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UnrestrictedSitar3693

Uploaded by UnrestrictedSitar3693

University of Arkansas – Fort Smith

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nursing standards nursing practices healthcare patient safety

Summary

This document outlines nursing standards and best practices, emphasizing patient safety and ethical care. It also describes different levels of healthcare and evidence-based approaches. The document further touches on fall risk assessment.

Full Transcript

Nursing standards play a crucial role in ensuring high-quality and consistent nursing care. They define the scope of nursing practice, outline the responsibilities and expectations of nurses, and serve as guidelines for providing safe and effective patient care. Nursing standards influence various a...

Nursing standards play a crucial role in ensuring high-quality and consistent nursing care. They define the scope of nursing practice, outline the responsibilities and expectations of nurses, and serve as guidelines for providing safe and effective patient care. Nursing standards influence various aspects of nursing care, including:\ \ 1. Establishing best practices: Standards are derived from evidence-based knowledge, guidelines, and recommendations from professional organizations. They outline the appropriate procedures, interventions, and care plans for specific conditions or situations, ensuring that nurses provide care based on the latest research and best practices.\ \ 2. Promoting patient safety: Standards emphasize patient safety by providing guidelines for procedures such as intravenous therapy, infection control, and medication administration. Following these standards helps nurses minimize risks and prevent complications, ultimately improving patient outcomes.\ \ 3. Maintaining ethical practice: Nursing standards incorporate ethical principles and values, guiding nurses in making ethical decisions that respect patient autonomy, promote beneficence, and uphold professional integrity.\ \ 4. Ensuring competency: Standards outline the knowledge, skills, and behaviors expected of nurses, helping them maintain competency and professionalism in their practice. This includes effective communication, collaboration with the healthcare team, and continuous professional development.\ \ 5. Providing a legal framework: Nursing standards serve as a legal reference for evaluating the quality of nursing care. They can be used as benchmarks in legal cases involving nurses, ensuring that their actions are consistent with accepted professional standards.\ \ By adhering to nursing standards, nurses can provide consistent, evidence-based, and ethical care that meets the expectations of the profession and promotes positive patient outcomes. ### Nurses and healthcare professionals provide primary, secondary, and tertiary healthcare in various settings: Primary care is typically provided in outpatient clinics, physician offices, community health centers, school-based clinics, and patients\' homes. Nurses in these settings focus on health promotion, disease prevention, and management of chronic conditions. Secondary care involves specialized treatment for acute illnesses or injuries. It is provided in hospitals, emergency departments, specialty clinics (e.g. cardiology, oncology), and ambulatory surgery centers. Nurses monitor patients\' conditions, administer treatments, and provide education. Tertiary care addresses complex, rare or high-risk conditions requiring highly specialized expertise and technology. It is delivered in academic medical centers, specialty hospitals (e.g. children\'s hospitals, cancer centers), and advanced diagnostic and treatment facilities. Nurses collaborate with multidisciplinary teams to provide intensive, complex care. Across all levels, nurses play vital roles in assessment, treatment, education, care coordination, and supporting patients and families throughout the healthcare continuum. ### Evidence-based practice (EBP), research, and performance improvement (PI) are closely interrelated processes that exist along a continuum of clinical scholarship. All three aim to use the best available evidence to provide high-quality patient care, but they differ in their specific goals and methods. Similarities: - All three processes involve identifying clinical problems or areas for improvement. - They require gathering and analyzing data or evidence. - The ultimate goal is to enhance patient care and outcomes. Differences: - EBP focuses on implementing the best available research evidence into clinical practice to improve care delivery. - Research aims to generate new knowledge through systematic investigation and analysis. - PI involves ongoing monitoring and evaluation of organizational processes and outcomes to identify and address areas for improvement. EBP and PI often reveal problems that create opportunities for research. For example, if a PI project identifies an issue with patient satisfaction related to pain management, a research study may be conducted to further investigate the factors influencing this problem. Research findings can inform EBP projects by providing the evidence base for implementing changes in clinical practice. Similarly, PI data can guide EBP initiatives by identifying areas that need improvement within an organization. While there is overlap among these processes, it is essential for nurses to understand their distinctions and select the appropriate approach based on the specific clinical problem or goal. ### Conducting a fall risk assessment in a healthcare setting typically involves the following steps: 1. Use a validated fall risk assessment tool or scale, such as the Morse Fall Scale, STRATIFY, or Hendrich II Fall Risk Model. These tools evaluate various risk factors like age, fall history, mobility, cognition, and medications. 2. Assess the patient\'s intrinsic (patient-related) risk factors, including balance and gait issues, visual impairment, cognitive status, continence, medication side effects, and any previous falls. 3. Evaluate extrinsic (environmental) risk factors, such as cluttered rooms, poor lighting, lack of assistive devices, and obstacles like equipment or wires. 