Fundamental Of Nursing (First Year) PDF

First Year FUNDAMENTAL OF NURSING THEORITCAL BOOK  Prepared By Dr. Mai El-Sayed Mohsen Medical- Surgical Nursing Dr. Mayada Soliman Rashed MSc. Abdullah Shokrey Ismail Obstetrics and Gynecology Nu...

First Year FUNDAMENTAL OF NURSING THEORITCAL BOOK  Prepared By Dr. Mai El-Sayed Mohsen Medical- Surgical Nursing Dr. Mayada Soliman Rashed MSc. Abdullah Shokrey Ismail Obstetrics and Gynecology Nursing Critical Care and Emergency Nursing MSc. Muhammad Said Seif Dr. Hanaa El-sayed Mohamed Medical- Surgical Nursing Pediatric Nursing  List of content Content Page Chapter one foundation of Nursing Practice 1. Definition of Nursing. 3 2. The Nursing Profession and Its Characteristics 4 3. The Role of The Nurse and Its Functions. 6 4. Ethics in Nursing Profession. 8 5. Patient’s Safety 11 6. Health and Illness Concept 15 Chapter two Communication 1. Components of the communication process 22 2. Mods (forms) of communication 24 3. Levels of communication 26 4. Factors influencing the communication process 27 5. Therapeutic communication technique 29 Chapter three Critical Thinking in Nursing Practice 1. Critical thinking 34 2. Nursing process 36 3. Health assessment and physical examination 43 Chapter four A Physiological Basis for Nursing Practice 1. Maslow hierarchy of basic human need 58 2. Physiological needs: 61 62 a. Fluids, electrolyte and acid base 69 b. Oxygen 74 c. Nutrition 77 d. Elimination 82 e. Rest and sleep 85 f. Sex concept 87 g. Activity 90 99 Chapter five Admission Transfer and Discharge 1. Patient admission 104 2. Patients transfer and referral 109 3. Patient discharge 111 Chapter six First Aid 1. Medical emergencies 117 2. injury emergencies 128 3. environment emergencies 135  List of abbreviation Abbreviation Meaning ANA American Nursing Association RN Registered nurse ICN International Council of Nurses CDC Centers for Disease Control and Prevention WHO World Health Organization NANDA North American Nursing Diagnosis Association ECF Extracellular fluid I&O Intake & Output ABG Arterial Blood Gases STD Sexual Transmitted Disease GI Gastro intestinal ADL Activity of Daily Living RTA Road Traffic Accident ER Emergency OPD Outpatient Department ICU Intensive Care Unit AED Automated External Defibrillator CPR Cardiopulmonary Resuscitation PPE Personal Protective Equipment 1|Page  Chapter one (Foundation of Nursing Practice) Learning objectives: At the end of the chapter the students will be able to: 1. Describe the historic background of nursing, definitions of nursing, and the status of nursing as a profession and as a discipline. 2. Discuss the development of professional nursing roles. 3. Explain the aims of nursing as they interrelate to facilitate maximal health and quality of life for patients. 4. Identify purpose of patient safety 5. List factors influencing patient safety 6. Illustrate international patient safety goal 2|Page  Introduction Nursing is an art and a science. As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient’s dignity and personhood. As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations. Definition of nursing. Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations. (ANA, 2018). Definition of a Nurse. The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Aim of nursing: Four broad aims of nursing practice can be identified in the definitions of nursing: 1. To promote health 2. To prevent illness 3. To restore health 4. To facilitate coping with disability or death To meet these aims, the nurse uses knowledge, skills, and critical thinking to give care in a variety of traditional and expanding nursing roles. 3|Page The nursing profession and its characteristics: A variety of career opportunities are available in nursing, including clinical practice, education, research, management, administration, and even entrepreneurship. As a student it is important for you to understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families, and their communities. The patient is the center of your practice. Types of standards for nursing » Standards of Practice. The nursing process is the foundation of clinical decision making and includes all significant actions taken by nurses in providing care to patients. ▪ Assessment: The registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation. ▪ Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. ▪ Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. ▪ Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. ▪ Implementation: The registered nurse (RN) implements the identified plan. ▪ Evaluation: The nurse evaluates progress toward attainment of outcomes. 4|Page » Standards of Professional Performance: The American Nurses Association ANA Standards of Professional Performance describes a competent level of behavior in the professional role (ANA,2010). The standards provide a method to assure patients that they are receiving high-quality care. 1. Ethics: The registered nurse practices ethically. 2. Education: The registered nurse attains knowledge and competency that reflects current nursing practice. 3. Evidence-Based Practice and Research: The registered nurse integrates evidence and research findings into practice. 4. Quality of Practice: The registered nurse contributes to quality nursing practice. 5. Communication: The registered nurse communicates effectively in all areas of practice. 6. Leadership: The registered nurse demonstrates leadership in the professional practice setting and the profession. 7. Collaboration: The registered nurse collaborates with health care consumer, family, and others in the conduct of nursing practice. 8. Professional Practice Evaluation: The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. 