Foundations Week 1 Objectives
describe professional nursing responsibilities and roles to include autonomy and accountability, caregiver, advocate, educator, communicator, manager, and career development
-AUTONOMY is essential in the nursing profession that involves the initiation of independent nursing interventions without medical orders -ACCOUNTABILITY means that the nurse is responsible professionally and legally for the type and quality of nursing care provided -must remain current and competent in nursing and scientific knowledge and technical skills -as a CAREGIVER, a nurse helps patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process -must meet all health care needs of a patient by providing measures to restore a patient's emotional, spiritual, and social well-being -the nurse helps patients and families set realistic goals and meet them -as an ADVOCATE, the nurse protects the patient's human and legal rights and provides assistance in asserting these rights if the need arises -act on behalf of the patient and secure the patient's health care rights -sometimes must defend the patients' rights to make health care decisions in a general way by speaking out against policies or actions that put patients in danger or conflict with their rights -as an EDUCATOR, the nurse explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning -always use teaching methods that match the patient's capabilities and needs and incorporate other resources such as the family in teaching plans -effectiveness as a COMMUNICATOR is central to the nurse-patient relationship -communication is essential for all nursing roles and activities -without clear communication it is impossible to advocate for patients or to give comfort and emotional support, give care effectively, make decisions with patients and families, protect patients from threats to well-being, coordinate and manage patient care, assist patients in rehabilitation, or provide patient education -quality communication is a critical factor in meeting the needs of individuals, families, and communities -nurse MANAGERS need to establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes -coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency -uses appropriate leadership styles to create a nursing environment for patients and staff that reflects the mission and values of the health care organization CAREER DEVELOPMENT -majority of nurses practice in hospital settings, followed by community-based care, ambulatory care, and nursing homes/extended care settings -offers different career opportunities
describe perineal care and clients who require perineal care (according to your textbook)
-cleansing patients' genital and anal areas -usually occurs as part of a complete bed bath; however, it must be provided at least once a day and more often if a patient has a urinary catheter -patients most in need of perineal care include those at greatest risk for acquiring an infection: --uncircumcised males, patients who have indwelling urinary catheters, those recovering from rectal or genital surgery or childbirth, and women who are having a menstrual period
explain the importance of foot care for the patient with diabetes or peripheral vascular disease as well as precautions for the same
certain conditions place patients with diabetes at increased risk for amputation such as peripheral neuropathy, limited joint mobility, bony deformity, peripheral vascular disease, and a history of skin ulcers or previous amputation advise patients to use the following guidelines in a routine foot and nail care program: -inspect the feet daily, including the bottoms and tops, heels, and areas between the toes (use a mirror to help inspect the feet thoroughly or ask a family member to check daily) -wash feet daily in lukewarm water; dry thoroughly, especially between the toes -avoid harsh chemicals or long soaks, which can cause skin softening or maceration of tissue, causing ulceration or infections -wear well-fitting shoes and clean, dry socks at all times; never go barefoot -keep skin soft and smooth by applying emollient lotion over all surfaces of the feet but not between the toes -trim toenails straight across and square file the edges smooth -keep blood flowing to your feet by putting them up when sitting wiggling your toes and moving your ankles up and down for 5 minutes, 2 or 3 times a day -do not cross your legs -do not smoke -protect the feet from hot and cold; do not use heating pads or electric blankets and always wear shoes at the beach or on hot pavement
list common hair and scalp problems and their related interventions
dandruff-shampoo regularly with medicated shampoo ticks-using blunt tweezers, grasp tick as close to the head as possible and pull upward with even, steady pressure; hold until tick pulls out, usually for about 3-4 minutes; save tick in plastic bag and put in freezer if it is necessary to identify type of tick pediculosis (capitis)-wearing gloves, check entire scalp by using tongue depressor or special lice comb; use medicated shampoo for eliminating lice; manual removal is best option when treatment has failed; vacuum infested areas of home pediculosis corporis-bathe or shower thoroughly; after skin is dried, apply recommended pediculicide lotion; after 12-24 hours take another bath or shower; bag infested clothing or linen until laundered in hot water; vacuum rooms thoroughly and throw away bag after completion pediculosis pubis-shave hair off affected area; clean as for body lice; if lice were sexually transmitted, notify partner hair loss-stop hair care practices that damage hair; use of curlers, hair picks, tight braiding, and hot comb contributes to hair-loss condition
