CHAPTER 5: DIVERSITY & HUMAN NEEDS & DEVELOPMENT Roosevelt Health Science Clinical Rotations Successful Nursing Assistant Care, 2nd Ed. (Ch. 5) Simmers DHO Health Science, 8th ED. (Ch. 4, 8) Medical Assisting: Administrative & Clinical Competencies, 7 th ED (Unit 1, 4) CHAPTER 5 OBJECTIVES Define important words Explain health and wellness Explain the importance of holistic care Identify basic human needs and discuss Maslows Hierarchy of Needs Identify ways to accommodate
cultural differences Discuss the role of the family in health care Explain how to meet emotional needs of patients and their families Explain ways to help patients with their spiritual needs Identify ways to accommodate sexual needs Describe the stages of human growth and development Discuss stereotypes of the elderly Discuss developmental disabilities HEALTH AND WELLNESS Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
This view of health looks at the whole person. It also takes the focus off disease and redirects it to healthy attitudes and lifestyles. Wellness has to do with successfully balancing things that happen in our everyday lives. There are five types of wellness: physical, social, emotional, intellectual, and spiritual. Physical Wellness- includes things like being able to complete everyday tasks. Social Wellness- has to do with relating to other people. Emotional Wellness- covers managing stress and expressing feelings. Intellectual Wellness- deals with growing and learning throughout the life span. Spiritual Wellness- includes religious beliefs, ethics, values, and more. Mores are the accepted traditional customs of a particular social group.
IMPORTANCE OF HOLISTIC CARE Holistic care involves considering the whole person, which includes his/her physical and psychosocial needs. Psychosocial needs include social contact, emotions, thought, and spirituality A simple example of holistic care is taking time to talk with the patient while helping them bathe. You are meeting the physical need with the bath You are meeting the psychosocial need for interaction with others at the same time Health care is formed around the thought that harmony or balance in ones life promotes good health. If the balance is disturbed, illness can result. Holistic care supports the harmony, which can improve a residents chances of living a better life.
BASIC HUMAN NEEDS A need is something necessary for a person in order to survive and grow. Physical needs include: Food and water Protection and shelter Activity Sleep and rest Safety Comfort, especially freedom from pain Success and self-esteem Psychological needs include: Love and affection
Acceptance by others Security Self-reliance and independence in daily living Contact with others MASLOWS HIERARCHY OF NEEDS Abraham Maslow developed a model to show how physical and psychosocial needs are arranged in order of importance. He believed that physical needs must be met before psychosocial needs can be met. The needs at the bottom of the pyramid are physical needs. These are the ones that must be met to survive. Ex: a person can live only a few days without water. The second level is safety and security needs.
These include shelter, clothing, protection from harm, and stability. Ex: moving a person from her home into a facility can cause anxiety. Because it is not yet a stable environment. MASLOWS HIERARCHY OF NEEDS The third level is love, acceptance, and belonging. Ex: when residents move into a facility, they may be separated from their loved ones. Living in a new place with strangers can be very lonely, especially true if the loved ones do not visit often. Residents need to feel as if they belong. The fourth level is the need for self-esteem. Ex: Patients may feel less of a sense of self-worth as they become dependent on others. The highest level is self-actualization. A person must reach his or her highest potential to be self-actualization.
