Lecture 1A Patient Care Concepts; Cultural Concepts

Introduction Medical Surgical Nursing Care of adults during illness Goals – Promote and maintain health – Alleviate suffering “Clients” Nurses – Focus on the clients response to actual or potential disruption in health

5 core competencies 1.Provide client-centered care 2.Working in interdisciplinary teams 3.Using evidence-based practices 4.Applying quality improvement principles 5.Using information technology

Provide Client-Centered Care Unique Specific Listen & respect Relieve pain

Working in interdisciplinary teams All members of the health care team work together – Communicate – Cooperate – Collaborate

Using evidence-based practices Nursing knowledge must be established through – Clinical research

Applying quality improvement principles Identify Reduce Quality Assurance

Using information technology Computers

Describe the application of the nursing process to basic medical-surgical nursing.

Introduction: Nursing Process is a systematic method of providing care to clients Allows nurses to communicate plans and activities to – Clients – Health care providers – Families Encourages orderly thought, analysis, planning

Holistic Health Treat the Whole person – Mental – Emotional – Spiritual – Physical – Social

Overview of the Nursing Process Purpose is to provide client care that is: – Individualized – Holistic – Effective – Efficient

Overview of the Nursing Process Consists of 5 steps Build on each other Not linear

Dynamic Nursing Process Used throughout the life span in any care setting

Small group questions: 1.Describe the steps of the nursing process? 2.What is the purpose of the nursing process? 3.In what clinical setting is the nursing process used?

Assessment Step #1 Involves – Collecting data – Validating the data – Organizing the data – Interpreting the data – Documenting the data

Assessment Purpose of assessment: – Data collection Types of assessment: – Comprehensive – Focused – Ongoing

Assessment Comprehensive assessment – Baseline – Physical & psychosocial

Assessment Focused Assessment – Limited in scope – Screening for a specific problem – Short stay Ongoing assessment – Follow-up – Monitoring and observing changes related to specific problems

Assessment Types of data – Subjective Data from the client’s point of view – Interview – Objective Observable & measurable – Physical assessment – Lab – Dx testing

Assessment Validating the Data Organizing the Data Interpreting the Data – Relevant vs. irrelevant – Gaps? – Identify patterns Document the Data

iClicker 1.Baby Jane a 2 month infant goes into the doctor for her initial immunization and well baby check-up. What type of assessment should the nurse perform? A. Comprehensive B. Focused C. Ongoing

Which one of the following is objective data? A.Nausea B.Pain C.Dizziness D.Unsteady gait E.Anxiety

Which one of the following is subjective data? A.Vomiting B.Warm, moist skin C.Head ache D.Bruise on the right arm E.Temperature 99.3 o F

Diagnosis Step 2 in the nursing process

Nursing diagnosis: – “A clinical judgment about individual, family or community responses to actual or potential heal problems / life processes. – A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosis Identifies conditions the MD is licensed & qualified to treat Identifies situations the nurse is licensed & qualified to treat Focuses on illness, injury or disease processes Focuses on the clients responses to actual or potential health / life problems

Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosis Remains constant until a cure is effected Changes as the clients response and/or the health problem changes i.e. Breast canceri.e. Knowledge deficit Powerlessness Grieving, anticipatory Body image disturbance Individual coping, ineffective

Diangosis Nursing diagnosisMedical diagnosis Breathing patterns, ineffective Chronic obstructive pulmonary disease Activity intoleranceCerebrovascular accident PainAppendectomy Body image disturbanceAmputation Body temperature, risk for altered Strep throat

Planning & Outcome identification Step 3 – Types of planning Initial Ongoing Discharge

Planning & Outcome identification Identifying outcomes – Goals An aim, intent or end. – Short term goals Hours to days (less than a week) – Long term goals Weeks to months

Planning & Outcome identification Developing specific nursing interventions – Independent nursing interventions No order needed – Elevate edematous legs – Interdependent nursing interventions With interdisciplinary team member – Assist client with physical therapy exercises – Dependent nursing interventions Require an order – Administering of medications

The nursing care plan includes “administer digoxin per MD order”. What type of intervention is this? A.Dependent B.Interdependent C.Independent

The nursing care plan includes “Check apical pulse before administering digoxin”. What type of intervention is this? A.Dependent B.Interdependent C.Independent

Prioritizing Nrs Dx Maslow’s hierarchy of needs

Maslow’s Hierarchy of Needs Physiological: – Breathing, food, water, sex (gender) sleep, homeostasis, excretion – ABC’s Safety – Security of body, employment, resources, morality, family, health or property Love/Belonging – Friendship, family, sexual intimacy Esteem – Self esteem, confidence, achievement, respect of others, respect by others Self-Actualization – Morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts

Implementation 4 th step: – Execution of the nursing care plan – DO IT – DO IT RIGHT – DO IT RIGHT NOW! Direct Assist Supervise Delegate Teach Monitor

Evaluation 5 th step – Have the clients goals have been met, partially met or not met.

