1. Medical-Surgical Nursing
3rd edition
Chapter 1
Caring for Medical-Surgical Patients
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Objectives
Compare the roles and functions of the licensed practical/nurse (LPN/LVN) with those of the registered nurse.
Identify sites of employment for LPNs/LVNs in medical-surgical nursing.
Correlate the nurse practice act and the standards of practice for the LPN/LVN that guide the practice of each nurse.

3. Objectives (Cont.)
Relate how quality and safety education for nurses (QSEN) applies to LPN/LVN practice.
Demonstrate the knowledge of how evidence-based practice is formulated.
Explain the importance of National Patient Safety Goals and how they relate to patient safety.
Predict how Healthy People 2020 can decrease health care costs.

4. Objectives (Cont.)
Determine how the current health care system attempts to provide health care for all.
Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare, including care excluded from reimbursement.
Illustrate ways to provide holistic care.

5. Roles of the LPN/LVN Uphold clinical standards.
Provide safe patient care.
Teach patients.
Communicate effectively.
Work as a collaborative member of the health care team.
Advocate for the patient.
How are these roles indicated in the state’s scope of practice for the licensed practical/vocational nurse?
What is the role of the LPN/LVN regarding working with other health care providers, such as nursing aides, registered nurses, physical therapists?
How does the LVN/LPN advocate for the patient in your specific work environment?

6. Leader and Delegator Uphold clinical standards.
Delegation and assignment
Delegation involves transferring to qualified unlicensed assistive personnel (UAP) the authority to perform a selected nursing task or activity in a selected patient situation that is within the job description of the LPN/LVN.
Assignment involves assigning nursing tasks or activities within the job description of the UAP to a particular individual.
Give examples of how the LVN/LPN can delegate a specific task.
Give examples of how the LVN/LPN can assign a specific task.
Can an LVN/LPN become a charge nurse? Under what circumstances?

7. Five Rights of Delegation
Right task
Right circumstances
Right person
Right direction/communication
Right supervision
Right task—a task that can legally be delegated for a specific patient
Right circumstances—the patient is stable, independent nursing judgment is not required for the task and resources to perform the task are available
Right person—the person asked to perform the task is competent and qualified to do so
Right direction/communication—objective and specific explanation of what should be done and when, what to report to the delegating nurse, and when to make the report
Right supervision—the charge nurse needs to monitor the performance of the task, intervene when needed, evaluate the results of the task, and provide feedback to the UAP
Based on the five rights of delegation, identify a specific task that the LVN/LPN can delegate to the nursing assistant.
How do you ensure that the task delegated is completed?
Can an LVN/LPN delegate to another LVN/LPN?
Can an LVN/LPN delegate to a registered nurse?

8. Employment Opportunities for LPN/LVNs
In hospitals:
Outpatient surgery
Intermediate care unit (step-down unit)
IV therapy team
Emergency department

9. Employment Opportunities for LPN/LVNs (Cont.)
Long-term care (nursing homes)
Ambulatory care
Rehabilitation services
Hospice
Group homes
Assisted-living facilities

10. Employment Opportunities for LPN/LVNs (Cont.)
Homes for developmentally disabled individuals
Home health care
Private offices
Military
Dialysis centers
Jails and prisons

11. Audience Response Question 1
What should the nurse consider before delegating a specific task? (Select all that apply.)
Know the scope of practice.
Be aware of the staff competency and experience.
Seek approval from the administration.
Determine stability of patient condition.
Correct answer: 1, 2

12. Ethical and Legal Practice
Each state’s Nurse Practice Act defines the role and scope of practice of LPNs/LVNs.
Ethical practice means that the LPN/LVN abides by the Code for Nurses, adheres to the National Patient Safety Goals, and honors privacy via the Health Insurance Portability and Accountability Act (HIPAA).

13. Quality and Safety Quality and Safety Education for Nurses (QSEN)
Patient-centered care means the patient is a full partner in decisions about his or her care.
Compassionate and coordinated care should be planned and delivered with respect for the patient’s preferences, values, and needs.
Care manager may be a designated nurse or social worker within the hospital.

14. Evidenced-based Practice (EBP)
Uses the best current evidence from research findings to make decisions about patient care
Five steps in the process of developing evidence-based practice (Figure 1-3)
Nurses must consider the patient’s unique circumstances and preferences.
Nurses must continually seek scientific evidence that supports best patient outcomes.

15. Quality improvement process

16. Quality Improvement
Continuous Quality Improvement program in place that set standards for care
These standards are based on standards for nursing practice set by the American Nurses Association, the American Hospital Association, and The Joint Commission.

17. Informatics
Using information and technology to communicate, manage knowledge, prevent or mitigate error, and support decision making comprises informatics (QSEN, 2011).
The electronic medical record (EMR) or electronic health record (EHR) is at the heart of informatics.
What electronic devices may be used by health care professionals?

18. Safety
Patients are vulnerable to injury when ill or incapacitated in the hospital.
The National Council of State Boards of Nursing (NCSBN) has identified areas where nursing practice can improve safety.
What are the National Patient Safety Goals (Table 1-1)?

19. Health Care Today Biomedicine Complementary and alternative medicine
The goal of biomedicine is to find the cause of disease and to eliminate or correct the problem.
Complementary and alternative medicine
Patients need to be reminded that all herbals and supplements need to be included when they are asked for a list of drugs taken.
Cost containment
What are the ethical implications of cost containment?

20. Healthy People 2020
Attain high-quality, longer lives free of preventable disease, disability, and the opportunities for progress.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Healthy People 2020 is a nationwide health promotion and disease prevention agenda to improve the health of all Americans during the first decade of the 21st century. It includes a set of health objectives based on best scientific knowledge. Healthy People 2020 has the potential to affect the health of all Americans and reduce health care costs.

21. Financing of Healthcare
The Affordable Care Act
Medicare and Medicaid
Fee for service
Provider
Deductible
Copayment
Co-insurance
Capitation

22. Financing of Healthcare (Cont.)
Group health insurance
Managed care
Health maintenance organizations (HMOs)
Preferred provider organizations (PPOs)
Government-sponsored health insurance
Medicare
Medicaid
Retrospective payment system
Diagnosis-related groups (DRGs)
Prospective payment system (PPS)

23. Holistic Care
Involves being aware of and attending to the following needs of patients:
Physiologic
Psychological
Social
Cultural
Spiritual
Holistic care involves dealing with the total person.

24. Promoting a Therapeutic Nurse–Patient Relationship
Use empathy.
Establish trust.
Therapeutic communication skills.
Maintain patients’ self-esteem.
Display competence.
Ensure pain control.
Display compassion.
Use therapeutic touch.

25. Audience Response Question 2
Which statement(s) indicate(s) therapeutic nurse–patient relationship? (Select all that apply.)
“You poor thing; I had a similar surgery.”
“You seem upset about your procedure.”
“What do you mean when you say that?”
“You will be fine.”
“May I hold your hand?”
Correct answer: 2, 3, and 5

26. Meeting Cultural Needs
Nurses should be open-minded, nonjudgmental, and
Take differences at face value.
Accept people as they are.
Give high-quality care.
Define:
Biomedicine
Complementary and alternative medicine

27. Meeting Spiritual Needs
Patients’ beliefs and values can profoundly affect their response to these crises, attitude toward treatment, and rate of recovery.
The need for spiritual care for patients and families may be intensified by hospitalization, pain experiences, chronic or incurable disease, terminal illness, or the death of a loved one.