stomatitis
inflammation of the oral mucosa -causes burning, pain, and change in food and fluid tolerance -brush with a soft toothbrush and floss gently to prevent bleeding of the gums *chemotherapy, immunosuppressive agents, head and neck radiation, and NG tubes place patients at higher risk
effleurage
long, slow, gliding strokes of a massage -associated with reduced measured anxiety, heart rate, and respiratory rate -studies show that slow-stroke back massages of 3 minutes and hand massages of 10 minutes significantly improve both physiological and psychological indicators of relaxation in older people
describe various types of nursing education to include education required to become a registered nurse, graduate education, continuing education, and in-service education
-currently the most frequent way to become a registered nurse (RN) is through completion of either an associate or baccalaureate degree program; graduates of both programs are eligible to take the NCLEX-RN to become RNs in the state in which they will practice -a nurse completing a graduate program can receive a master's degree in nursing which provides the advanced clinician with strong skills in nursing science and theory *important for the roles of nurse education and nurse administrator and is required for an APRN -professional doctoral programs in nursing prepare graduates to apply research findings to clinical nursing -other doctoral programs prepare nurses for more rigorous research and theory development -continuing education programs help nurses maintain current nursing skills, gain new knowledge, and theory, and obtain new skills reflecting the changes in the health care delivery system -it involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions -in-service education programs are instruction or training provided by a health care agency or institution -they are held in the institution and are designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution
discuss different approaches used in maintaining a patient's comfort and safety during hygiene care to include frequency of bathing, temperature, use of chlorhexidine gluconate (CHG) cloths/wipes, etc
-educate and counsel patients and caregiver on why proper hygiene techniques are necessary -variety, frequency, and timing of hygiene measures vary across health care settings and according to individual patient needs -a complete bed bath is administered to totally dependent patient in bed -a partial bed bath consists of bathing only body parts that would cause discomfort if left unbathed such as the hands, face, axillae, and perineal area (may also include washing back and providing back rub) -sponge bath at the sink involves bathing from a bath basin or sink with patient sitting in a chair (patient is able to perform part of the bath independently) -a tub bath involves immersion in a tub of water that allows more thorough washing and rinsing than a bed bath (commonly used in long-term care) -a shower provides more thorough cleaning than a bed bath but can cause fatigue as the patient sits or stands under a continuous stream of water -a bag bath or travel bath contains several soft, nonwoven cotton cloths that are premoistened in a solution of no-rinse surfactant cleanser and emollient (offers an alternative because of the ease of use, reduced time bathing, and patient comfort) -a CHG (chlorhexidine gluconate) bath is an antimicrobial bath wipe used to decrease the frequency of hospital-acquired infections on skin, invasive lines, and catheters
describe the impact of nursing on politics, health policies, and state legislation and policies
-nurses' involvement in politics is receiving greater emphasis in nursing curricula, professional organizations, and health care settings -professional nursing organizations and state nursing boards employ lobbyists urge state legislastures and the U.S. Congress to improve the quality of health care -nurses and their professional organizations lobby for health care legislation to meet the needs of patients, particularly the medically underserved -participating in local and national efforts are critical to exerting nurses' influence early in the political process
discuss factors that influence the condition of the nails and feet
-patients with diseases that affect peripheral circulation and sensation -a patient's gait -lesions, dryness, inflammation, or cracking
conduct a comprehensive assessment of a patient's total hygiene needs
-requires a nursing history and physical assessment -ask the patient about their preferred personal hygiene and grooming practices (ex. personal care products desired and preferences such as frequency, time of day, and amount of assistance needed) -determine the patient's awareness of any hygiene-related problems and their knowledge and ability to perform hygiene care measures -assess a patient's physical statues as it relates to ability to perform or assist with hygiene care safely and efficiently (include assessment of the patient's muscle strength, flexibility, balance, visual acuity, and ability to detect thermal and tactile stimuli) -perform an assessment of the skin, noting color, texture, thickness, turgor, temperature, and hydration -examine all skin surfaces of the feet, including the areas between the toes and over the entire sole of the foot -observe the patient's gait because painful foot disorders or decreased sensation may cause limping or an unnatural gait -inspect all areas of the mouth carefully for color, hydration, texture, and lesions -assess the condition of a patient's hair and scalp before performing hair care -examine the condition and function of the eyes, ears, and nose -for patients who wear eyeglasses, contact lenses, artificial eyes, or hearing aids, assess their knowledge and methods use for care and have them describe the typical approach used in routine care -assess the patient's preferences for grooming -as what makes a patient feel most comfortable during a bath or other hygiene measures -anticipate whether a patient is predisposed to risks and follow through with a complete assessment
