Module 7 Outcomes - Notes PDF

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Module 7 Learning Outcomes: Health & Wellness

Safety

MO.1: Describe components of the National Patient Safety Goals. CO.2 National Patient Safety Goals (NPSGs): areas of patient safety concern identified annually by the Joint Commission that, if rectified, may have the most positive impact on improving patient care and outcomes. The Joint Commission is a nonprofit organization that accredits hospitals and health care organizations. -

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Recently adopted NPSGs revolve around identifying patients correctly, improving staff communication, using medications safely, using alarms safely, preventing infections, identifying patient safety risks, and preventing surgery-related mistakes. The Joint Commission provides Evidence Based Practice solutions for these NPSGs. Core measures: benchmark standards of best practices used to gauge how well a hospital gives care to its patients who are admitted seeking treatment for a specific disease (e.g., heart failure) or who need a specific treatment (e.g., an immunization). The percentage of the patients who receive the best care or treatment as specified at a given hospital is then calculated and reported so that hospitals can use those results to continue to improve processes and performance until they consistently meet the best practice standards 100% of the time.

MO.2: Describe the principal criteria included in a client safety assessment. CO.2 When performing a safety assessment, the nurse focuses on three categories: the person, the environment, and specific risk factors. Assessing the person: -

Be alert to any history of falls or accidents, because a person with a history of falling is twice as likely to fall again. Note assistive devices that the patient uses. Be alert to any history of drug or alcohol abuse. Assess the patient’s mobility status, ability to communicate, level of awareness or orientation, and sensory perception in the physical examination.

Assessing the Environment: -

Hazards in the home, community, and health care facility may cause injury. Environmental safety hazards can result in falls, fires, poisoning, suffocation, and accidents involving motor vehicles, equipment, and procedures.

Assessing for Specific Risk Factors:

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Assessment of the risk for falling includes the use of nursing history and physical examination. Falls can be categorized as either accidental (clutter or a spill cause a person to trip), an anticipated physiologic fall (a direct consequence of gait imbalances, effects of medication, or dementia), unanticipated physiologic falls (caused by unknown or unexpected medical issues such as a stroke or seizure), or intentional falls (occur when patients act out behaviorally with intent to fall).

MO.3: Select an example of anticipatory guidance. CO.2 Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event. -

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Nurses use this technique when they teach patients about procedures and the surgical experience. When patients know what to expect, their anxiety is reduced, and their coping mechanisms are more effective. Example: before performing a painful procedure (such as ambulating for the first time after surgery), teaching would include information about the pain involved, including onset, severity, cause, and methods of relief. With this knowledge, the patient feels less threatened and tolerates the procedure more easily.

MO.4: Define and describe safety across the lifespan. CO.2 Health care needs and safety risks change as people progress from infancy to the older adult stage. -

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Safety risks exist from conception. Studies have confirmed, for example, that pregnant women who use drugs, consume alcohol, or smoke expose their unborn children to substances that may adversely affect the normal growth and development of the fetus. For children, potential hazards multiply as their motor skills develop and their environment expands. Nurses promote safe sleeping practices for infants when they advise parents to avoid stuffed animals and crib bumpers that increase the risk for suffocation. The risk of falling is noticeably higher for children. Toddlers are increasingly active and need appropriate safeguards to prevent falls in the home. Outdoor play and the associated injuries become an issue in the years between toddlerhood and adolescence. Adolescents face dangers when they abuse drugs/alcohol or engage in high-risk sexual activity. Outcomes of these unsafe behaviors include alcohol-related motor vehicle accidents, pregnancy, sexually transmitted infections (STIs), and suicide. Drug and/or alcohol abuse are concerns for young and middle-aged adults employed in stressful work environments. Older adults experiencing altered balance or decline in cognitive abilities are increasingly vulnerable to falls and episodes of confusion. Nurses have first-hand experience with the specific hazards confronting each age group and situation.