9. Resources: The registered nurse uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. 10. Environmental Health: The registered nurse practices in an environmentally safe and healthy manner. 5|Page The role of the nurse and its functions: Nurses provide care and comfort for patients in all health care settings and concern for meeting their patient’s needs. These roles are described as the following: - 1- Direct care provider/ caregiver: As a caregiver, the nurse integrates the roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to meet physical, emotional, intellectual, sociocultural, and spiritual needs for all patients. 2- Communicator: The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of healthcare settings. 3- Teacher/Educator: The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families. 4- Counselor: The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient’s problem-solving and decision-making skills. 5- Leader: The assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups. 6- Researcher: The participation in or conduct of research to increase knowledge in nursing and improve patient care. 7- Advocate: The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. 6|Page 8- Collaborator: The effective use of skills in organization, communication, and advocacy to facilitate the functions of all members of the healthcare team as they provide patient care. The nurse carries out these roles in many different settings, with care increasingly provided in the home and in the community. Examples for providing patients are the following: Hospitals Ambulatory surgery centers Emergency helicopter services Clinics Homes Educational programs Public health offices Doctors’ offices Industry Long-term care facilities Mobile healthcare units Schools Offices Hospice Mental health facilities State health programs Skilled-care facilities Churches Prisons 7|Page  Ethics in nursing profession Introduction Ethical values are essential for any healthcare provider. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Definition of ethics: Ethics are moral principles that govern how the person or a group will behave or conduct themselves. Definition of nursing ethics: systematic rules or principles governing right conduct. Each nurse, is practiced with the responsibility to adhere to the standards of ethical practice and conduct set by the profession. Ethical principles: Ethical principles are the basis of all nursing practice and provide a framework to help the nurse in ethical decision making. The primary ethical principles include: ▪ Beneficence: Acting for the good and welfare of others and including such attributes as kindness and charity. ▪ Nonmaleficence: Acting in such a way as to prevent harm to others or to inflict the minimal harm possible. ▪ Autonomy: Recognizing the individual’s right to self-determination and decision-making. ▪ Justice: Acting in fairness to all individuals, treating others equally and showing all individuals the same degree of respect and concern. 8|Page  ▪ Veracity: Being truthful, trustworthy, and accurate in all interactions with others. ▪ Fidelity: Being loyal and faithful to individuals who place trust in the nurse. ▪ Integrity: Acting consistently with honesty and basing actions of moral standards. International Council of Nurses Code of Ethics Preamble The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct Elements of the Code 1. Nurses and People 1. The nurse’s primary professional responsibility is to people requiring nursing care. 2. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. 2. Nurses and Practice ▪ The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. ▪ The nurse maintains a standard of personal health such that the ability to provide care is not compromised 3. Nurses and the Profession ▪ The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. 9|Page  ▪ The nurse is active in developing a core of research-based professional knowledge. 4. Nurses and Co-workers ▪ The nurse sustains a co-operative and respectful relationship with co- workers in nursing and other fields. ▪ The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. 10 | P a g e  Patient Safety Safety, often defined as freedom from psychological and physical injury, is a basic human need. Health care provided in a safe manner and a safe community environment is essential for a patient’s survival and well- being. Definition of patient safety: The world health organization (WHO) defined patient safety as the prevention of errors and adverse effects to patients associated with health care. Purpose of patient safety: It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Factors influencing patient safety ▪ Age and Development ▪ Lifestyle factors that place individuals at risk for injury include unsafe environments. ▪ Mobility and Health Status Alterations in mobility related to paralysis, muscle weakness, diminished balance, and lack of coordination place clients at risk for injury. ▪ Sensory Perceptual Alterations Accurate sensory perception of environmental stimuli is vital to safety. ▪ Emotional State states can alter the ability to perceive environmental hazards. 11 | P a g e  ▪ Ability to Communicate Individuals with diminished ability to receive and convey information are at risk for injury. ▪ Environmental Factors Client safety is affected by the healthcare setting. ▪ Cognitive Awareness is the ability to perceive environmental stimuli and body reactions and to respond appropriately through thought and action. The Joint Commission National Patient Safety Goals Effective January 2023 for the Hospital Program Goal: Improve the accuracy of patient identification. ▪ Use at least two patient identifiers when administering medications, blood, or blood components; when collecting blood samples and other specimens for clinical testing; and when providing treatments or procedures. Goal: Improve the effectiveness of communication among caregivers. ▪ Report critical results of tests and diagnostic procedures on a timely basis. Goal: Improve the safety of using medications. ▪ Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. ▪ Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. ▪ Maintain and communicate accurate patient medication information. 