NURS4414: Health and Safety Legislation

Legislation and Health and Safety

• The Health and Safety at Work Act of 2015 requires employers and employees to identify and assess hazards, control hazards, and notify accidents.
• Employers' responsibilities include: • Providing a safe place of work • Providing instructions and training • Regularly assessing risks • Providing safe equipment • Providing safe systems of work • Providing safe access and egress to emergency drills, evacuation, and sign alarms • Providing personal protective equipment (PPE)
• Employees' responsibilities include: • Familiarizing themselves with policies and procedures • Familiarizing themselves with emergency and evacuation procedures • Using PPE correctly • Reporting defects in fixtures, fittings, and equipment • Caring for their own and others' safety and health

General Hazards in Healthcare Settings

• Physical hazards
• Chemical hazards
• Clinical hazards
• Biological hazards
• Infection control hazards
• Security hazards
• Data protection hazards

Healthcare Waste

• Sharps safety: place sharps in yellow plastic sharps containers
• Linen: use color-coded systems
• Infectious wastes: use yellow biohazard bags and personal protective equipment (PPE); use safe handling techniques; and be aware of spills

Emergency Procedures

• RACE (Remove, Announce, Contain, Extinguish, and Evacuate) for fire safety
• Be aware of local emergency procedures (e.g. fire safety, civil defense emergencies, intruders, gas, and local flooding)
• Identify emergency exits and equipment
• Participate in emergency drills
• Observe "NO SMOKING" requirements
• Evacuation principles: • Remove from immediate danger • Remove to a safe place beyond doors and fire doors • Evacuate the building
• Order of evacuation: • Ambulant (1) - patients/residents who can walk • Semi-ambulant (2) - patients/residents who need assistance with wheelchairs and walkers • Non-ambulant (3) - patients/residents who are unable to walk

Hazard Management

• Local systems for identifying and managing risks include: • Hazard registers • Identifying actual and potential hazards • Reporting hazards, incidents, and adverse events
• Hazard management strategies: • Eliminate • Isolate • Minimise
• Reporting hazards and incidents is important to: • Generate a database • Identify hazards and adverse events • Evaluate response to adverse events • Continuously improve safety and welfare of the environment • Improve procedures for reducing, controlling, and managing adverse events

Hand Hygiene

• Hand hygiene is the most important element of standard precautions
• Removes microorganisms such as bugs and germs from hands
• Reduces the risk of person-to-person transmission of harmful organisms
• 5 Moments of Hand Hygiene: • Before touching a patient • Before a procedure • After a procedure or body fluid exposure risk • After touching a patient • After touching a patient's surroundings

Personal Protective Equipment (PPE)

• The purpose of using gloves: • Unsterile gloves for contact with body fluids • Sterile gloves for sterile procedures
• The purpose of using gowns: • To prevent contamination of clothing and act as a barrier isolation
• Face protection: • Goggles: must fit snug over and around eyes • Face shields/visor masks: must cover forehead, extend below chin, and wrap around the side of the face • Masks: must cover nose and mouth and prevent fluid penetration • N95 masks: disposable, high-filtration face masks or particulate respirators

Infection Control

• Chain of infection: • Infectious agent • Source • Portal of exit • Means/modes of transmission • Portal of entry • Susceptible host
• Standard precautions: • Effective hand hygiene • Personal hygiene • Personal protective equipment (PPE) • Aseptic technique • Sharps safety
• Examples of patients at risk: • Dyspnoeic clients • Patients who are febrile and dehydrated • Patients who are taking medications • Patients who are unable to care for themselves • Patients with impaired movement • Patients with feeding tubes or catheters • Patients with dentures or partial plates

Hygiene Care

• Factors affecting hygiene care (SLAPEECKE): • Stage of development • Level of independence • Availability of facilities • Physical and cognitive ability • Environment • Economic status • Choice • Knowledge • Emotional
• Patients/clients at risk: • Dyspnoeic clients • Patients who are febrile and dehydrated • Patients who are taking medications • Patients who are unable to care for themselves • Patients with impaired movement • Patients with feeding tubes or catheters • Patients with dentures or partial plates
• Hygiene cares: • Bathing and hygiene • Oral care • Toileting • Dressing • Grooming
• Nursing observations and assessments to look out for when bathing older adults: • Observation • Mobility • Sensation • Mood • Skin condition • Change in ability