Ex: Some residents will be content with the level they have reached in life. Other residents will still be striving to do more. MASLOWS HIERARCHY OF NEEDS ROLE OF FAMILY IN HEALTHCARE Families play an important part in most peoples lives. The concept of family is always changing. Families can have many different make ups, including two parent, single parent, unmarried couples, extended family, and blended. Treat all kinds of families with respect. Do not judge families, even if they are different from your own idea of what a family is. The only time a staff member should be involved is when there are concerns about a residents safety around one or more family members. Families have an important role in patient care. They may help in making decisions, read mail, shop for personal items, assist with ADLs, and much
more. EMOTIONAL NEEDS OF FAMILIES It is important to maintain professional boundaries with patients and their families. Nursing Assistants provide the primary care for residents. Because of this, residents and their families may come to CNAs with problems, needs, or in an emotional crisis. Do not interrupt them with they are talking. Do not respond with clichs, such as Everything will be alright. Offer support and encouragement Nursing assistants may be the person that families and residents turn to when they feel fear, anger, or stress. After a resident dies, his/her family may seek a CNA out for comfort or to talk. Always respond to a worry or fear with a meaningful message. When families ask questions regarding a residents diagnosis, treatment, and
therapies, refer them to the nurse. ACCOMMODATE CULTURAL DIFFERENCES Cultural diversity has to do with the wide variety of people throughout the world. Each culture may have similar lifestyles, religions, traditions, customs, and behaviors. Understanding other cultures will help you provide better care. Be sensitive to and respect people who are different from you. Handle religious or cultural items carefully. SPIRITUAL NEEDS People have different spiritual needs. Patients may have varying beliefs in God from very strong to no belief. It is important to remember to respect all patients beliefs, whatever they are. Do not make judgments about patients spiritual beliefs or try to push your own beliefs on patients.
Common types of religions include: Buddhism Christianity Hinduism Islam Judaism SPIRITUAL NEEDS Spirituality refers to concerns of the spirit, the sacred or the soul. Some patients may consider themselves to be spiritual, but not religious Others believe that their spiritual self is the same as their religious self.
Spirituality centers around thoughts of a spiritual aspect of life and nature beyond worldly things. It may be associated with inner peace and wellbeing. It may refer to a persons beliefs about the overall meaning or purpose in life. Many Native American tribes follow spiritual traditions. Some people may not believe in God or a higher power at all. Agnostics Atheists SPIRITUAL NEEDS Islam The five pillars of this religion include ritual prayer five times daily and donations to the poor and needy. Muslims are followers of the prophet Muhammad (Mohammad). They worship God; the Arabic term
for God is Allah. Quran (Koran) is the religious text. Fast during the month of Ramadan. Mecca is the holy city. Most Muslims do not eat pork or drink alcohol. Buddhism Evolved from Siddhartha Gautama, who reach enlightenment and took the title of Buddha. Believe that morality, meditation, and wisdom are the path to enlightenment. They believe in reincarnation, and that people must ravel through birth, life, and death. After these travels, a person can
reach Nirvana, a state of peace and happiness and freedom from worry or pain. SPIRITUAL NEEDS Hinduism Hindus believe in the unity of everything, called Brahman. The purpose of life is to realize that all are part of God. People move through birth, life, death, and rebirth. How a person moves towards enlightenment is determine by karma. Karma is the result of actions in past lives, and actions in this life can determine ones destiny in future
lives. Judaism Religion of the Jews Divided into Reform, Conservative, and Orthodox. Jewish people believe in one God, and that God is merciful. Believe God gave them laws and commandments through Moses in the form of the Torah. Jewish services are usually on Friday evenings and sometimes on Saturdays in synagogues or temples. SPIRITUAL NEEDS Christianity
Believe that Jesus Christ was the son of God and that he died so that their sins would be forgiven. Christians believe in heaven, and that those that repent their sins before God will be able to go to heaven. Christians may Protestant or Catholic. Protestant includes groups such as Baptist, Lutheran, Methodist, etc. They may be baptized and take communion as a symbol of Christs sacrifice. Atheists People who claim that there is no God.
Agnostic Claim that they do not know or cannot know if God exists. They do not deny that God my exist, but they feel that there is no true knowledge of Gods existence. ACCOMMODATE SPIRITUAL NEEDS Honor dietary restrictions. Dietary restrictions are rules about what and when followers can eat. Muslims may not eat shellfish Catholics dont eat meat on Fridays during Lent. Orthodox and Jews may only eat koshers foods and no pork.
