Purpose of Nursing Assessment
To gather data that:
• Allows nurse to make judgment about patient’s
health state
• Will be used for rest of nursing process
• Determines patient’s:
• Baseline
• Normal function
• Presence of (or risk for) dysfunction
• Strengths

YAKUBU H.YAKUBU---------------MY VIEW TO A FIRST TRIMMESTER SUCCESS.

Quiz - Freud's Theory of Psychosexual Development

1. According to Freud, personality is mostly established by what age?

5

10

15

20

2. What energy did Freud believe was the driving force behind behavior?

Motivation

Stress

Libido

Drive

3. What is the period following the phallic stage called?

The anal stage

The latent stage

The genital stage

The oral stage

4. As an adult, Cassandra is uptight and extremely rigid, often unwilling to make even small adjustments in her schedule. At which stage is she fixated?

Oral

Anal

Phallic

Genital

5. Steve struggled for years to quit smoking, but he finally succeeded. Now, he chews several packs of gum a day. At which stage is he fixated?

Oral

Anal

Phallic

Genital

6. Which psychologist famously criticized Freud's concept of penis envy, instead suggesting that men experience womb envy?

Mary Whiton Calkins

Anna Freud

Melanie Klein

Karen Horney

7. A common criticism of Freud's theory of psychosexual development is that:

It is focused almost exclusively on male development

His theory is difficult to test scientifically

Freud's research methods were unscientific an non-empirical

All of the above

8. Freud believed that the pleasure-seeking energies of the _______ becoming focused on different areas during development.

Preconscious

Id

Ego

Superego

9. This term refers to Freud's idea that children have an unconscious desire to possess their opposite-sex parent.

Sublimation

Libido

Oedipus complex

Manifest content

10. What did Freud call the process through which children come to identify with their same-sex parent?

Regression

Suppression

Sublimation

Identification

Major Thinkers in Behaviorism

• Ivan Pavlov
• B. F. Skinner
• Edward Thorndike
• John B. Watson
• Clark Hull

YAKUBU H.YAKUBU

My view on Nursing Assessment

Assessment – First Step in the Nursing Process

• it is systematic and continuous collection, validation and communication of client data as compared to what is standard/norm.
• it includes the client’s perceived needs, health problems, related experiences, health practices, values and lifestyles.

Purpose: To establish a data base (all the information about the client):

• nursing health history
• physical assessment
• the physician’s history & physical examination
• results of laboratory & diagnostic tests
• material from other health personnel

4 Types of Assessment:

a. Initial assessment – assessment performed within a specified time on admission

Ex: nursing admission assessment

b. Problem-focused assessment – use to determine status of a specific problem identified in an earlier assessment

Ex: problem on urination-assess on fluid intake & urine output hourly

c. Emergency assessment – rapid assessment done during any physiologic/physiologic crisis of the client to identify life threatening problems.

Ex: assessment of a client’s airway, breathing status & circulation after a cardiac arrest.

d. time-lapsed assessment – reassessment of client’s functional health pattern done several months after initial assessment to compare the clients current status to baseline data previously obtained.

Activities:

1. Collection of data
2. Validation of data
3. Organization of data
4. Analyzing of data
5. Recording/documentation of data

Assessment = Observation of the patient + Interview of patient, family & SO + examination of the patient + Review of medical record

I. Collection of data

• gathering of information about the client
• includes physical, psychological, emotion, socio-cultural, spiritual factors that may affect client’s health status
• includes past health history of client (allergies, past surgeries, chronic diseases, use of folk healing methods)
• includes current/present problems of client (pain, nausea, sleep pattern, religious practices, meds or treatment the client is taking now)

Types of Data:

1. Subjective data

• also referred to as Symptom/Covert data
• information from the client’s point of view or are described by the person experiencing it.
• information supplied by family members, significant others, other health professionals are considered subjective data.

Example: pain, dizziness, ringing of ears/Tinnitus

1. Objective data

• also referred to as Sign/Overt data
• those that can be detected, observed or measured/tested using accepted standard or norm.