Elimination: Urinary and Urinalysis

• Urinary retention: • Accumulation of urine in the bladder • Inability to empty urine in the bladder
• Residual urine: • Urine retained in the bladder after voiding
• Incontinence: • Loss of voluntary control to void • Possible causes: infection, nerve damage, spinal cord damage, or the aging process
• Urinary terminologies: • Frequency: abnormal frequent urination • Urgency: abrupt, strong need to urinate • Nocturia: frequent urination at night • Oliguria: low passing urine, less than 500 mls/24hr • Enuresis: involuntary discharge of urine • Renal anuria: cessation of urine production, less than 100 mls/24hr

Urinalysis

• Reagent strips: used to screen urine samples • Leukocytes and nitrates: sign of possible UTI • Protein: sign of kidney damage • Ketones or glucose: sign of kidney damage • Blood: sign of kidney disease • Bilirubin: sign of liver damage • pH levels: measures acidity or alkalinity/acid-base balance of the body • Specific gravity: gives measure of concentration of components of urine sample

• Abnormal results: • pH levels: acidosis or alkalosis • Protein: proteinuria • Glucose and ketones: ketoacidosis • Blood: haematuria • Bilirubin and urobilinogen: liver or gallbladder disease### Urinary Elimination

• Incontinence is the loss of bladder control.

• Urinary retention is the inability to empty the bladder completely.

• Residual urine is the urine retained in the bladder after voiding.

• Enuresis is bed-wetting or nighttime loss of bladder control.

Bowel Elimination

• The function of bowel elimination is to excrete and eliminate waste products of digestion.
• Determinants that affect elimination include dietary patterns and fluid intake.
• A daily fluid intake of 6-8 glasses of water (1400-2000ml) helps to liquify stool and stimulate peristalsis.

Factors Affecting Elimination

Fibre

• Fibre is an undigestible residue that provides bulk to stool, absorbs fluids, and increases stool mass, triggering peristalsis.

Personal Habits

• Postponing bowel movements can lead to constipation.

Activity and Exercise

• Immobile activity can lead to constipation.

Medications

• Laxatives stimulate evacuation of bowels.
• Morphine and narcotics with codeine can harden stool, cause constipation, and slow down peristalsis.

Emotions

• Anxiety can increase peristalsis and cause diarrhea.
• Depression can lead to low peristalsis.

Pain

Surgery

• Anaesthetics can cause temporary cessation of peristalsis.
• Direct manipulation of the bowel during abdominal surgery can stop peristalsis.
• Paralytic ileus is a temporary paralysis of intestinal muscles.

Common Problems of Elimination

• Constipation is the difficult passage of dry stool.
• Faecal impaction is a large, hard mass of stool stuck in the rectum.
• Diarrhea is a liquid stool.
• Flatulence is the accumulation and expulsion of gas from the digestive system.
• Incontinence is the inability to control passage of stool.
• Haemorrhoids are swollen, inflamed veins in the rectum or anus.

Promoting Healthy Bowel Elimination

• Privacy and comfort can aid bowel elimination.
• Squatting position and bedpan position can aid bowel evacuation.
• Cathartics, laxatives, and enemas can help induce bowel movements.
• Stool softeners and anti-diarrheal agents can aid bowel elimination.

Assisting with Elimination

• Residents often have the urge to defecate after one hour of a meal.
• Bedpans, urinals, and commodes can aid bowel elimination.

Causes of Constipation in the Elderly

• Reduced activity, fibre intake, and fluid intake contribute to constipation.
• Side effects of medications and co-existing medical conditions can also contribute to constipation.

Secondary Causes of Constipation in the Elderly

• Depression, dementia, diabetes, hypercalcaemia, hypothyroidism, stroke, and Parkinson's disease can contribute to constipation.

Skin Care

• Urinary and faecal incontinence can cause skin damage and irritation.
• Skin dampness is the main cause of perineal dermatitis.
• Incontinence dermatitis is skin irritation and inflammation caused by prolonged contact with urine or faeces.

Risk Factors for Impaired Skin Integrity

• Reduced mobility, immunodeficiency, nutritional deficiencies, pressure, altered circulation, psychosocial disorders, and increased excretions contribute to impaired skin integrity.

Nutrition and Fluid Balance: Older Adults

• Nutrition is the process that involves taking in nutrients for proper body functioning and maintenance of health.

Factors Affecting Nutrition in Older Persons

• Reduced saliva and dry mouth, reduced sensory ability, reduced strength, and malabsorption affect nutrition in older persons.
• Arthritis, eyesight changes, taste and smell changes, swallowing and chewing problems, and oral problems also affect nutrition.
• Income, health, and medications can also affect nutrition in older persons.

Terminologies

• Aphagia is the complete inability to swallow.
• Dysphagia is the difficulty or discomfort in swallowing.
• Aspiration pneumonia is the inflammatory condition of lungs and bronchi due to inhalation of foreign material like food and vomit.