Report any fasting requests to the nurse. Report requests to see clergy to the nurse promptly. Give privacy for clergy visits. Help patients to the chapel when asked. Respect all religious items. Handle religious items carefully. When asked, help patients apply religious articles of clothing. Allow time and privacy for prayer. If you are asked to do so, read religious materials aloud. Residents have the right to attend religious services if they choose to do so. Report to the nurse or social worker if
a patient needs help finding spiritual resources. ACCOMMODATE SEXUAL NEEDS A common myth is that elderly people no longer have sexual needs or desires. That is not true. Always knock and wait for permission to enter before going into a residents rooms. Honor Do Not Disturb signs if your facility uses them. If you encounter any sexual situation between consenting adults, provide privacy and leave the room. Do not judge sexual choices or patients sexual orientation. Do not judge the sexual orientation of patients family members or friends. If you ever see a patient being sexually abused, remove the patient from the situation. Make sure he/she is taken to a safe place, then report this to the nurse immediately. Never delay in reporting sexual abuse. HUMAN GROWTH AND DEVELOPMENT
Growth refers to the physical changes that can be measured. Development means the emotional, social and physical changes that occur. Many things affect growth and development; including the parents involvement, the childs surroundings, nutrition, exercise, medical care and overall lifestyle. There are different types of development, such as cognitive, language, moral, motor, physical, and social. INFANTS (BIRTH TO 12 MONTHS) Babies grow fast during the first year. Infants tend to triple birth weight in the first year of life. Physical development in infancy moves from the head down. Ex: Infants gain control over the neck muscles before the muscles in their shoulders. Infants learn to grasp, lift their heads, and crawl. They may be able to pick things up towards the end of the first year.
Infants are completely dependent on others for care. Lots of touch is important as a communication tool during this time. Touch helps babies grow and thrive TODDLER (AGES 1 TO 3) Toddlers grow fast between the ages of one to three. Most toddlers can move about quickly, and run and jump. During the toddler years, speech improves. During the toddler gain coordination of their limbs and learn to control their bladders and bowels. It is important to protect toddlers as they explore their world, for they can take risks. Toddlers do not understand what kinds of things can harm them. Parents begin to teach them language, the difference between right and wrong, and accepted behavior. PRE-SCHOOL (AGES 3 TO 6)
Pre-school aged children become more independent and have social relationships. They play better with other children, and they can play in groups. Their language ability improves. Pre-schoolers learn to care for themselves They become more physically coordinated, and their sense of imagination develops. Playing dress-up in parents clothing is common SCHOOL-AGE (AGES 6 TO 12) School-age childrens development centers on cognitive and social development. Children learn to get along with each other They begin to develop a conscience, morals, and self-esteem. During this time, boys develop more muscle, but girls may be larger than boys.
The period between 9-12 is also called pre-adolescence. Hormone changes occur and there is a growing interest in the opposite sex Puberty is when a person develops secondary sex characteristics. Females: growth of body hair and development of breasts and hips Males: growth of body hair, growth of the testes and penis, broadening of the shoulders, and a lower voice. ADOLESCENCE (AGES 12 TO 18) During adolescence, genders become sexually mature. Boys tend to reach puberty. If girls did not reach puberty during the prior stage, it will start here. Adolescents may have a hard time adapting to changes caused by puberty. Adolescents become more independent. They must make important decisions, mostly by themselves, each day. Moral values that the child has learned play a part in these decisions.
Adolescents can sometimes become stubborn and difficult for their parents to handle. They may have mood swings. Adolescents are concerned with acceptance from others. YOUNG ADULTHOOD (AGES 18 TO 40) Growth has usually been completed by this time. Boys can continue to grow up to the age of 25 During this stage, people make decisions on whether to continue their education or join the work force. Many young adults meet a life partner. Some people decide to have children during this time. MIDDLE ADULTHOOD (AGES 40 TO 65)
During middle adulthood, people usually become more comfortable and stable. Their children may have left home to go to college or to live on their own. This can be a very happy time for people, because they find there is more time and money to spend on themselves. Couples may take trips and spend more time together. A person may decide to start on a second career. Some people may find themselves in a mid-life crisis during this stage. This is a period of unrest due to a desire for change and fulfillment of unmet goals. People can change the way they dress, act or behave during this time. LATE ADULTHOOD (AGES 65+) People in adulthood can see may changes such as retiring from jobs, traveling more, and seeing children, friends, and family. Medical care may be needed for problems that develop during this time. Mobility can become limited due to these health problems.