discuss factors that influence personal hygiene practices
-some patients prefer to shower, whereas others prefer to bathe -patients select different hygiene and grooming products according to personal preferences -help patients develop know hygiene practices when indicated by an illness or condition
discuss how advancements in nursing informatics and technology have affected the nurse's role in providing patient care
-the focus of nursing informatics is on the organization, analysis, and dissemination of information -technological advancements influence where and how you provide care to patients and help you deliver evidence-based care -telemedicine/telehealth is an emerging technology that is used to improve patient outcomes by utilizing electronic medical records and video teleconferencing by health care providers and nurses to provide care from a remote location
discuss advancement; to include Advanced Practice Registered Nurse (APRN), Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Certified Nurse Midwife (CNM), and Certified Registered Nurse Anesthetist (CRNA). discuss their functions and how they differ in their education and roles
APRN -advanced practice registered nurse -most independently functioning nurse -advanced education in pathophysiology, pharmacology, and physical assessment and certification and expertise in a specialized area of practice CNS -clinical nurse specialist -an APRN who is an expert clinician in a specialized area of practice -may be identified by a population, a setting a disease specialty, a type of care, or a type of problem NP -nurse practitioner -an APRN who provides health care to a group of patients, usually in an outpatient, ambulatory care, or community-based setting -provide care for patients with complex problems and a more holistic approach than physicians -provides comprehensive care, directly managing the nursing and medical care of patients who are healthy or who have chronic conditions -established a collaborative provider-patient relationship and works with a specific group of patients or with patients of all ages and health care needs CNM -certified nurse-midwife -an APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwives -involves providing independent care for women during normal pregnancy, labor, and delivery and care for the newborn -includes some gynecological services such as routine Pap smears, family planning CRNA -certified registered nurse anesthetist -an APRN with advanced education from a nurse anesthesia-accredited program -nurse must have at least 1 year of critical care or emergency experience -provide anesthesia under the guidance and supervision on an anesthesiologist who is a physician with advanced knowledge of surgical anesthesia
explain rationale for use of CHG solution or cloths vs. soap and water in basin for bathing hospitalized patients
CHG baths are used to decrease the frequency of hospital-acquired infections on skin, invasive lines, and catheters rather than just to clean the patient
differentiate between licensure and certification
LICENSE -all boards of nursing require RN candidates to pass the NCLEX-RN -regardless of educational preparation, the examination for the RN licensure is exactly the same in every state in the US -provides a standardized minimum knowledge base for nurses CERTIFICATION -specific areas of nursing practice -minimum practice requirements are set, based on the certification the nurse seeks -national nursing organizations have many types of certification to enhance your career -after passing the initial examination, you maintain your certification by ongoing continuing education and clinical or administrative practice
discuss conditions that place patients at risk for impaired skin integrity; impaired oral mucous membranes
Oral Problems -inability to use upper extremities because of paralysis, weakness, or restriction -dehydration, inability to take fluids or food by mouth -presence of NG or oxygen tubes; mouth breathers -chemotherapeutic drugs -lozenges, cough drops, antacids, and chewable OTC vitamins -radiation therapy to head and neck -oral surgery, trauma to mouth, placement of oral airway -immunosuppression; altered blood clotting -diabetes mellitus -endotracheal intubation with mechanical ventilation -dialysis Skin Problems -immobilization -bariatric patient -reduced sensation caused by stroke, spinal cord injury, diabetes, local nerve damage -altered cognition resulting from dementia, psychological disorders, or temporary delirium -limited protein or caloric intake and reduced hydration -excessive secretion or excretion on skin from perspiration, urine, watery fecal material, and wound drainage -presence of external medical devices -vascular insufficiency
discuss the types of settings that provide various health care services and the types of services provided