Example: pallor, diaphoresis, BP=150/100, yellow discoloration of skin

Methods of Data Collection:

1. Interview

• a planned, purposeful conversation/communication with the client to get information, identify problems, evaluate change, to teach, or to provide support or counseling.
• it is used while taking the nursing history of a client

1. Observation – use to gather data by using the 5 senses and instruments.

1. Examination

• systematic data collection to detect health problems using unit of measurements, physical examination techniques (IPPA), interpretation of laboratory results.
• should be conducted systematically:

a.       Cephalocaudal approach – head-to-toe assessment

b.      Body System approach – examine all the body system

c.       Review of System approach – examine only particular area affected

Source of data:

a.       Primary source – data directly gathered from the client using interview and physical examination.

b.      Secondary source – data gathered from client’s family members, significant others, client’s medical records/chart, other members of health team, and related care literature/journals.

In the Assessment Phase, obtain a Nursing Health History – a structured interview designed to collect specific data and to obtain a detailed health record of a client.

Components of a Nursing Health History:

·         Biographic data – name, address, age, sex, martial status, occupation, religion.

·         Reason for visit/Chief complaint – primary reason why client seek consultation or hospitalization.

·         History of present Illness – includes: usual health status, chronological story, family history, disability assessment.

·         Past Health History – includes all previous immunizations, experiences with illness.

·         Family History – reveals risk factors for certain disease diseases (Diabetes, hypertension, cancer, mental illness).

·         Review of systems – review of all health problems by body systems

·         Lifestyle – include personal habits, diets, sleep or rest patterns, activities of daily living, recreation or hobbies.

·         Social data – include family relationships, ethnic and educational background, economic status, home and neighborhood conditions.

·         Psychological data – information about the client’s emotional state.

·         Pattern of health care – includes all health care resources: hospitals, clinics, health centers, family doctors.

II. Validation of Data – the act of “double-checking” or verifying data to confirm that it is accurate and complete.

Purposes of data validation:

a.       ensure that data collection is complete

b.      ensure that objective and subjective data agree

c.       obtain additional data that may have been overlooked

d.      avoid jumping to conclusion

e.       differentiate cues and inferences

Cues – subjective or objective data observed by the nurse; it is what the client says, or what the nurse can see, hear, feel, smell or measure.

Inferences – the nurse interpretation or conclusion based on the cues.

Example: red, swollen wound = infected wound
Dry skin = dehydrated

III. Organization of Data – uses a written or computerized format that organizes assessment data systematically.

- Maslow’s basic needs

- Body System Model

- Gordon’s Functional Health Patterns:

1. Health perception-health management pattern.
2. Nutritional-metabolic pattern
3. Elimination pattern
4. Activity-exercise pattern
5. Sleep-rest pattern
6. Cognitive-perceptual pattern
7. Self-perception-concept pattern
8. Role-relationship pattern
9. Sexuality-reproductive pattern
10. Coping-stress tolerance pattern
11. Value-belief pattern

IV. Analyze data – compare data against standard and identify significant cues. Standard/norm are generally accepted measurements, model, pattern:

Ex: Normal vital signs, standard Weight and Height, normal laboratory/diagnostic values, normal growth and development pattern

V. Communicate/Record/Document Data

• nurse records all data collected about the client’s health status
• data are recorded in a factual manner not as interpreted by the nurse
• record subjective data in client’s word; restating in other words what client says might change its original meaning.                                                                                                                                

YOUR ANTEDOTE TO PSYCHOLOGY!

Kohlberg’s Stages of Moral Development

Although it has been questioned as to whether it applied equally to different genders and different cultures, Kohlberg’s (1973) stages of moral development is the most widely cited. It breaks our development of morality into three levels, each of which is divided further into two stages:

Preconventional Level (up to age nine):

     ~Self Focused Morality~

1. Morality is defined as obeying rules and avoiding negative consequences. Children in this stage see rules set, typically by parents, as defining moral law.

2. That which satisfies the child’s needs is seen as good and moral.

Conventional Level (age nine to adolescence):

     ~Other Focused Morality~

3. Children begin to understand what is expected of them by their parents, teacher, etc. Morality is seen as achieving these expectations.

