-quality day
care represents the following:

1. A vulnerability process

2. A critical period
3. Attachment

4. A protective process

Answers:
1. 4
2. 1
3. 1
4. 1
5. 4
6. 4
7. 1
8. 2
9. 3
10. 4

Part 3 of Unit 5:

• Nurses provide care for individuals and families throughout their lives. Developmental theories
provide a basis for nurses to assess, interpret, and understand the responses seen in their
patients.
• Development continues throughout life.
• Individuals have unique patterns of growth and development within broad limits.
• Development is not just a series of distinct linear tasks; it is also a process that varies across
and within individuals.
• Three major categories of factors influence human growth and development: (1) genetic or
natural forces within the person, (2) the environment in which the person lives, and (3) the
interaction that takes place between these two.
• Theories within the organic tradition explore how individuals develop when mostly biological
components are believed to stimulate developmental progress.
• Theories in the psychoanalytic and psychosocial tradition describe the development of the
human personality with regard to conflict resolution between the internal biological forces and
the external societal and cultural forces.
• According to the mechanistic approach, human development and behaviour are responses to
environmental forces rather than driven by internal causes such as maturation.
• Within the contextual tradition, the individual and the environment are viewed as mutually
influential, acting on one another in dynamic interaction.
• In the dialectical tradition, the complete complexity of development is acknowledged. Theorists
who work in this tradition strive to combine divergent ways of viewing human development.
End of chapter questions:

1. The nurse is assessing a 48-year-old patient with a history of coronary heart disease,
osteoarthritis, and obstructive sleep apnea. The nurse suspects the patient is obese,
based on which of the following assessment findings? (Select all that apply.)

1. Fasting blood glucose level of 9 mmol/L

2. Fasting blood glucose level of 5 mmol/L

3. Body mass index (BMI) of 33 kg/m2

4. BMI of 28 kg/m2

5. Blood pressure of 125/85 mmHg

6. Blood pressure of 145/90 mmHg

2. The nurse knows that young adults usually have good health and directs health care
education in this population toward activities related to:

1. Health promotion

2. Primary prevention

3. Secondary prevention

4. Tertiary prevention

3. When planning the prescribed course of therapy, the nurse considers which of the
following factors that may affect the individual's adherence with the regimen? (Select all
that apply.)

1. Gender

2. Lifestyle

3. Sexuality

4. Education level
5. Health literacy

6. Motivation and desire to learn

4. The nurse caring for a patient in the second trimester of pregnancy instructs the
patient to expect which common physiological change?

1. Morning sickness

2. Amenorrhea

3. Increased colostrum

4. Quickening

5. The nurse knows that firearm injuries are a major health concern in Canada. When
caring for patients with firearm injuries, the nurse is aware that in Canada:

1. Approximately 80% of firearm-related injuries are the result of criminal activity.

2. Approximately 20% of firearm-related injuries are the result of criminal activity.

3. Approximately 50% of suicides are carried out with firearms.

4. Approximately 20% of suicides are carried out with firearms.

6. The nurse is developing a smoking reduction and cessation intervention with

HIV-positive gay men. Which action demonstrates the use of cultural safety?

1. The nurse invites several HIV-positive gay men to participate in intervention development to
overcome stigma and power imbalances these men experience in the health care system.

2. The nurse collaborates with the Medical Health Officer of the local health district to develop
the intervention.

3. The nurse engages with families of HIV-positive gay men to develop the smoking reduction
and cessation intervention.

4. The nurse acknowledges that HIV-positive gay men have unique cultural traditions and works
to implement a standardized smoking reduction and cessation intervention.

7. A patient's father and paternal grandfather had myocardial infarctions (heart attacks)
in their 50s. Therefore, the patient is at risk for a future myocardial infarction. The patient
faces what type of health risk?
1. Lifestyle

2. Poor personal hygiene

3. Family history

4. Hereditary disease

8. A nurse is evaluating the effectiveness of health teaching about human lactation to the
parents of a newborn. Which statement demonstrates that the family has increased
health literacy?