MO.5: Identify the correct use of infant and child car seats. CO.2 At a minimum, toddlers should be in a rear-facing car seat with harness straps and a clip until 2 years of age. After age 2 years, a forward-facing seat may be used. (A) A lower anchor and top tether secure the forward-facing car seat. (B) The shoulder safety strap may also be used to secure the toddler seat. If a child younger than 12 years of age must sit in the front seat because there are not enough rear seats available, then the front passenger seat air bag should be deactivated.

MO.6: Apply knowledge of client pathophysiology to home safety interventions. CO.2 (Taylor Ch. 27) Nursing interventions are designed for each developmental level as well as for specific hazards in the environment. Adults who are developmentally disabled or who are experiencing dementia or delirium may require the same safety measures typically considered for children. Injury control includes preventing injuries, providing acute care for injured patients, and rehabilitation services. Home safety assessment and modification interventions effectively reduced both the rate of falls and risk of falling in older adults living in the community, especially those at high risk of falling. -

Older adults are not the only population at high risk for falling. Falls are the leading cause of nonfatal injuries for all children of ages 0 to 19.

Nurses need to review existing fire prevention strategies and escape plans in their home safety assessment. Additionally, home safety interventions should be developed in homes to prevent poisoning, asphyxiation or choking and to teach about firearm and electrical safety.

MO.7: Identify factors that influence accident/injury prevention (e.g., age, developmental stage, lifestyle, mental status). CO.2 Motor vehicle accidents, drowning, choking, burns, falls, and poisoning are the most common injuries suffered by toddlers. -

Never leave a toddler unsupervised out of doors. Lock doors to dangerous rooms. Install safety gates at the top and bottom of staircases. Keep pot handles on the stove turned inward, out of an inquisitive toddler’s reach. Teach the toddler to avoid the oven, stove, and iron. Keep electrical equipment, cords, and matches out of reach. Remove firearms from the home/keep them in a locked cabinet.

Preschoolers are at an ideal age to be taught about safety and safe behaviors. They are capable of learning safe behaviors but may not always be able to transfer those behaviors to a different situation. Parents must continue to closely supervise preschool children to avoid accidental injury during this period. -

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Five years of age is an appropriate time for a child to learn to swim. Parents and caregivers should be trained in infant/child CPR. Home swimming pools should have life-saving devices. Should be taught never to dive into water and should not be left unattended. Should never be allowed to swim in a canal or any fast-moving water and should wear a personal flotation device on boats. Caution of young children walking, skating, or riding near thin or weak ice.

School-age children become more independent with age which leads to an increased selfconfidence and decreased fears, which may contribute to accidents and injuries. -

Peers may influence his or her behavior; may also increase exposure to dangerous situations such as the approach of strangers or unsafe streets. Children younger than 13 years of age should not ride in the front seat of a vehicle with an airbag. Teach to look both ways when crossing street, wear helmet with bike, teach fire and water safety.

The typical adolescent is opposed to authority and is interested in showing peers and others his or her independence. It is also normal for teens to take risks. These factors coupled with inexperience with driving may lead to underestimating hazardous and dangerous situations. -

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Promote driver education, to teach about the importance of wearing seat belts, and to explain laws about teen driving and curfews. Explain gun safety. Educate adolescents about the risk of tattooing including blood-borne infections, such as hepatitis B and C, HIV, skin infections, scarring, bleeding, and allergic reactions to dyes used in the tattoo process. Promote education on sexuality and proper media use.

MO.8: Describe what constitutes Standard Precautions. CO.2 Standard precautions: precautions used in the care of all hospitalized patients regardless of their diagnosis or possible infection status. -

Apply to blood, all body fluids, secretions, excretions except sweat (whether or not blood is present or visible), non-intact skin, and mucous membranes. Additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures.

(Transmission-based precautions is the second tier designated by CDC used in addition to standard precaution)

Self/Leadership

MO.9: Define and describe normal wellness of self-concept throughout the lifespan (Ex: Freud). CO.1 (Taylor Ch. 41) p. 1638 Self-concept: mental image or picture of self; includes body image, subjective self, ideal self, and social self. Has the power to either encourage or thwart personal growth. -

Specific components: personal identity, body image, self-esteem, and role performance. Global self: composite of all the basic facts, qualities, traits, images, and feelings people hold about themselves.