PREVENTIVE AND PRIMARY HEALTH CARE -focuses on improved health outcomes for an entire population -includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunization, and control of diseases -ex. prenatal and well-baby care, nutrition counseling, family planning, exercise, yoga, and mediation classes, BP and cancer screenings, immunizations, mental health counseling and crisis prevention, community legislation SECONDARY/TERTIARY ACUTE CARE -the diagnosis and treatment of illnesses are traditionally the most common services -ex. emergency care, acute medical-surgical care, radiological procedures for acute problems, hospitals, intensive care, psychiatric facilities RESTORATIVE CARE -patients recovering from an acute or chronic illness or disability often require additional services to return to their previous level of function or reach a new level of function limited by their illness or disability -ex. home care, rehabilitation, extended care facilities CONTINUING CARE -a variety of health, personal, and social services provided over a prolonged period -for people who are disabled, who were never functionally independent, or who suffer a terminal disease -ex. assisted living, psychiatric and older adult day care, respite care, hospice
explain the impact of quality and safety initiatives on delivery of health care, especially for nursing
QSEN -quality and safety education for nurses -targets knowledge, skills, and attitudes -integrated into pre-licensure education
describe adaptations in hygiene care for a patient who is cognitively impaired, to include oral care adaptations (rationale)
patients with decreased levels of consciousness need special attention because they often do not have a gag reflex -proper oral hygiene requires keeping the mucosa moist and removing secretions that contribute to infection -pooling of salivary secretions in the back of the throat harbors microorganism growth -you must protect the patient from choking and aspirating when providing oral hygiene to an unconscious patient -use a small oral airway or a padded tongue blade to hold the mouth open
maceration
softening of tissue by soaking in fluids -routine care involves soaking the hands and feet to soften cuticles and layers of horny cells, thorough cleaning, drying, and proper nail trimming **exception is patients with diabetes mellitus or peripheral vascular disease, who are at risk for tissue ulceration or infection
describe the ANA's Standards of Practice and Standards of Professional Performance and the goal of this
the Standards of Practice describe a competent level of nursing care which are demonstrated by a critical thinking model known as the nursing process, which is the foundation of clinical decision making and includes all significant actions taken by nurses in providing care to patients 1. ASSESSMENT-the registered nurse collect comprehensive data pertinent to the patient's health and/or the situation 2. DIAGNOSIS-the registered nurse analyzes the assessment data to determine the diagnoses or issues 3. OUTCOMES IDENTIFICATION-the registered nurse identifies expected outcomes for a plan individualized to the patient or the situation 4. PLANNING-the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes 5. IMPLEMENTATION-the registered nurse implements the identified plan 5a. COORDINATION OF CARE-the registered nurse coordinates care delivery 5b. HEALTH TEACHING AND HEALTH PROMOTION-the registered nurse uses strategies to promote health and a safe environment 5c. CONSULTATION-the graduate level-prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of other, and effect change 5d. PRESCRIPTIVE AUTHORITY AND TREATMENT-the advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations 6. EVALUATION-the registered nurse evaluates progress toward attainment of outcomes the Standards of Professional Performance provide a method to assure patients that they are receiving high-quality care, that the nurses must know exactly what is necessary to provide nursing care, and that measure are in place to determine whether nursing care meets the standards ETHICS-the registered nurse practices ethically EDUCATION-the registered nurse attains knowledge and competency that reflects current nursing practice EVIDENCE-BASED PRACTICE AND RESEARCH-the registered nurse integrates evidence and research findings into practice QUALITY OF PRACTICE-the registered nurse contributes to quality nursing practice COMMUNICATION-the registered nurse communicates effectively in all areas of practice LEADERSHIP-the registered nurse demonstrates leadership in the professional practice setting and the profession COLLABORATION-the registered nurse collaborates with nurse health care consumer, family, and others in the conduct of nursing practice PROFESSIONAL PRACTICE EVALUATION-the registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations RESOURCES-the registered nurse uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible ENVIRONMENTAL HEALTH-the registered nurse practices in an environmentally safe and healthy manner
explain the purpose and function of the Nurse Practice Act
the State Boards of Nursing oversee NPAs -they regulate the scope of nursing practice and protect public health, safety, and welfare -includes shielding the public from unqualified and unsafe nurses -each state defines for itself the scope of nursing practice but most have similar NPAs -they recently expanded their scope of practice to include minimum education requirements, required certifications, and practice guidelines for APRNs such as nurse practitioners and certified RN anesthetists