1. Parents teach back how to care for their breastfeeding newborn and describe where to find
information about care and when they should contact a health care provider with concerns.

2. Parents listen to the nurse describe how to care for their breastfeeding newborn and thank
the nurse for sharing this knowledge with them.

3. Parents teach back how to care for their breastfeeding newborn and are actively engaged in
learning about the care of their newborn.

4. Parents listen to the nurse and describe how to care for their breastfeeding newborn and
report that they do not understand what the nurse has taught them.

9. A nurse is teaching a transmasculine patient about infant feeding options. Which

statement demonstrates that the nurse is providing culturally safe care?

1. I am here to teach you about lactation and infant feeding practices, including chestfeeding.
How do you prefer I address you?

2. Hi Jonah, I am here to teach you about lactation and breastfeeding your newborn.

3. I refuse to provide care to transmasculine persons because it is against my philosophical and

religious beliefs.

4. I am here to teach you about lactation and infant feeding practices. I encourage you to
formula-feed your newborn.

10. To help recondition the patient's response to stress, the nurse can use: (Select all
that apply):

1. Biofeedback
2. Imagery

3. Medication

4. Time management strategies

5. Relaxation techniques

6. Assertiveness training

Answers:
1. 1, 3, 6
2. 1
3. 1, 2, 4, 5, 6
4. 4
5. 2
6. 1
7. 3
8. 1
9. 1
10. 1, 2, 5

Part 4 of Unit 5:

• The number of older persons, especially the number of older persons older than 85 years, is
increasing.
• Because the nurse's attitudes toward older persons influence the quality of care, those
attitudes should be based on accurate information about older persons, rather than on myths
and stereotypes.
• Biological and psychosocial theories of aging offer possible explanations for the changes seen
in aging, but every older person is a unique individual who ages in a unique way.
• The physical changes that accompany aging are considered normal, not pathological, although
they may predispose older persons to disease.
• Cognitive impairment is not normal in older persons, and it necessitates assessment and
intervention.
• Cognitive impairment includes acute, potentially reversible disorders (delirium) and chronic,
irreversible, progressive disorders (dementia).
• Issues and events involving psychosocial changes related to aging include retirement, social
isolation, change in housing, death of friends and family, sense of own mortality, and sexuality.
• Nursing interventions for psychosocial concerns include therapeutic communication, touch,
cognitive stimulation, reminiscence, and interventions to improve body image.
• The leading causes of death in the older population are cancer, heart disease, stroke, lung
disease, accidents and falls, diabetes, kidney disease, and liver disease.
• Health promotion recommendations for older persons include good nutrition, regular exercise,
smoking cessation, measures to reduce the risk for falls, and measures to reduce adverse
medication reactions.
• Acute care settings increase older persons' risk for delirium, dehydration, malnutrition,
healthcare–associated infections, urinary incontinence, and falls.
• Restorative nursing interventions, whether accomplished in the older person's home or in
long-term care institutions, stabilize chronic conditions, promote health, and promote
independence in basic and instrumental ADLs.

End of the chapter questions:

1. What two factors contribute to the projected increase in the number of older persons?

1. Financial success and improved environment

2. Fewer medical problems associated with aging

3. Improved medication plan and increase in federal health care funding

4. The aging of the “baby-boom” generation and the growth of the population segment older
than 85 years

2. The three common conditions affecting cognition in older persons are:

1. Stroke, heart attack, and cancer of the brain

2. Cancer, Alzheimer's disease, and stroke

3. Delirium, depression, and dementia

4. Blindness, hearing loss, and stroke

3. Sexuality is recognized as a factor in the lives of older persons; thus:

1. Any expression of sexuality should be discouraged.

2. All older persons, whether healthy or frail, need to express sexual feelings.

3. An older person's need for sexual expression decreases.

4. The need to touch and be touched is decreased.

4. The libido does not decrease in older persons; however:

1. Frequency of sexual activity may decline

2. Physical changes do not usually affect sexual functioning

3. The need to touch and be touched is decreased

4. The sexual preferences of older persons are not as diverse

5. Visual acuity declines with age. Presbyopia is a progressive decline in:

1. Distinguishing between blues and greens and among pastel shades

2. The ability to see in darkness

3. The ability to focus on near objects

4. Adaptation to abrupt changes from darkness to light

6. A common age-related change in auditory acuity is called:

1. Presbycusis

2. Presbyopia

3. Calcification

4. Hypertrophy

7. Taste buds atrophy and lose sensitivity. Older persons are less able to discern:

1. Salty, sweet, sour, and bitter tastes

2. Hot and cold temperatures

3. Moistness and dryness

4. Spicy and bland tastes

8. Changes in the musculoskeletal system lead to changes in the configuration of the

thorax. This is known as:

1. Hypertrophy

2. Calcification
3. Presbycusis

4. Kyphosis

9. Frontotemporal dementia has an insidious onset and progresses slowly. Early

symptoms include:

1. Poor hygiene, lack of social tact, and sexual disinhibition

2. More involvement in surroundings and social situations

3. Fluctuating cognition and visual or auditory hallucinations (or both)

4. Motor features of Parkinsonism

10. A palliative approach to care includes:

1. Persons with nonchronic conditions

2. Older persons with noncancer and cancer diagnosis

3. Specialist care

4. Self-management of chronic illness

Answers:
1. 4
2. 3
3. 2
4. 1
5. 3
6. 1
7. 1
8. 4
9. 1
10. 2

Part 5 of Unit 5:

• When caring for patients who have experienced a loss, nurses facilitate the grieving process
by assisting survivors in feeling the loss, expressing the loss, and moving through the tasks of
grieving.
• Loss comes in many forms, depending on the values and priorities learned within a person's
sphere of influence, which includes family, friends, society, and culture.
• The type of loss and the perception of the loss influence the degree of grief a person
experiences.
• Death is difficult for the dying person, as well as for the person's family, friends, and
caregivers.
• Survivors go through a bereavement period that is not linear; rather, a grieving individual will
move back and forth through a series of stages, tasks, or both many times, possibly over a
period of several years.
• Several theorists have formulated stages of the grieving process and a series of tasks for
survivors to successfully complete their bereavement and adapt to life with a loss.
• Nurses' knowledge of the types of grief enables them to implement appropriate bereavement
therapies.
• The way an individual perceives and responds to a loss is influenced by development,
psychosocial perspectives, socioeconomic status, personal relationships, the nature of the loss,
culture, and spiritual beliefs.
• Nursing interventions involve reinforcing patients' successful coping mechanisms and
introducing new coping approaches, such as the promotion of hope.
• When assessing patients in grief, nurses must not assume how or whether patients experience
grief or whether a particular behaviour indicates grief; rather, they allow patients to share in their
own way what is happening.
• Nurses must assess the terminally ill patient's and family's wishes for end-of-life care, including
the preferred place for death, the level of life-sustaining measures to use, and expectations
regarding pain and symptom management.
• A plan of care is developed by integrating patients' resources such as physical energy and
activity tolerance, supportive family members, spiritual faith, and methods for coping.
• Nurses need to establish a caring presence and use therapeutic communication strategies that
enable patients to discuss their loss and find ways to manage it.
• Palliative care enables patients to make more informed choices, better alleviate symptoms,
and have more opportunities to manage unfinished business.
• Nurses can promote a patient's self-esteem and dignity by conveying respect for the patient as
a whole person.
• Hospice is not a facility but a concept for family-centred care designed to assist the patient in
being comfortable and maintaining a satisfactory lifestyle until death.

