Unit 1: Introduction to MedSurge PDF

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From first real Medsurge lecture. Unit 1 is on the first exam....

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Unit 1: Care of the Patient in the Acute Care Setting January 25, 2019 Multiple Roles of the Professional Nurse: What is Nursing?: 

Definitions of Nursing: o ANA (American Nursing Association)  Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations o Florence Nightingale o Henderson

Nursing Practice:  

Domains of nursing practice Nursing’s view of humanity o Physiologic (biophysical) o Psychologic (emotional) o Sociocultural (interpersonal) o Spiritual o Environmental

Roles of the professional nurse:      

Autonomy & Accountability Caregiver Advocate Educator Communicator Manager

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Basically need a doctor’s order for everything (Tylenol, oxygen, etc.) o Sometimes obtain doctors order after ex. Patient in respiratory distress give them oxygen then obtain order

Influences on professional nursing practice: 

Quality and Safety Education for Nurses (QSEN) o *Six Core Competencies* 1.) Patient-Centered Care 2.) Teamwork and Collaboration

3.) Safety 4.) Quality Improvement 5.) Informatics and Technology 6.) Evidence-Based Practice *Competency 1: Patient-Centered Care:  

Recognizes the patient and caregivers as full partners in providing compassionate and coordinated care based on respect for patients’ preferences, values and needs Knowledge, Skills & Attitudes o Provide care with sensitivity and respect o Assess level of comfort and treat appropriately o Engage the patient in an active partnership o Facilitate patient’s informed consent for care

*Competency 2: Teamwork and Collaboration: 

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Function effectively within nursing and interprofessional teams o Interprofessional Team  Providers from various disciplines (physicians, nurses, pharmacists, occupational and physical therapists, social workers) Knowledge, Skills & Attitudes: o Value the skill and enterprise of each interprofessional member o Initiate referrals when appropriate o Follow communication practices that minimize risks with handoffs and transitions in care  Effective communication is a key component  Structured model for communication  SBAR (Situation-Background-AssessmentRecommendation) o Participate in interprofessional rounds

Communication:    

S-Situation B-Background A-Assessment R-Recommendation/ Request

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Hand-off Communication o Standardized and verbal o Allow for questions and exchange of information

*Competency 3: Safety:  

Minimize risk of harm to patients Knowledge, Skills & Attitudes: o Follow recommendations from national safety campaigns o Appropriately communicate observations or concerns to hazards and errors o Contribute to designing systems to improve safety

*Competency 4: Quality Improvement:  

Use data to monitor the outcomes of care and to improve the quality and safety of healthcare systems Knowledge, Skills and Attitudes: o Use quality measures to understand performance o Identify gaps between local and best practices o Participate in investigating the circumstances surrounding a sentinel event or serious reportable event

*Competency 5: Informatics:  

Use information and technology to communicate, manage knowledge, reduce errors and support decision making Knowledge, Skills and Attitudes: o Protect confidentiality of patients protected health information

o Document appropriately in electronic health records o Use communication technologies to coordinate patient care o Respond correctly to clinical decision-making alerts *Competency 6: Evidence Based Practice:  

Integrate best current evidence with clinical expertise and the patient/family preferences and values for delivery of optimal health care Knowledge, Skills and Attitudes: o Read research, clinical practice guidelines and evidence reports related to areas of practice o Base individual patient care plan on patients’ values, clinical expertise and evidence o Continuously improve practice based on new knowledge

Impact of Nursing Research on Nursing Care: Evidence Based Practice: 

The need for evidence-based practice o Evidence-based care  Improves quality, safety, and patient outcomes  Increases nurse satisfaction  Reduces costs o Sources of evidence  Textbooks  Articles from nursing and health care literature  Quality improvement and risk management data  Standards of care  Infection control data  Benchmarking, retrospective, or concurrent chart reviews  Clinicians expertise

Steps of Evidence-Based Practice:       

Cultivate a spirit of inquiry Ask a clinical question in PICOT format Search for the most relevant evidence Critically appraise the evidence you gather Integrate all evidence with your clinical expertise and patient preferences and values Evaluate the outcomes of practice decisions or changes using evidence Share the outcomes with others

Delegation: 

Need to know what other personnel are allowed to do

o Licensed practical/vocational nurses (LPN/LVN)  Gather data, follow care plan, nursing tasks/med administration (no IV medications)  No assessment, analysis, or evaluation o Certified Nursing Assistant/ Unlicensed assistive personnel (CAN/UAP)  Task oriented (VS, bed baths, blood draws) o Hospital Policy o Do they have knowledge to perform the task? o Communicate task clearly and ask them if they understand what the task is 5 Rights of Delegation:     

