Key Competencies in Medical-Surgical Nursing

Key Competencies in Medical-Surgical Nursing

• Essential knowledge domains: Anatomy & Physiology, Pathophysiology, Chemistry, Pharmacology, Microbiology
• Nursing Process components: Recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, evaluating outcomes
• Key competencies: Clinical decision-making, evidence-based care, patient-centered care, quality & safety, interprofessional practice

Accountability for Patient-Centered Care

• HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems): A survey measuring patient experience. Key areas: communication with nurses/providers, staff responsiveness, medication communication, discharge info, care transition, cleanliness, quietness, overall rating, recommendation.
• TJC (The Joint Commission): An organization accrediting most U.S. hospitals. Focus: healthcare quality & safety. National Patient Safety Goals: patient identification, safety risk identification, staff communication, health equity, medication safety, alarm safety, surgical safety, infection prevention.

Communication & Collaboration

• SBAR (Situation, Background, Assessment, Recommendation): A communication tool for safe communication in healthcare, critical in shift changes and transfers
• Hand-off communication: Essential during every shift transition & transfer to ensure consistent patient care

QSEN Focus

• Quality & Safety Education for Nurses (QSEN): Emphasizes Patient-centered care, quality improvement, teamwork & collaboration, safety, evidence-based practice, informatics

Interprofessional Collaboration

• Definition: Two or more professionals working together to solve problems/coordinate care.
• Effect on patient care: Improves patient outcomes, reduces adverse drug reactions, avoids emergency hospitalizations, optimizes medication dosages
• Incorporating the patient: Communication, shared decision-making & comprehensive care plans

Patient Education and Cultural Considerations

• "Teach-back": Ensuring patient understanding by asking them to repeat information/directions.
• Cultural humility: Self-evaluating biases, self-critique and reflection toward flexibility and openness for patient interactions
• Cultural awareness: Recognizing how personal beliefs influence views of others' cultural health beliefs.
• Cultural sensitivity: Person-centered care grounded in appreciating one's own and others' cultural practices/beliefs
• Health disparities: Disadvantages stemming from social, economic, or environmental factors. Disadvantage categories include age, disability, economic instability, education level, gender, income inequality, language proficiency, mental health condition, race, sexuality, geography

Managing Language Barriers

• Solution: Interpreters or resources in different languages

Age-Related Changes

• Senescence: Normal age-related organ system changes.
• Common terms: Sclerosis (hardening), Stenosis (narrowing), Atrophy (wasting), Calcification (calcium deposits), Decreased elasticity
• Impact: Difficulty maintaining homeostasis (body's balance). Homeostenosis = failure of homeostasis.
• Important tables: Review tables 6.1, 6.2, 6.3, 6.4, 6.5, 6.8 in Chapter 6

Patient Safety & Falls

• Risk factors for falls (older adults): Impaired eyesight, slower body systems, stairs, rugs, poor lighting, pets, lack of clear walkways
• Prevention: Community resources, encourage physical activity, be aware of environmental hazards

Dementia vs. Delirium

• Delirium: Acute, reversible, commonly found in older adults.
• Dementia: Progressive cognitive decline, impacting social/occupational function.

Chronic Diseases

• Patient management: Empowering patients, educating individuals and their families, encouraging health promotion and including caregivers for support.
• Impact on patients & family: Family strain, caregiver strain, financial strain, chronic sorrow, spiritual distress, powerlessness
• Coping strategies: Educate, encourage, offer help, include family/caregivers, offer resources

Skin Assessment & Wounds

• Important factors in medical history: Medications, family history, environmental/social history
• Braden Scale: Assessing risk of pressure injuries. Higher scores are better. Scores of 1 or 2 in mobility are sensitive indicators. Scores of 18 or lower necessitate clinical decision-making for prevention strategies.
• Wound bed assessment terms: (Specific terms should be reviewed from Chapter 50)
• Skin conditions:(Specific descriptions should be reviewed from Chapter 50)
• Psoriasis patient education: Educate on medications, side effects, skin assessment during phototherapy, handwashing, adverse reactions, infection signs, sunlight avoidance (if applicable), daily skin checks
• Contagious skin conditions: Fungal infections (e.g., tinea capitis, corporis, cruris, faciei, pedis, versicolor)

Obesity

• Pathophysiology: (Review chapter's description)
• Risk factors: DM2, heart disease, metabolic syndrome, airway obstruction, chronic kidney disease, NAFLD, infertility issues, GERD, cancer, increased medication use, stroke, sleep apnea, osteoarthritis, decreased glomerular filtration and psychosocial health
• Bariatric surgery benefits: Weight loss, improved health/mental health, reduced medication/risk, increased physical activity/fertility.
• Surgical procedures: Restrictive (adjustable banding, sleeve gastrectomy, duodenal switch, inflatable intragastric balloon), malabsorptive (jejunileal bypass, biliopancreatic diversion), combination (Roux-en-Y gastric bypass)
• Complications: (Short-term and long-term). Review specific complications for each type of procedure
• Post-op assessment: Monitoring for complications, supporting dietary/lifestyle changes, nutritional deficiencies, and advocacy for social support
• Dumping syndrome: Rapid emptying of stomach contents into small intestine. Symptoms: nausea, vomiting, cramps, diarrhea, dizziness, etc. Nursing education: incentive spirometry, compression devices, ambulation, lifting restrictions, recovery activity, diet restrictions, medication side effects, wound & drain care, support groups