End of the chapters questions:

1. A child is grieving over the loss of a pet. This is an example of:

1. An actual loss

2. A perceived loss

3. A situational loss
4. A maturational loss

2. A middle-aged man comes to a community clinic for his annual flu shot. In the
discussion, you learn that he still works at a local law firm. However, he has recently lost
two important cases, and his boss has been pressuring him “to turn it around.” The
patient may be experiencing:

1. An actual loss

2. A perceived loss

3. A situational loss

4. A maturational loss

3. The community health nurse's job is to provide grief counselling for the residents of a
community in which a major flood has occurred. The loss associated with flooding is
best described as:

1. An actual loss

2. A perceived loss

3. A situational loss

4. A maturational loss

4. A patient has received a diagnosis of terminal brain cancer. When you visit him during
rounds, he asks you whether the cancer could have been caused by something he ate or
by exposure to some chemical toxin. The patient is probably experiencing:

1. Bowlby's phase of numbing

2. Kübler-Ross's stage of acceptance

3. Worden's tasks of emotionally relocating

4. Bowlby's phase of disorganization and despair

5. According to Kübler-Ross's stages of dying, a patient may feel overwhelmingly lonely

and withdraw from interpersonal interaction during this phase:

1. Denial
2. Anger

3. Bargaining

4. Depression

6. Since the death of his wife, the patient has assumed full responsibility for the care of
his children. He has noticed over the past few weeks that friends are calling less often.
He is most likely in which of the following phases of mourning?

1. Anticipatory grieving

2. Worden's task 3 of mourning

3. Kübler-Ross's phase of bargaining

4. Bowlby's phase of disorganization and despair

7. Which of the following is one of the most common and difficult issues faced by older
bereaved spouses?

1. Adjusting to physical problems

2. Overcoming mental health problems

3. Completing the tasks of daily living

4. Managing finances

8. “Patient will express hopefulness that cancer treatment will control symptoms” is an
example of:

1. A goal

2. An intervention

3. A plan

4. An expected outcome

9. A 16-year-old patient has been admitted to the Critical Care Unit after suffering a
closed-head injury. The patient is soon declared brain dead. The physician and nurse are
preparing to approach the family to consider the donation of the patient's heart and
lungs. When working with families in this situation, it is important to explain that:

1. The ventilator is being used to prevent brain death.

2. The ventilator maintains organ perfusion until the time for harvesting.

3. Tissues such as corneas can be harvested only if the patient remains ventilated.

4. Organ donation can occur only if the patient has made a request to donate organs in the past.

10. Which of the following types of care allows patients to make more informed choices,
achieve better alleviation of symptoms, and have more opportunities to manage
unfinished business?

1. Acute care

2. Mourning care

3. Palliative care

4. Terminal care

Answers:
1. 1
2. 2
3. 3
4. 4
5. 4
6. 2
7. 3
8. 4
9. 2
10. 3
Session 4 chap 5

1. A theory is best understood as a set of assumptions or propositions that becomes

useful when it does which of the following?

1. Helps people meet their self-care needs

2. Isolates concepts

3. Helps the nurse implement care

4. Provides a systematic view of explaining, predicting, and prescribing phenomena

2. The enterprise of early theorizing about nursing practice was primarily driven by:

1. Physicians

2. Political leaders

3. Nursing educators

4. Policymakers

3. The nursing process in its original form involved which four basic steps?

1. Assessment, planning, intervention, evaluation

2. Assessment, nursing diagnosis, planning, intervention

3. Nursing diagnosis, planning, intervention, evaluation

4. Planning, assessment, intervention, evaluation

4. The metaparadigm concepts that formed the structure of concepts that nursing
theories were concerned about included:

1. The person, environment, health, and nursing

2. Caring, health promotion, and supportive care

3. Chaos theory and systems theory

4. Existentialism, phenomenology, and metaphysics

5. The main question to which the early nursing theorists put their attention was to work
out which of the following?

1. How to differentiate between nursing theories and medical theories

2. How to reconcile the generalizations of the North American Nursing Diagnoses Association
with the unique situations of each client

3. How to organize and make sense of general nursing knowledge and apply this knowledge to
an individual clinical case

4. Whether to use theories from other disciplines such as philosophy and to apply them to
nursing

6. According to Kuhn, scientific advances are most likely to happen when creative
individuals do which of the following?

1. Approach a problem in a new way

2. Use the cause-and-effect model to solve problems

3. Use the work of other scientists to solve problems

4. Use empirical evidence to solve problems

7. The central idea characterizing the McGill model for nursing is that it:

1. Focuses on health rather than on illness or treatment

2. Accounts for holistic aspects of the individual, rather than component parts

3. Views the person as an energy field in constant interaction with the environment

4. Considers the human experience to be based on behavioural drives

8. Building upon a psychoanalytic perspective, theorist Hildegard Peplau considered

which of the following as fundamental aspects of nursing practice?

