Holistic Patient Care Understanding the Person

Holistic Patient Care Understanding the Person
Slide 0 Copyright © 2004 Mosby, Inc. All rights reserved.

Copyright © 2004 Mosby, Inc. All rights reserved.
State Standards 8) Examine the skills needed to effectively and respectfully communicate with an LTC resident. Discuss such facets as verbal and nonverbal communication, how to respond to residents’ negative or changing behaviors, cultural diversity, residents with special needs or cognitive impairments, barriers to communication, and integration of assistant’s interpersonal skills. Practice communication skills, professional and ethical behavior, and non-discrimination standards in a classroom clinical and LTC setting with classmates, families, geriatrics, and persons with special needs, obtaining objective and subjective patient information. 19) Understand principles of and successfully perform skills related to personal care. Incorporate guidelines for residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: Page 6 a. Principles of self-care versus full care b. Bathing/skin care/back rub c. Grooming/shaving/hair care/nail care d. Mouth care/denture care of conscious and comatose resident e. Dressing f. Transfers, positioning, turning in bed g. Bed making, occupied and unoccupied h. Care for resident when death is imminent Copyright © 2004 Mosby, Inc. All rights reserved.

Objectives Students will be able to… Identify the basic needs of the elderly patient. Identify the needs of a dying patient. Demonstrate nail and hair care for an elderly patient using the step by step skills rubric. Copyright © 2004 Mosby, Inc. All rights reserved.

Holism Holism is a concept that considers the whole person. Physical, social, psychological, and spiritual parts All parts are woven together and can not be separated. Copyright © 2004 Mosby, Inc. All rights reserved.

Basic Needs Must be met for survival and function. According to Abraham Maslow, basic needs are: Physiological or physical Safety and security Love and belonging Self-esteem Self-actualization Lower level needs must be met to move on to higher level needs. Copyright © 2004 Mosby, Inc. All rights reserved.

Culture and Religion Culture Characteristics from a group of people passed from one generation to the next. Religion relates to spiritual beliefs, needs, and practices. Both can be affected when ill. And both can determine how we handle illness. Copyright © 2004 Mosby, Inc. All rights reserved.

Being Sick Affects the person physically, psychologically, and socially People do not choose sickness or injury Disabilities may occur. Disabilities is a loss, absence, or impaired physical or mental function. Maybe temporary or permanent. Normal activities may be difficult or impossible to perform. Fear of death, disability, chronic illness, and loss of function may occur. Copyright © 2004 Mosby, Inc. All rights reserved.

Psychological Effects
Think about it!!! Physical Effects Psychological Effects Social Effects Copyright © 2004 Mosby, Inc. All rights reserved.

What are your favorite foods?
Copyright © 2004 Mosby, Inc. All rights reserved.

Persons You Will Care For
Mothers and newborns (obstetrics) Children (pediatrics) Adults with medical problems Persons having surgery Persons with mental health problems (psychiatry) Persons in special care units Persons needing subacute care or rehabilitation Older adults (geriatrics) Families of all these persons Copyright © 2004 Mosby, Inc. All rights reserved.

Persons You Will Care For in long term care:
Alert and oriented persons May have physical problems Extent depend on disability Confused and disoriented persons Mild to severe Alzheimer’s disease or dementias Persons needing complete care They can not meet their own needs Short-term residents Need to recover from fractures, acute illness, or surgery They usually return home. Life-long residents Mentally ill persons Terminally ill persons Copyright © 2004 Mosby, Inc. All rights reserved.

The Dying Patient Death can be sudden or expected. Death is seen often in health care, some areas more than others, but it is a part of health care regardless. You will need to face your personal feelings regarding death, so you can be a supportive and helpful caregiver, to the patient and their family. Its ok to cry with the family, but don’t become an emotional train wreck… Copyright © 2004 Mosby, Inc. All rights reserved.

Terminal Illness A disease or illness where there is no recovery expected. No one is a predictor of death. Hope and the will to live strongly influence living and dying. Copyright © 2004 Mosby, Inc. All rights reserved.

Stages Of Dying (Dr. Elisabeth Kübler-Ross)
Five stages of dying Denial Anger Bargaining Depression Acceptance Copyright © 2004 Mosby, Inc. All rights reserved.

Psychological, Social, and Spiritual Needs
Dying persons may want: Family and friends present To talk about their fears, worries, and anxieties To be alone To talk at night Listen and use touch. Some people want to see a spiritual leader or take part in religious practices. Provide privacy. Be courteous to the spiritual leader. The person has the right to have religious objects nearby. Handle these objects with care and respect. Copyright © 2004 Mosby, Inc. All rights reserved.

Physical Needs The dying process may take a few hours, days, or weeks. Body processes begins to slow. The person is allowed to die with dignity and peace. Copyright © 2004 Mosby, Inc. All rights reserved.

Hospice Care Focuses on the physical, emotional, social, and spiritual needs. Provides follow-up care and support groups after the loved one has passed. Copyright © 2004 Mosby, Inc. All rights reserved.

Legal Issues Consent is needed for any treatment. The Patient Self-Determination Act and OBRA Advanced Directives Living wills Durable power of attorney for health care “Do not resuscitate” orders Copyright © 2004 Mosby, Inc. All rights reserved.

As death nears Mouth muscles relax: The jaw drops. The mouth may stay open. The facial expression is often peaceful. The respiratory system fails. Cheyne-Stokes, slow, or rapid respirations are observed. Mucus collects in the airway. This causes the death rattle. The body temperature rises. The person feels cool or cold, looks pale, and perspires heavily. Copyright © 2004 Mosby, Inc. All rights reserved.