Certain inborn tendencies, such as temperament, when interacting with social and interpersonal experiences, are crucial in the formation of self-concept. Psychoanalysts have also emphasized the importance of inborn traits, such as innate aggression, because they affect a child’s interpersonal experiences and shape self-concept (Freud). Stages in the development of the self include self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6 to 7 years). -

Developmental considerations Culture: family, peer group Internal and External Resources History of Success and Failure Crises/Life stressors Aging, illness trauma

Formation of self-concept is further described in developmental theories, especially in Erikson’s stages of development, Piaget’s cognitive developmental stages, and Havighurst’s developmental tasks. P. 1637

MO.10: Identify personal traits of a leader. CO.3 Leaders value learning and must be knowledgeable. Also good to be flexible, charismatic, dynamic, enthusiastic, poised, confident, and self-directed. -

Commitment to excellence, Problem-solving skills, Commitment to and passion for your work, Trustworthiness and integrity, Respectfulness, Accessibility, Empathy and caring, Desire to be of service, Responsibility to enhance the personal growth of all staff.

Autocratic leadership, also called directive leadership or authoritarian leadership.

Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants. Laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Servant leadership is a philosophy and set of practices that enriches the lives of individuals, builds better organizations, and ultimately creates a more just and caring world. Quantum leadership theory views an organization and its members as interconnected and collaborative—a helpful approach when unpredictable events and changing environments present themselves. Transactional leadership style is based on a task-and-reward orientation. Transformational leadership can create revolutionary change.

MO.11: Identify workplace goals in the nursing profession. CO.3 Promoting, maintaining, and restoring health. Planning, organizing, staffing, directing, controlling, collaborating. There are more than 100 professional organizations address specialty interests, goals, and purposes, as well as advocate for nurses and nursing.

Stress & Coping

MO.12: Define and describe stress and coping as it relates to wellness, as well as the effect of resilience on stress and coping. CO.2 (ATI Ch. 33) Stress can impair and weaken the immune system. Causal factor in numerous health conditions. Can delay return to health like an infection delays healing of wound. Stressors can be physiologic or psychosocial. A physiologic stressor may cause psychosocial stress, and vice versa. -

Situational stressors- stressful job, role changes Developmental- losing parents, having baby, getting married Sociocultural factors- substance use, poverty, poor education

Nursing advise to reduce stress: exercise, journal writing, assertiveness training, workplace stress management, yoga, medication, good nutrition, adequate sleep/rest. Coping is how individuals deal with problems/issues (managing stress). Unique to each individual and can vary with each stressor.

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Influencing factors: number, duration, intensity of stressors, past experiences, current support system, available resources.

To promote coping, identify client’s strengths and weaknesses, decision making. Adaptation is coping behavior that describes how individual handles demands of environment. -

General adaptation syndrome (GAS) – “stress syndrome” o Alarm stage- body functions heightened; fight or flight. o Resistance stage: body functions normalize and respond to stressor. Attempts to cope and return to homeostasis. o Exhaustion stage: body functions no longer maintain response and cannot adapt. Results in recovery or death

Adherence is the ability of client and family to follow a given treatment regimen. Simplify as much as possible. Allostasis to describe this process of achieving stability or homeostasis through physiologic or behavioral change. Resilience: the capacity to thrive not only in spite of, but because of, challenges. Here are a few hints for developing resilience: -

Begin and end the day with gratitude. Practice mindfulness: What is the most important thing right now? See Chapter 1. Appreciate that all humans are limited; some things can’t be “fixed.” Appreciate the power of connectedness and presence. Stop frequently to stretch and take deep diaphragmatic breaths. Reflect frequently on what brings you joy, makes you smile. Keep a positive, hopeful outlook. Hope allows us to envision a positive future and work to bring this into being.

Ponte and Koppel (2015) recommend using the STOP technique to reduce stress and be able to respond more skillfully during challenging times. -

S—Stop and take a step back T—Take a few breaths O—Observe inside yourself P—Proceed after you pause....