Right task Right circumstances Right person Right direction/communication Right supervision

Legal Issues: 

In order to provide safe and competent care nurses need to have: o Clinical reasoning o Understanding of legal framework of healthcare o Understanding of the Nurse Practice Act in the state where they practice o Understanding of the scope and standards of nursing practice o Critical thinking

Professional Nursing Code of Ethics: 

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Code of nursing ethics o A set of guiding principles that all members of a professions accept o Helps professional groups settle questions about practice or behavior o Includes advocacy, responsibility, accountability, and confidentiality Social networking o Presents ethical challenges for nurses

Issues in Health Care Ethics:    

Quality of life: central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR) Disabilities: Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges Care at the end of life: Interventions unlikely to produce benefit for the patient Health care reform: facilitated access to care for millions of uninsured Americans

Nursing Care of the Hospitalized Client: Levels of Prevention in the Acute Care Setting: 

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Primary Prevention o Precedes disease or dysfunction o Applied to people considered physically and emotionally healthy o Includes health promotion efforts and wellness education o Primary doctor Secondary Prevention o Focus on people with a health problem or illness and are at risk for developing complications or a worsening condition o Includes diagnosis and prompt interventions o Care delivered in homes, hospitals, and skilled nursing facilities o Screening activities very important Tertiary Prevention o Defect or disability is permanent or irreversible (chronic) o Activities focus on rehabilitation; prevent complications and deterioration o Help people achieve highest level of functioning that is possible

Methods and Models of Care Delivery in the Acute Care Setting:  

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Acute Care (hospitals) (secondary and tertiary prevention) Diagnosis and treatment of illness o Hospital emergency department o Urgent care centers o Critical care units o Inpatient medical-surgical units Patients sicker, more complex, not stable

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Limited inpatient days due to managed care o Role of case manager Nursing care depends on: o Communication o Collaboration/ interprofessional care o Critical thinking o Evidence-based care to improve patient outcomes

Acute Illness with Multiple Chronic Illnesses (Comorbidities):

Complexities of Acute Illness and Comorbidities:  

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Acute Illness with multiple chronic illnesses (Co-Morbidities) Chronic disease accounts for 70% of deaths in U.S. o Arthritis o Cancer o Diabetes o CAD, stroke o Obesity o COPD o CHF Complexity of care o Need to monitor status/deterioration of acute disease and co-morbidities

o Treatment of acute illness may exacerbate chronic illness o Chronic illness may make it harder to treat acute illness o Interactions of treatments/medications Trajectory of Chronic Illness:    

Can repeat many times Treat acute symptoms Return to baseline Patient teaching to prevent recurrent exacerbations

Current Trends in Health Care Delivery: Complex Health Care Environment: 

Clinical decision making o Problem-solving activity in which critical thinking is used to make decisions that lead to the best patient outcomes o Dynamic process that involves  Knowledge of clinical problems  Patient information  Available treatment options

Current Trends in Health Care Delivery: Influences on the Health Care System: 

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Health care financing- efforts to provide more cost-effective care o Prospective payment systems o Managed care systems o Reimburse hospitals for their performance on quality-of-care measures o Withhold payment for care if patients develop certain healthcare conditions during hospital stay  Considered preventable—pressure ulcer, CAUTI Changing populations o Aging population o Cultural diversity Expanding medical knowledge and technology Health disparities Consumerism- more informed clients

Reducing Health Disparities & Increasing Cultural Competency:   

Nurse’s self-assessment Patient assessment Nursing implementation o Advocacy o Community advisory group o Standardized guidelines o Communication

Discharge Planning:   

Discharge planning begins the moment a patient is admitted to a healthcare facility Involves patients and families Case management: o Collaborative process  Managing care across multiple settings and multiple levels of care

Restorative Care:   

Serves patients recovering from an acute or chronic illness/disability Helps individuals regain maximal function and enhance quality of life Examples: o Home health care  Includes nursing, medical and social services; physical, occupational, speech, and respiratory therapy; and nutritional therapy o Rehabilitation

Includes physical, occupational, and speech therapy, and social services o Extended Care  Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities  Extended care facilities include intermediate care and skilled nursing facilities 

Continuing Care: 

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A variety of health, personal, and social services provided over a long period of time for individuals who are: o Disabled o Unable to function independently o Suffer from a terminal illness Available within institutional settings or in the home: o Nursing centers or facilities o Assisted living o Respite care o Adult day care centers o Hospice...