Postmortem Care Care of the Body after Death It is done to maintain good appearance of the body. The right to privacy and the right to be treated with dignity and respect apply after death. Valuables and personal items are gathered for the family. Within 2 to 4 hours after death, rigor mortis develops. The body is positioned in normal alignment before rigor mortis sets in. Assisting with Postmortem Care p. 812 Copyright © 2004 Mosby, Inc. All rights reserved.

Holistic Patient Care The Person’s Unit Patient’s and residents spend a lot of time in their room. Rooms should be designed to provide comfort. Slide 26 Copyright © 2004 Mosby, Inc. All rights reserved.

State Standards 8) Examine the skills needed to effectively and respectfully communicate with an LTC resident. Discuss such facets as verbal and nonverbal communication, how to respond to residents’ negative or changing behaviors, cultural diversity, residents with special needs or cognitive impairments, barriers to communication, and integration of assistant’s interpersonal skills. Practice communication skills, professional and ethical behavior, and non-discrimination standards in a classroom clinical and LTC setting with classmates, families, geriatrics, and persons with special needs, obtaining objective and subjective patient information. 19) Understand principles of and successfully perform skills related to personal care. Incorporate guidelines for residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: Page 6 a. Principles of self-care versus full care b. Bathing/skin care/back rub c. Grooming/shaving/hair care/nail care d. Mouth care/denture care of conscious and comatose resident e. Dressing f. Transfers, positioning, turning in bed g. Bed making, occupied and unoccupied h. Care for resident when death is imminent Copyright © 2004 Mosby, Inc. All rights reserved.

Objectives Students will be able to… Identify common equipment seen in a patients room. Demonstrate proper bed making of an occupied and unoccupied bed using the step by step skills rubric Copyright © 2004 Mosby, Inc. All rights reserved.

Room Furniture and Equipment
Rooms are furnished and equipped to meet basic needs. The right to privacy is considered. OBRA requires that nursing center rooms be as homelike as possible. The resident is allowed to have and use personal items. This promotes their dignity and self-esteem. Copyright © 2004 Mosby, Inc. All rights reserved.

Room Equipment Privacy curtains Prevent views, but not sound Always pull the curtain around the bed to provide privacy Call system The signal light must always be within the person’s reach Bathroom A toilet, sink, call system, and mirror are standard equipment Closet and drawer space OBRA requires closet space for each nursing center resident. Copyright © 2004 Mosby, Inc. All rights reserved.

Other Room Furniture and Equipment
Overbed table The table is raised or lowered for the person in bed or in a chair. It is used for meals, writing, reading, and other activities. The nursing team uses the overbed table as a work area. Chairs The person’s unit has at least one chair. Bedside stand Used to store personal care items used for hygiene and elimination. Copyright © 2004 Mosby, Inc. All rights reserved.

Personal care items wash basin kidney basin Bedpan Urinal water pitcher and glass soap and soap dish Powder Lotion Toothbrush and toothpaste, mouthwash Tissues comb or brush Copyright © 2004 Mosby, Inc. All rights reserved.

Temperature and Ventilation
OBRA requires centers maintain a temp. between 71°F - 81°F Loss of fatty tissue and poor circulation cause the resident to be cold. Copyright © 2004 Mosby, Inc. All rights reserved.

Odors Some people are sensitive to odors they become nauseated. To reduce odors: Empty and clean bedpans, commodes, urinals, and kidney (emesis) basins promptly. Change soiled linens and clothing promptly. Follow agency policy for soiled linens and clothing. Check incontinent persons often Clean persons who are wet or soiled from urine, feces, vomitus, or wound drainage. Dispose of incontinence and ostomy products promptly Keep laundry containers closed. Provide good hygiene to prevent body and breath odors Use a room deodorizer as needed. Do not use sprays around persons with breathing problems. Ask the nurse if you are unsure. Copyright © 2004 Mosby, Inc. All rights reserved.

Noise Ill people are sensitive to noises and sounds. Common health care sounds may disturb them. Wheels on stretchers, wheelchairs, carts, and other items must be oiled properly. When loud talking and laughter occur in hallways and at the nurses’ station, patients and residents may think that the staff is talking and laughing about them. Patients and residents may find sounds dangerous, frightening, or irritating. What is noise to one person may not be noise to another. Health care agencies are designed to reduce noise. To decrease noise: Control your voice. Handle equipment carefully. Keep equipment working properly. Answer phones, signal lights, and intercoms promptly. Copyright © 2004 Mosby, Inc. All rights reserved.

Lighting Good lighting is needed for safety and comfort. Adjust lighting to meet the person’s changing needs. Persons with poor vision need bright light. Bright light is very important at mealtime and when moving about. Bright light also helps staff perform procedures. Keep light controls within the person’s reach. This protects the right to personal choice. Copyright © 2004 Mosby, Inc. All rights reserved.

Bed positions Flat Usual sleeping position. It is used after spinal cord surgery or injury and with cervical traction. Fowler’s position The head of the bed is elevated 45 to 90 degrees. Semi-Fowler’s position The head of the bed is elevated 30 degrees. Or the head of the bed is raised 30 degrees, and the knee portion is raised 15 degrees. Know the definition that your agency uses. Trendelenburg’s position The head of the bed is lowered, and the foot of the bed is raised. A doctor orders this position. Reverse Trendelenburg’s position The head of the bed is raised, and the foot of the bed is lowered. This position requires a doctor’s order. Copyright © 2004 Mosby, Inc. All rights reserved.

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