1. Interacting in a therapeutic manner

2. Developing the relationship between the nurse and patient

3. Investigating the meaning of patient behaviour

4. All of the above

9. The distinctive contribution that Canadian theorist Evelyn Adam added to nursing's
thinking at the time was a conceptualization of the essence of nursing as:

1. A collaboration with health care providers

2. A helping process

3. The management of patients and health care systems

4. All of the above

10. The idea that nursing theorists drew specifically from systems theories was to
consider the human being as:

1. An irreducible whole

2. A whole and component parts in intricate interaction with one another

3. An embodiment of mind, body, and spirit

4. All of the above

11. The most distinctive feature of Rosemarie Parse's theory is that it considers the
individual as a unitary being who is engaged in which of the following?

1. Seeking health

2. Engaging in a continuing process of making choices

3. Striving for homeostasis

4. All of the above

Answers: 1. 4; 2. 3; 3. 1; 4. 1; 5. 3; 6. 1; 7. 1; 8. 4; 9. 2; 10. 2; 11. 2

Chap 19

1. Who should a nurse consider as family?

1. Parents and their children

2. People related by marriage, birth, or adoption

3. The nuclear family and aunts, uncles, grandparents, and cousins

4. A set of relationships that the patient identifies as family

2. The patient is remarried, and her two children from a previous marriage live in the
same household. Her husband's children visit on the weekend. This is an example of
which form of family configuration?

1. A nuclear family

2. A blended family

3. An extended family

4. An alternative family

3. What is the primary social context in which health promotion and disease prevention
take place?

1. At educational institutions

2. From friends and colleagues

3. From physicians and nurses

4. In the family

4. What are two factors that contribute to the long-term health of a family?

1. Structure and function

2. Caregiving and reciprocity

3. Hardiness and resiliency

4. Context and system

5. What does the nurse focus on when viewing the family as patient?

1. Health and development of an individual member existing within a specific environment

2. Family process and relationships

3. Family relational and transactional concepts

4. Family within a system

6. What does asking a patient “Who is in your family?” help the nurse assess?

1. Internal structure

2. External structure

3. Context

4. Instrumental functioning

7. What is a goal of approaching family from a relational inquiry perspective?

1. Professional collaboration

2. Systematic problem solving

3. Inquiry to understand the family in context

4. Circular questions

8. What are two of the components of relational inquiry?

1. Using both open- and closed-ended questions

2. Applying both a strict assessment format and corresponding interventions

3. Incorporating both letting be and emancipatory action

4. Assessing the presenting problem and history of the presenting problem

9. Emotional communication belongs to which CFAM subcategory?

1. Instrumental functioning

2. Development

3. Internal structure

4. Expressive functioning
10. “What do you think when your husband won't visit your son in the hospital?” is an
example of a circular question. What can asking the family circular questions
accomplish?

1. Facilitating change by inviting the family to discover their own answers

2. Encouraging family members to be caregivers

3. Validating their emotional responses

4. Targeting specific yes or no answers

11. Which intervention can the nurse accomplish during a family interview?

1. Educate the family

2. Enforce change

3. Engage a family to assess, explore, and identify strengths and problems

4. Establish roles

Answers: 1. 4; 2. 2; 3. 4; 4. 3; 5. 2; 6. 1; 7. 3; 8. 3; 9. 4; 10. 1; 11. 3

Session 5 chap 9

1. Which of the following are environmental risk factors that nurses should know
contribute to diseases and injuries to people worldwide? (Select all that apply)

1. Chemical exposure

2. Climate change

3. Air, water, and soil pollution

4. Ultraviolet radiation

2. The nurse assesses the health status of a population by analyzing the global burden of
disease (GBD) of a country. The nurse's next step is to:

1. Document the health status data

2. Analyze the DALY indicator

3. Validate the data with the country

4. Assign the DALY indicator with a number

3. Which of the following are defining characteristics for the Sustainable Development
Goals (SDGs)? (Select all that apply.)