4. Fulfilling obligations as well as following expectations are seen as moral law for children in this stage.

Postconventional Level (adulthood):

     ~Higher Focused Morality~ 

5. As adults, we begin to understand that people have different opinions about morality and that rules and laws vary from group to group and culture to culture. Morality is seen as upholding the values of your group or culture.

6. Understanding your own personal beliefs allow adults to judge themselves and others based upon higher levels of morality. In this stage what is right and wrong is based upon the circumstances surrounding an action. Basics of morality are the foundation with independent thought playing an important role.

Quiz:  Personality Development

1.The initial struggle between autonomy and shame and doubt occurs around the ages of one and three according to Erikson..
    True
    False

2.

Freud's theory of psychosexual development has six stages that occur in the same order for all children.
    True
    False

3.

The Oedipus Complex is resolved at the beginning of the genital stage.
    True
    False

4.

Freud's Structural Model is made up of the id, ego, and superego.
    True
    False

5. 

The vast majority of what we have experienced is stored in the unconscious according to Freud.
    True
    False

6.

Finding a way to do something that is typically unacceptable in an acceptable manner is called sublimation.
    True
    False

7.

Ego defense mechanisms are almost always unhealthy no matter how they are used.
    True
    False

8.

Object Permanency refers to a child's ability to understand that objects can exist outside of their immediate awareness.
    True
    False

9.

Erikson is to sexual development as Freud is to social development.
    True
    False

10.

Individuals who are focused on the punishment or rewards of their behavior are considered by Kohlberg to be in the preconventional level of morality..
    True
    False

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Quiz:  Learning and Behavioral Theory

1.B. F. Skinner is considered the father of behaviorism.
    True
    False

2.

In the original classical conditioning experiments, the sound of the bell is considered the conditioned response.
    True
    False

3.

In the original classical conditioning experiments, the salivation after being presented with food is considered an unconditioned response.
    True
    False

4.

In Operant conditioning, the response comes after the consequence.
    True
    False

5. 

Positive reinforcement refers to adding something positive in order to increase the probability of a behavior occurring.
    True
    False

6.

Negative reinforcement refers to the adding of something negative in order to reduce the probability of a behavior occurring.
    True
    False

7.

Slot machines work well because they are based on a variable ratio schedule of reinforcement.
    True
    False

8.

Not using a candy machine again after losing money one time represents a major problem with variable interval schedules of reinforcement.
    True
    False

9.

The experiments in classical conditioning were originally developed by Ivan Pavlov after accidentally stumbling on the phenomenon.
    True
    False

10.

Conditioning could be considered synonymous with learning in that a conditioned response occurs only after it has been learned.
    True
    False

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Level 1. Preconventional Morality

• Stage 1 - Obedience and Punishment
  The earliest stage of moral development is especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment.

• Stage 2 - Individualism and Exchange
  At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz’s needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests.

Level 2. Conventional Morality

• Stage 3 - Interpersonal Relationships
  Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships.

• Stage 4 - Maintaining Social Order
  At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty and respecting authority.

Level 3. Postconventional Morality

• Stage 5 - Social Contract and Individual Rights
  At this stage, people begin to account for the differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards.

• Stage 6 - Universal Principles
  Kolhberg’s final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.

Criticisms of Kohlberg's Theory of Moral Development:

• Does moral reasoning necessarily lead to moral behavior? Kohlberg's theory is concerned with moral thinking, but there is a big difference between knowing what we ought to do versus our actual actions.

• Is justice the only aspect of moral reasoning we should consider? Critics have pointed out that Kohlberg's theory of moral development overemphasizes the concept as justice when making moral choices. Factors such as compassion, caring and other interpersonal feelings may play an important part in moral reasoning.

• Does Kohlberg's theory overemphasize Western philosophy? Individualistic cultures emphasize personal rights while collectivist cultures stress the importance of society and community. Eastern cultures may have different moral outlooks that Kohlberg's theory does not account for.