4. Involve the patient and family members, as they can provide valuable information about the patient\'s baseline function, fall history, and potential risks. 5. Complete the assessment upon admission, after any change in condition, following a fall incident, and during transfers between units or facilities. 6. Calculate the patient\'s overall fall risk score based on the assessment tool\'s scoring system, typically categorizing them as low, moderate, or high risk. 7. Document the assessment findings, risk score, and implement appropriate interventions based on the identified risks, such as patient education, environmental modifications, assistive devices, and close monitoring. 8. Reassess the patient\'s fall risk regularly or whenever their condition changes to ensure interventions remain effective and address any new or evolving risks. ### To assess mobility alterations that pose a risk for falling, follow these steps: 1. Observe the patient\'s gait pattern, looking for shuffling, unsteadiness, or difficulty initiating steps. 2. Assess lower extremity strength, range of motion, and proprioception (awareness of body position). 3. Evaluate balance by having the patient stand with feet together, eyes open and closed. 4. Check for orthostatic hypotension by taking blood pressure readings while lying, sitting, and standing. 5. Note any assistive devices used and whether they are properly fitted. 6. Inquire about dizziness, vertigo, vision problems, or lower extremity pain or numbness. 7. Review medications that may cause drowsiness, dizziness, or orthostatic hypotension. 8. Assess cognitive status, as confusion or impaired judgment can increase fall risk. 9. Evaluate the safety of footwear and any potential environmental hazards. 10. Document all findings thoroughly, calculate the patient\'s fall risk score, and implement appropriate interventions based on identified mobility issues. Regular reassessment is crucial, as mobility status can fluctuate during the patient\'s stay. Promptly address any new or worsening mobility alterations to prevent falls. ### ### To prevent procedure-related events, follow these strategies: Adhere strictly to policies, procedures, and standards of nursing practice. Review protocols before performing high-risk procedures. Take a \"time-out\" before initiating procedures, especially unfamiliar ones. Reflect on the steps, review your knowledge, and refer to resources if needed. Minimize distractions and interruptions during medication administration and other critical tasks. Designate \"No Interruption Zones.\" Perform the \"rights\" of medication administration - right patient, drug, dose, route, time, and documentation. Report any errors, near misses, or safety concerns through proper incident reporting channels. This data helps identify areas for improvement. Participate in ongoing education and training to maintain competency in nursing skills and procedures. Foster a culture of safety by encouraging open communication, teamwork, and learning from mistakes without blame. ### Standard Precautions: Handwashing, using personal protective equipment (PPE) like gloves and gowns when anticipating contact with blood or body fluids, safe injection practices, and proper handling of contaminated equipment. Apply to all patient interactions. Contact Precautions: In addition to Standard Precautions, wear gown and gloves for all interactions involving contact with the patient or their environment. Indicated for infections spread by direct or indirect contact. Droplet Precautions: Wear a surgical mask within 6 feet of the patient in addition to Standard Precautions. Indicated for respiratory infections spread by large droplets from coughing or sneezing. Airborne Precautions: Wear an N95 or higher respirator when entering the patient\'s room in addition to Standard Precautions. Perform patient care in an airborne infection isolation room. Indicated for infections spread over longer distances by small airborne particles. The signs and symptoms of a localized infection are typically confined to a specific area of the body, such as redness, warmth, swelling, pain or tenderness, and drainage from an open wound or lesion. In contrast, a systemic infection causes more generalized symptoms like fever, fatigue, nausea/vomiting, malaise, and enlarged lymph nodes. Systemic infections can develop if a localized infection is not properly treated and spreads through the body. They may also involve specific symptoms related to the affected body system, such as a productive cough with a lung infection or cloudy, foul-smelling urine with a urinary tract infection. Infection control measures differ in the home versus the hospital setting in several ways:\ \ In the hospital, sterile technique is often used for procedures like wound care, IV insertions, and surgeries. At home, clean technique is more common due to limited resources. Hospitals have access to sterilization equipment that homes lack.\ \ Hospitals follow strict hand hygiene protocols with alcohol-based hand sanitizers readily available. At home, soap and water handwashing may be the only option if sanitizers are unavailable.\ \ Hospitals have negative pressure rooms to contain airborne pathogens. Most homes do not have this capability, so isolating infected individuals is crucial.\ \ Hospitals can implement contact, droplet, and airborne precautions with specialized personal protective equipment (PPE). PPE may be limited at home.\ \ Environmental cleaning and disinfection occur frequently in healthcare facilities by trained staff. Home cleaning relies on the patient/family following proper techniques.\ \ Hospitals have teams dedicated to surveillance, reporting, and prevention of healthcare-associated infections. Infection control education for home care is provided as needed.