1. Align with a planetary perspective on health

2. Focus on ending poverty

3. Address the health of persons of all ages

4. Target health risks of prosperous countries

4. The best definition for the term multiculturalism is:

1. An experience with a new or different culture that is extremely negative

2. A person who maintains his or her culture and interacts peacefully with people of other
cultures

3. A person who gives up his or her ethnic identity in favour of the dominant culture

4. A person who adapts to and adopts a new culture

5. Cultural awareness involves in-depth self-examination that requires:

1. Acknowledgement of one's background, and recognizing biases and prejudices

2. Recognizing social, cultural, and biophysical factors

3. Engagement in culturally safe interactions

4. Motivation and commitment to caring

6. Nurses are responsible to provide culturally safe care for their patients. It is very
important for the nurse to:

1. Learn about vast cultures

2. Deliver care that is based on knowledge of the patient's values, beliefs, and attitudes

3. Influence treatment and care of patients

4. Review cultural assessment models

7. Which of the following is the best definition of ethnocentrism:

1. Stereotypes, biases, and prejudices

2. Meanings by which people make sense of their experiences

3. Cultural beliefs

4. Individualism and self-reliance in achieving and maintaining health

8. The disparities in health outcomes between rich and poor patients is an example of:

1. An attribution of illness to natural, impersonal, and biological forces

2. Biological and sociocultural health risks

3. An influence of socioeconomic factors in morbidity and mortality

4. A combination of naturalistic, religious, and supernatural modalities

9. The concept of global health is best defined as:

1. Issues that affect the health of the population of a particular community or country

2. Prevention programs for populations

3. Issues that directly or indirectly affect health that can transcend national boundaries

4. Issues that affect the health of a few disciplines

Answers: 1. 1, 2, 3, 4; 2. 2; 3. 1, 2, 3; 4. 2; 5. 1; 6. 2; 7. 1; 8. 3; 9. 3.

Chap 16

1. Changes that occurred in the health care system over the last few decades that have
contributed to the recognition of nursing informatics include which of the following:

1. Decreasing technology in health care and the evolution toward evidence-informed practice

2. Requests for nursing informatics from administrators and national databases

3. A recognition among nurses that specific nursing data must be documented consistently in
order to create high-quality health data, support evidence-informed decision making, and
represent nursing contributions

4. Competition among professions to lead technology adoption

2. The factors behind the need for standardized nursing documentation include which of
the following?

1. To facilitate aggregation of nursing data and support data analysis

2. To enhance communication among nurses

3. To improve representation regarding nursing contributions

4. All of the above

3. Which of the following standardized nursing terminology is being used in Canada?

1. interRAI

2. ICNP

3. SNOMED CT

4. HOBIC

4. Which of the following privacy legislation influences nursing practice in Canada?

1. PIPEDA and the Privacy Act

2. PIPEDA and SCWGs

3. Standards Collaborative Working Groups (SCWG) and Standards

4. Privacy Act and Code of Ethics

5. How can you, as a nurse, enact the e-Nursing Strategy?

1. Buy your own laptop, and design a nursing-related website

2. Complete mandatory education on your hospital information system

3. Support access to technology for all nurses, develop your technology competencies, and
participate in advancing information and communication technology and nursing informatics

4. Work at the Canadian Nurses Association

6. What nursing or health informatics communities are available to nurses?

1. CNIA, IMIA-SIGNI

2. CNA, CMA

3. HOBIC, TTYL

4. CSA, ICD-10

Answers: 1. 3; 2. 4; 3. 2; 4. 1; 5. 3; 6. 1