Role of the LVN Use the nursing process Contribute to diagnosis & nursing care plan The RN has ultimate responsibility RN’s can independently LVN’s work in conjunction with RN’s Provide info Implement

Multiple Roles: Caregiver Provide personal, individual assistance – Caring is the means by which the nurse is connected with and concerned for the client

Multiple Roles: Manager Leader Coordinate care Manage time, resources and environment Prioritizing

Multiple Roles: Advocate “One who speaks for another” Protects the clients right Communication Educate Supports Resources / Referrals

Multiple Roles: Teacher Who? – Family & Patient What? – Health promotion – Illness prevention Why? – Continuity of care How? – Interpersonal skills

Critical Thinking & the Nursing Process Critical thinking definition – “A goal-directed thinking in which a person attempts to use cognitive knowledge and skills to determine the best overall result or choose the best action, given the particular circumstances.” Thinking like a nurse – How a nurse thinks!

Characteristics of a Critical Thinker Thinking Independently Use analytic process Use intuition Having intellectual courage Having empathy Being fair-minded Being disciplined Being creative Being confident in self (See Box 1-2, pg 8 of Med-Surg text book)

Nurse-Patient Relationship Professional Boundaries – “The limits maintained between a person who is vulnerable (the client) and the person with power (the nurse)”

Zone of Helpfulness Under- involved Over- involved

Is it consistent with the Code of Ethics Is it consistent with Nursing Practice Standards Is it consistent with your duty to act in the best interest of your client? Does it promote client autonomy and self- determination? Is this a behavior or interaction you would want other people to know you had engaged in with a client? If the Answer is NO to any question, stop and report

Communication Convey Respect competence, caring, honest – Do not overwhelm the client – Matter-of-fact questions – Don't make promises you can't keep – Be dependable – Treat each client as an individual Listen Empathy – Respect the client

Communication Establishing the Setting – Comfortable environment – Relaxed, unhurried – Sit down – Face the speaker – Maintain eye contact – Provide for privacy – Avoid interruptions

Communication – Let the client talk – Keep questions brief and simple – Use understandable language – Ask one question at a time – Give the client time to answer – Clarify client responses – Avoid leading questions. – Avoid how or why questions – Avoid the use of cliché statements – Open ended questions – Avoid interrupting the client

Communication Interviewing Techniques – Reflection – Restating – Open-ended questions – Silence – Clarification

Health-illness continuum What is health? – The individual's state of health is one of continual change

Culture / Race / Ethnic group / Prejudice Culture: – “Is the learned behavior, values, beliefs, norms, and practices shared by a particular group of people that guide their thinking, decisions and actions” Race: – “To identify differences in physical characteristics, such as skin color, eye shape and bone structure.” Ethnic group: – “A group of people who share and are unified by experiences and background based on such factors as socioeconomic status, religion, education and residence.” Prejudice – “The act or state of holding unreasonable preconceived judgments or convictions.” Ethnocentrism: – “Belief that their own cultural group’s beliefs and values are the only acceptable ones”

“People of every culture have the right to have their cultural values known, respected, and addressed appropriately” The nurse must be … – Sensitive – Aware – Respectful

6 cultural characteristic Communication – Listening – Verbal / Non-verbal – Touch Space – Personal space – Eye contact Social orientation – Definition of family – Religious beliefs – Diet Time – Social time – Future oriented vs. present oriented Environmental control – Can you control your environment or does it control you? Biological variations

Religious Care Consideration Islam: – Prayers – washing, privacy – Caregiver of the same gender – Food: Do not eat pork or alcohol – Fasting: Ramadan

Religious Care Consideration Judaism – Sabbath (Friday night – Saturday night) avoid activities – Food: Kosher (not milk + meat); NO PORK

Religious Care Consideration Hinduism – Vegetarian – No BEEF – (Cows are sacred)

Religious Care Consideration Catholic: – No meat on Friday – Religious icons (rosary, medals etc) don’t lose them – Anointment for healing, and when death imminent

Religious Care Consideration The Church of Jesus Christ of LDS/Mormon – No tea, coffee, alcohol – Wear special underclothing

Methodist – On request clergy anoint with oil Lutheran – On request clergy anoint with oil

Religious Care Consideration Assemblies of God – May seek divine healing thought prayer and laying on of hands

Religious Care Consideration Jehovah’s Witness – No blood transfusions – Do not observe national / religious holidays

Religious Care Consideration 7 th day Adventist – No caffeine, pork, lobster, crab, – Many vegetarian – Sabbath is on Saturday

Religious Care Consideration Christian Science – Gen. do not seek traditional medical treatment – Avoid immunizations on religious grounds

Cultural influences Technological factors Religious & philosophical factors Kinship and social factors Cultural values and life- ways Political and legal factors Economic factors Educational Factors