Caring for Medical-Surgical Patients Chapter 1

Chapter 1 Caring for Medical-Surgical Patients  Lesson 1.1 Caring for Medical- Surgical Patients Objectives (1 of 3)  Compare the roles and functions of the licensed practical/nurse (LPN/LVN) with those of the registered nurse.  Identify sites of employment f...

Chapter 1 Caring for Medical-Surgical Patients  Lesson 1.1 Caring for Medical- Surgical Patients Objectives (1 of 3)  Compare the roles and functions of the licensed practical/nurse (LPN/LVN) with those of the registered nurse.  Identify sites of employment for LPNs/LVNs in medical- surgical nursing.  Correlate the nurse practice act and the standards of practice for the LPN/LVN that guide the practice of each nurse.  Objectives (2 of 3)  Relate how quality and safety education for nurses (QSEN) applies to LPN/LVN practice.  Demonstrate the knowledge of how evidence- based practice is formulated.  Explain the importance of National Patient Safety Goals and how they relate to patient safety.  Predict how Healthy People 2030 can decrease health care costs.  Objectives (3 of 3)  Determine how the current health care system attempts to provide health care for all.  Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare, including care excluded from reimbursement.  Describe ways to provide holistic care.  Take part in delegation of tasks to unlicensed assistive personnel.  Caring for Medical-Surgical Patients  Promote and maintain health  Prevent disease and disability  Care for individuals during rehabilitation  Assist dying patients to maintain the best quality of life possible  Use nursing process to plan and deliver safe, competent care to patient.  Roles of the LPN/LVN  Uphold clinical standards.  Provide safe patient care.  Teach patients.  Communicate effectively.  Work as a collaborative member of the health care team.  Advocate for the patient.  Leader and Delegator  Uphold clinical standards.  Delegation and assignment  Delegation involves transferring to qualified unlicensed assistive personnel (UAP) the authority to perform a selected nursing task or activity in a selected patient situation that is within the job description of the LPN/LVN.  Assignment involves assigning nursing tasks or activities within the job description of the UAP to a particular individual.  Five Rights of Delegation 1) Right task 2) Right circumstances 3) Right person 4) Right direction/communication 5) Right supervision  Employment Opportunities for LPN/LVN’s (1 of 3)  In hospitals:  Outpatient surgery  Intermediate care unit (step-down unit)  IV therapy team  Emergency department  Employment Opportunities for LPN/LVN’s (2 of 3)  Long-term care (nursing homes)  Ambulatory care  Rehabilitation services  Hospice  Group homes  Assisted-living facilities  Employment Opportunities for LPN/LVN’s (3 of 3)  Homes for developmentally disabled individuals  Home health care  Private offices  Military  Dialysis centers  Jails and prisons  Audience Response Question 1 What should the nurse consider before delegating a specific task? (Select all that apply.) 1. Know the scope of practice. 2. Be aware of the staff competency and experience. 3. Seek approval from the administration. 4. Determine stability of patient condition.  Ethical and Legal Practice  Each state’s nurse practice act defines the role and scope of practice of LPNs/LVNs.  Ethical practice means that the LPN/LVN abides by the Code for Nurses, adheres to the National Patient Safety Goals, and honors privacy via the Health Insurance Portability and Accountability Act (HIPAA).  Quality and Safety  Quality and Safety Education for Nurses (QSEN)  Patient-centered care means the patient is a full partner in decisions about his or her care.  Compassionate and coordinated care should be planned and delivered with respect for the patient’s preferences, values, and needs.  Care manager may be a designated nurse or social worker within the hospital.  Evidenced-based Practice (EBP)  Uses the best current evidence from research findings to make decisions about patient care  Five steps in the process of developing evidence-based practice  Quality Improvement  Continuous quality improvement program in place that sets standards for care  These standards are based on standards for nursing practice set by the American Nurses Association, the American Hospital Association, and The Joint Commission.  Informatics  Using information and technology to communicate, manage knowledge, prevent or mitigate error, and support decision making comprises informatics (QSEN, 2011).  The electronic medical record (EMR) or electronic health record (EHR) is at the heart of informatics.  Safety  Patients are vulnerable to injury when ill or incapacitated in the hospital.  The National Council of State Boards of Nursing (NCSBN) has identified areas where nursing practice can improve safety.  Health Care Today  Biomedicine  The goal of biomedicine is to find the cause of disease and to eliminate or correct the problem.  Complementary and alternative medicine  Patients need to be reminded that all herbals and supplements need to be included when they are asked for a list of drugs taken.  Cost containment  Healthy People 2030  Attain high-quality, longer lives free of preventable disease, disability, and the opportunities for progress.  Achieve health equity, eliminate disparities, and improve the health of all groups.  Create social and physical environments that promote good health for all.  Promote quality of life, healthy development, and healthy behaviors across all life stages.  Financing of Health care (1 of 2)  Health Insurance: Government and private funding  Fee for service  Provider  Deductible  Copayment  Co-insurance  Capitation  Medicare and Medicaid  Financing of Health care (2 of 2)  Group health insurance  Managed care  Health maintenance organizations (HMOs)  Preferred provider organizations (PPOs)  Government-sponsored health insurance  Medicare  Medicaid  Retrospective payment system  Diagnosis-related groups (DRGs)  Prospective payment system (PPS)  Providing Holistic Care  Involves being aware of and attending to the following needs of patients:  Physiologic  Psychological  Social  Cultural  Spiritual  Promoting a Therapeutic Nurse- Patient Relationship  Establish trust.  Use empathy.  Use therapeutic communication skills.  Maintain patients’ self-esteem.  Ensure pain control.  Display compassion.  Use therapeutic touch.  Audience Response Question 2 Which statement(s) indicate(s) therapeutic nurse- patient relationship? (Select all that apply.) 1. “You poor thing; I had a similar surgery.” 2. “You seem upset about your procedure.” 3. “What do you mean when you say that?” 4. “You will be fine.” 5. “May I hold your hand?”  Meeting Cultural Needs  Nurses should be open-minded, nonjudgmental, and  Take differences at face value.  Accept people as they are.  Give high-quality care.  Meeting Spiritual Needs  Patients’ beliefs and values can profoundly affect their response to these crises, attitude toward treatment, and rate of recovery.