NUR 121 Intro to Medical Surgical Nursing Sasha A. Rarang, MSN, CCM, RN

Professional Role in Nursing  Review the Essentials of Baccalaureate Professional Nursing Education (see syllabus).  Client Rights Standards and Statutes:  The Nurse Practice Act -0 Series of statutes enacted by states to regulate the practice of nursing in that state.  Subjects covered – definition of the scope of practice, education, licensure, and grounds for disciplinary action.

Nurse Practice Act  Nurse Practice Act (Title 16 of California, Division 14 – Board of Registered Nursing. Skills and Functions that professional nurses performs in daily practice. 1. Providing direct and indirect client care services. 2. Performing and delivering basic healthcare services. 3. Implementing testing and preventing procedures. 4. Observing signs and symptoms of illness. 5. Administering treatments per physician’s order

Nurse Practice Act 6. Monitoring treatments reactions and responses. 7. Administering medications per physician’s order. 8. Monitoring medication responses and any side effects. 9. Observing overall general physical and mental conditions of individual clients. 10. Providing clients and family teaching. 11. Acting as a client advocate when needed. 12. Documenting nursing care. 13. Supervising allied nursing personnel. 14. Coordinating members of the healthcare team.

Standards of Clinical Nursing Practice  Standards of Care  Standards of professional Perfomance  Liability and Legal Issues. Guidelines for Drug Administration – Smith pg. 6.

Nurse Code of Ethics  Nurse Code of Ethics – set of formal guidelines for governing professional action.  It assist the nurse in problem solving where  judgment is required.  Revised by American Nurses Association in April See Smith pg. 2.

Definition of Professional Nursing  ANA 2003 defined professional nursing as the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities, and the population.  Assuming the Nursing Role – Smith pg. 2.  The Client Role – Smith pg. 3.

HIPPA  The Health Insurance Portability and Accountability Act enacted in 1996 went effect on  It ensures continuing healthcare insurance if the client has had existing insurance and the client either changes or losses his/her job, proposes standards for electronic transactions and security signatures, and ensures privacy of individual health information.  The major purpose of the privacy rule is to define and limit the circumstances in which an individual’s protected health information may be used or disclosed by the health plans, healthcare clearing houses, healthcare providers who transmits health information in electronic forms.

The Clients’ Rights and Responsibilities  State and federal regulations governing healthcare facilities mandate that certain right be afforded clients receiving health care.  Under the Patient’s Bill of Rights, hospitals must provide a foundation for understanding and respecting the rights and responsibilities of the clients, their families, physicians, and other caregivers.  See “The Client’s Bill of Rights” Smith pg. 8

Statutes  Consent to receive health services.  Confidentiality  Patient self-determination act  Advance medical Directives – Living will and Durable Power of attorney for health care.  DO Not Resuscitate (DNR)

Clinical Practice  Legal Issues  Guidelines for Safe Clinical Practice  Providing Client Care  Use of PDAs in Clinical Setting  Client Forms – Kardex/Client Profile Care Plan Critical or clinical pathways  Client’s Chart – Nurses Notes Medication Records Graphic Records Physician’s Orders Physician’s Progress Notes History and Physical Laboratory Forms

Clinical Practice  Basic Nursing Assessment –is completed at the beginning of each shift (usually a complete assessment is done once per day and focus assessment at the beginning and end of the other shifts).  Outline in completing a basic physical assessment 1. Vital Signs – T,P - apical, R – rate, depth, and rhythm, BP – Korotkoff’s sounds systole/diastole 2. Pain – location, and intensity, use pain sclae to determine pain level. 3. Response to medication if given. 4. Emotional Responses – client behavior, reactions, demeanor, general mood (crying, depression)

Clinical Practice  Skin, Hair, and Nails – presence or absence of abrasions, contusions, tears, erythema, pressure ulcers, incision line, color, turgor, temperature, edema. Inspect hair for distribution, thickness, thinness, texture and amount, inspect nails for curvature and angle, texture, color, and surrounding tissues. Presence of IV (site)- check redness, inflammation, coolness.  Musculoskeletal – activity level, general mobility, gait, ROM.  Neurologic – pupils (size, response, equality)hand grips, strength, sensation of all extremities, ability to follow commands, level of consciousness.

Clinical Practice  Respiratory – breath sounds, sputum color, and consistency, (productive or non productive)  Cardiovascular – heart sounds, presence of pulses, edema, observe presence of hair on extremities, (lack indicates poor circulation).  Gastrointestinal – bowel pattern and sounds, presence of nausea or vomiting, abdominal distention, consumption of diet, swallowing ability.  Genitourinary – voiding: color, odor, and consistency, dysuria, vaginal drainage or discomfort, penile discharge. Check for presence of urinary catheter.

Protocol for Procedures Each procedures follows basic protocol. To save space and prevent repetition, all steps in protocols are not outline in detail for each procedures. Remember however that these steps are important and must be followed if complete and responsible nursing care is to be delivered to the client. See Smith pg. 16.

Nursing Process  Assessment - Nursing Diagnosis (NANDA)  Planning - Outcome Identification and Planning  Implementation  Evaluation

Critical Thinking  Nurses are expected not only to master nursing content from many disciplines, but to think creatively, solve problems, communicate, and use reflective judgment in the practice of nursing.

Critical Thinking  To be critical means to ask questions, to analyze, to examine your own thinking and the thinking of others (Chaffee, 1994).  Critical thinking focuses on judgment, and nurses must use reflective judgment because each clinical situation they encounter is different and unique.

Critical Thinking  Critical thinking requires cognitive skills, the ability to ask pertinent questions, knowledge, and the ability to think clearly. An important aspect of critical thinking is the ability to use reflection and language properly.  Critical thinking competencies are: - cognitive processes - diagnostic reasoning - clinical inferences - clinical decision-making The nursing process is considered the specific critical thinking competency in nursing.

Nursing Diagnosis  Types of Nursing Diagnosis - actual - risk for (potential) - syndrome - wellness  Components of Nursing Diagnosis - Two parts statement - Diagnostic label/problem statement + etiology (related to) - Three Part statement - Diagnostic label+ etiology+ Defining characteristic (as evidence by)

Evidence- based Practice  Application of best available empirical evidence that applies recent research finding to clinical practice in order to aid clinical decision.

Communication and Nurse- Client Relationship  Communication  Guidelines for communicating to clients Smith pg. 64.  New Trends in communication  Joint Commission Safety Goal 2: Improve Effectivess of caregiver Communication 1. Read back 2. Develop a list of abbreviations, acronyms or symbols or dose that cannot be used in the facility because they are often misread or confused. 3. Critical test results must be reported immediately. This test results are abnormal and for client safety may require immediate intervention. 4. Hands-Off communication – means that the nurse pass off crucial information about the client. SBAR available technique that covers situation, background, assessment, and recommendations for the client that is being handed off.

Therapeutic Communication Techniques  See major therapeutic techniques Smith pg. 65.  Acknolwedgment  Nonverbal encouragement  Open ended questions  Reflection  Restatement  Validation

Blocks to Communication  False Re-aasurance  Giving advise  Incongruence  Assumptions  Invalidation  Overloading  Social response  Underloading  Value Judgements

Multicultural Healthcare  Cultural Awareness – cultural diversity  Cultural Sensitivity  Spiritual Assessment  Cultural assessment: Cultural background and orientation Communication patterns Family relationships Beliefs and perceptions relating to health, illness, and treatment modalities. Values relating to health practices Education Issues affecting the delivery of healthcare.

Cultural Awareness  Reference for Hispanics  Religious diversity considerations for client care.