\ \ Overall, the home environment has more limitations in achieving the same level of infection control as a hospital. Careful instruction and monitoring are required for effective home infection prevention. Medical asepsis refers to practices that reduce the risk of infection by eliminating as many microorganisms as possible. It involves thorough handwashing, using clean technique for procedures like wound care, and maintaining a clean patient environment. Surgical asepsis aims to make an area completely free of all microorganisms. It requires meticulous sterile technique, creating a sterile field, and using sterile instruments/supplies during invasive procedures like surgery. Surgical asepsis has a higher level of control to prevent any introduction of pathogens into a sterile operating site. Several conditions can place patients at risk for impaired skin integrity:\ \ Immobility - Lack of movement increases pressure and shear forces on bony prominences, raising the risk of pressure injuries.\ \ Incontinence - Moisture from urine or feces can lead to skin breakdown and increase friction.\ \ Poor nutrition/hydration - Inadequate nutrition impairs skin integrity and delays wound healing.\ \ Vascular disease - Conditions like diabetes and peripheral artery disease reduce blood flow and oxygenation to tissues.\ \ Neurological impairments - Sensory deficits prevent recognizing discomfort that signals the need to reposition.\ \ Edema - Excess fluid accumulation stretches skin and makes it more fragile.\ \ Advanced age - Thinning of skin and decreased elasticity occur with aging.\ \ Medical devices/equipment - Tubes, braces, and other devices can cause pressure damage.\ \ Moisture-associated skin damage and skin tears are also concerns, especially in older adults with fragile skin. Frequent monitoring and preventive measures are crucial for at-risk patients. Demonstrate proper assessment techniques for obtaining each vital sign (blood pressure, pulse, respiration, temperature, pulse ox) Blood Pressure: Position the patient properly, select the appropriate cuff size, palpate the brachial artery, place the cuff on the bare arm, pump up the cuff, and slowly release while listening with a stethoscope over the brachial artery.\ \ Pulse: Use the pads of your fingers, not your thumb, to palpate over an artery like the radial artery. Count for a full 60 seconds.\ \ Respiration: Observe the rise and fall of the chest, listen for breath sounds, and count the respirations for one full minute.\ \ Temperature: For oral, place the thermometer under the tongue with mouth closed for 3 minutes. For tympanic, gently pull the pinna back and insert the thermometer until it seals in the ear canal.\ \ Pulse Ox: Attach the probe to the patient\'s finger, toe, or earlobe. Ensure proper fit and that the area is warm and has good blood flow. Differentiate normal vital signs from abnormal vital signs ### Normal vital sign ranges can vary based on age, but general guidelines are: Temperature: 97.7-99.5°F (36.5-37.5°C) orally Pulse: 60-100 beats per minute Respirations: 12-20 breaths per minute Blood Pressure: 120/80 mmHg or lower Abnormal vital signs indicating potential issues include: Fever over 100.4°F (38°C) Bradycardia (low heart rate) or tachycardia (high heart rate) Bradypnea (low respiratory rate) or tachypnea (high respiratory rate) Hypertension (high blood pressure) or hypotension (low blood pressure) Any significant deviation from normal ranges requires further assessment and possible intervention. Vital signs provide an objective way to quickly evaluate a patient\'s condition. Examine how exercise and activity maintain and promote health Regular physical activity and exercise provide numerous benefits for maintaining and promoting overall health:\ \ - Strengthens the cardiovascular system by improving heart and lung function\ - Builds and maintains muscle strength, endurance, and flexibility\ - Promotes weight management and reduces obesity risk\ - Reduces inflammation and associated chronic diseases\ - Improves mood, reduces stress and anxiety\ - Lowers risk of chronic conditions like heart disease, diabetes, osteoporosis\ - For older adults, exercise helps maintain mobility, balance, and cognitive function\ \ Engaging in a combination of aerobic exercise like walking or swimming, along with strength training, provides the greatest overall health benefits. Both moderate and vigorous exercise have positive impacts. Developing an active lifestyle through regular physical activity is key for optimizing health and well-being across all ages. Discuss changes in physiological and psychosocial function associated with immobility ### Sherpath AIanswered: ### Immobility can lead to significant physiological and psychosocial changes: Physiological: - Muscle weakness and atrophy (disuse atrophy) - Decreased bone mass and risk of osteoporosis - Impaired cardiovascular function, orthostatic hypotension - Increased risk of thrombus formation and deep vein thrombosis - Constipation and other gastrointestinal issues - Pressure injuries and skin breakdown - Pulmonary complications like atelectasis and pneumonia Psychosocial: - Social isolation and loneliness - Depression, anxiety, and other mood disturbances - Loss of independence and self-care abilities - Changes in self-image and self-worth - Financial strains from lost productivity - Sensory deprivation and altered stimuli Immobility has profound effects on nearly every body system as well as one\'s mental health and quality of life. Proactive nursing care is crucial to prevent or minimize these complications. Discuss a nurse's role in the prevention of DVT in patients with reduced mobility. ### Nurses play a vital role in preventing deep vein thrombosis (DVT) in patients with reduced mobility. Key nursing interventions include: - Encouraging early and frequent ambulation as soon as medically permitted - Assisting with range-of-motion exercises and position changes every 2 hours - Applying sequential compression devices or antiembolism stockings as ordered - Administering prescribed anticoagulant medications properly and monitoring for side effects - Providing patient education on DVT risk factors, signs/symptoms, and preventive strategies - Advocating for mobility aids and assistive devices to promote ambulation - Collaborating with other team members to develop an individualized DVT prevention plan By implementing evidence-based nursing interventions, nurses can significantly reduce the risk of DVT and associated complications like pulmonary embolism in patients with limited mobility. Consistent monitoring, early mobilization, and preventive therapies are essential nursing responsibilities.

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