12 | P a g e Goal: Reduce patient harm associated with clinical alarm systems. ▪ Improve the safety of clinical alarm systems. Goal: Reduce the risk of health care-associated infections. ▪ Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. ▪ Implement evidence-based practices to prevent healthcare associated infections due to multidrug-resistant organisms in acute care hospitals and in nursing care centers. ▪ Implement evidence-based practices to prevent central line–associated bloodstream infections (CLABSI). ▪ Implement evidence-based practices for preventing surgical site infections. ▪ Implement evidence-based practices to prevent indwelling catheter- associated urinary tract infections (CAUTI). Goal: Reduce the risk of patient harm resulting from falls. ▪ Reduce the risk of falls. Goal: Prevent health care-associated pressure ulcers (decubitus ulcers). ▪ Assess and periodically reassess each patient’s and resident’s risk for developing a pressure ulcer and take action to address any identified risks. 13 | P a g e Goal: The organization identifies safety risks inherent in its patient population. ▪ Reduce the risk for suicide. ▪ Identify risks associated with home oxygen therapy, such as home fires. Goal: Improve health care equity. ▪ Improving health care equity for the organization’s patients is a quality and safety priority. Goal: Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery ▪ Conduct a preprocedural verification process. ▪ Mark the procedure site. ▪ A time-out is performed before the procedure. 14 | P a g e  Health and Illness Concept Definition of Health Defining health is difficult. The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity” (WHO, 1947). Definition of Illness o Illness is a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired. o Cancer is a disease process, but one patient with leukemia who is responding to treatment may continue to function as usual, whereas another patient with breast cancer who is preparing for surgery may be affected in dimensions other than the physical. Acute and Chronic Illness Both acute and chronic illnesses have the potential to be life threatening. An acute illness is usually reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. A chronic illness persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems. 15 | P a g e Characteristics of Acute and Chronic Illness Description Characteristics Acute Illness ▪ Usually, self-limiting Diseases that have a rapid onset and a short duration. ▪ Responds readily to treatment Examples: colds, influenza, acute ▪ Complications infrequent gastroenteritis ▪ After illness, return to previous level of functioning Chronic Illness ▪ Permanent impairments or deviations Diseases that are prolonged, do from normal. not resolve spontaneously, and are ▪ Irreversible pathologic changes rarely cured completely. ▪ Residual disability Examples: Alzheimer’s disease, ▪ Special rehabilitation required Arthritis, Cancer ▪ Need for long-term medical and/or nursing management Variables Influencing Health and Illness 1. Internal Variables ▪ Developmental Stage. A person’s thought and behavior patterns change throughout life. ▪ Intellectual Background. A person’s beliefs, knowledge, or incorrect information about body functions and illnesses, educational background, traditions, and past experiences. ▪ Perception of Functioning. The way people perceive their physical functioning affects health beliefs and practices. ▪ Emotional Factors. The patient’s degree of stress, depression, or fear can influence health beliefs and practices. ▪ Spiritual Factors. Spirituality including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. 16 | P a g e 2. External Variables ▪ Family Practices. The way that patients’ families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors. ▪ Psychosocial and Socioeconomic Factors. Socioeconomic and psychosocial factors increase the risk for illness and influence the way that a person defines and reacts to illness. ▪ Cultural Background. Cultural background influences beliefs, values, and customs. Health Promotion, Wellness, and Illness Prevention ▪ Health promotion activities such as routine exercise and good nutrition help patients maintain or enhance their present levels of health. ▪ Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility. ▪ Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Levels of Preventive Care 1. Primary Prevention. Primary prevention is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy. Primary prevention aimed at health promotion includes health education programs, immunizations, nutritional programs, and physical fitness activities. 17 | P a g e 2. Secondary Prevention Secondary prevention focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the patient to return to a normal level of health as early as possible. 3. Tertiary Prevention Occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of a long-term disease or a disability by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation rather than diagnosis and treatment. ▪ For example, a patient with a spinal cord injury undergoes rehabilitation to learn how to use a wheelchair and perform activities of daily living independently. Care at this level helps patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. 18 | P a g e