People may have to cope with a loved ones illness or death. Staying connected to others is vital to staying healthy and mentally alert. Hobbies and volunteering can help the person stay connected. It is important to encourage people in this stage to stay as active and involved as possible. STEREOTYPES OF THE ELDERLY It is common for people to have false beliefs about the elderly. Stereotype- a biased generalization about a group. Stereotyping of, prejudice toward, and/or discrimination against the elderly is called ageism. Common stereotypes of the elderly include: Faulty memory Totally Dependent No active sex life
Do not like to leave home Grumpy or grouchy Financially irresponsible No friends No interests Stereotypes are not true of most elderly people Research has shown that most older people are active and have many interests. Elderly people exercise, continue to learn, work, manage their finances, and have intimate relationships. Elderly people are relatively independent. Aging is a normal process; normal changes of aging do not mean that people will always become ill or dependent.
DEVELOPMENTAL DISABILITIES Developmental disabilities are present at birth or emerge during childhood. It is a chronic condition; it will exist throughout a persons life. May restrict physical or mental ability These disabilities prevent a child from developing at a normal rate Developmental disabilities can include cerebral palsy, autism, visual or hearing impairment, and mental retardation. Mental retardation is the most common Developmental disabilities cause problems with language, mobility, and learning. Can cause difficulty with self-care and the things people do every day. CEREBRAL PALSY (CP) Cerebral Palsy is a developmental disability that affects movement and balance. It can also cause mental disabilities.
A person with CP suffered brain damage while in the uterus or during birth. The part of the brain that was damaged controls muscle tone. People with CP may lack control of their head and have trouble using their arms and hands. They may have poor balance or posture, may be stiff or limp, or have speech difficulties. They may have problems with intelligence. CP, generally, does not worsen as the person gets older. There are for types: ataxic, athetoid, spastic (most common), and mixed. Spastic means that they might move awkwardly and have stiff muscles S/sx of CP can be different for each person; some have mild s/sx, others are more severe. People with CP can also have mental retardation, hearing or visual impairment, or a seizure disorder. AUTISM Autism is a group of developmental disabilities called ASDs or Autism Spectrum Disorders.
Autism starts prior to age three and continues through the persons lifetime. More often seen in boys. People with autism disorders have trouble with speech, language, and communication. They may have trouble relating to other people socially Autistic people may do specific actions over and over again, such as rocking back and forth. MENTAL RETARDATION The most common developmental disability is mental retardation that causes below-average mental functioning. People have difficulty in learning problems with social skills. People with mental retardation develop at a below-average rate. There are different degrees of mental retardation.
One method of determining the degree of mental retardation is IQ testing. Mental retardation is not a disease or a mental illness. People with mental retardation may need help with ADLs. They may work and live independently, depending upon the severity of the disability. Other names for mental retardation include developmental delay, intellectual disability, and learning disability. GUIDELINES FOR DEVELOPMENTAL DISABILITIES Treat adult patients as adults, regardless of their behavior. Praise and encourage them often, especially for positive behavior. Help teach ADLs by dividing tasks into small steps. Repeat words to make sure they understand. Talk to the patient, even if he/she cannot speak. Help patients with CP move slowly. They may take longer to adjust their body position.
Promote independence. Assist with activities and motor functions that are difficult. Encourage social interaction Always be patient.
Da tempo vari studiosi vanno ipotizzando con buone evidenze, che alla base della trascuratezza, del bullismo e persino dell'autismo, ove si evidenzia una ridotta attività dei neuroni specchio ( Ramachandran e Oberman), sussista una carenza empatica.
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