Lecture 1A

1. Lecture 1A Patient Care Concepts; Cultural Concepts

2. 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

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

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

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

6. Using evidence-based practices • Nursing knowledge must be established through • Clinical research

7. Applying quality improvement principles • Identify • Reduce • Quality Assurance

8. Using information technology • Computers

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

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

11. Holistic Health • Treat the Whole person • Mental • Emotional • Spiritual • Physical • Social

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

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

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

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

16. Assessment • Step #1 • Involves • Collecting data • Validating the data • Organizing the data • Interpreting the data • Documenting the data

17. Assessment • Purpose of assessment: • Data collection • Types of assessment: • Comprehensive • Focused • Ongoing

18. Assessment • Comprehensive assessment • Baseline • Physical & psychosocial

19. 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

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

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

22. iClicker • 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

23. Which one of the following is objective data? • Nausea • Pain • Dizziness • Unsteady gait • Anxiety

24. Which one of the following is subjective data? • Vomiting • Warm, moist skin • Head ache • Bruise on the right arm • Temperature 99.3 o F

25. Diagnosis • Step 2 in the nursing process

26. 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.”

27. Medical vs. Nursing diagnosis

28. Medical vs. Nursing diagnosis

29. Diangosis

30. Planning & Outcome identification • Step 3 • Types of planning • Initial • Ongoing • Discharge

31. 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

32. 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

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

34. Prioritizing NrsDx • Maslow’s hierarchy of needs

35. 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

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

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

38. 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

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

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

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

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

43. 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!

44. 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)

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

46. Zone of Helpfulness Under- involved Over- involved

47. 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

48. 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

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

50. 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