NUR1118 Unit 2 Notes

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Mississippi Gulf Coast Community College *

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1118

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Health Science

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Feb 20, 2024

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Unit 2 Fundamentals August 29, 2023 Communication Process of info being transferred from one person to another – patient, patient family, provider Verbal, written, body language The sender, the receiver, the message Feedback – allows sender and receiver to know the message was clearly understood SBAR – communication tool, used for shift report. Needed for client safety to know what is going on, what needs to be done, updates on client Feedback and client education – knowing the client understood the information Have them demonstrate how to properly administer their medication to themselves. SBAR EXAMPLE Situation – client has nausea after surgery Background – history of nausea following surgery Assessment – patient vomiting 100ml of green bile, bowel sounds present Recommendation – antiemetic given, recommend keeping the client NPO (nothing by mouth) Verbal communication – what is said Nonverbal communication – gestures, body language Auditorial communication – what the receiver hears; are there any deficits? If there is, are there any tools that are needed? Energetic communication – how a person projects themselves 4 modes of communication Verbal, nonverbal, electronic, written Verbal Things to include: making sure we are always speaking clearly so the receiver can hear, making sure the receiver understands what is said

(feedback), adjusting distractions, facing the receiver when speaking promotes active listening Written communication – educational material Electronic communication – video conferencing: ensuring privacy Nonverbal Body language: facial grimace Demonstrate an open posture towards client Communication styles Passive – avoid conflict; individual says nothing or simple agrees Ex. “I’ll do whatever you want” Assertive – honest and clear communication that does not violate the right of others Ex. “I express my ideas clearly, and the others in the meeting chose a different option” Aggressive – verbally and sometimes physically abusive Ex. “its your fault the client fell, you never listen to me” Passive – passive on surface while demonstrating anger in a subtle or indirect way Ex. A nurse ignoring a call light several times, or saying they will do something and not following through Nontherapeutic communiation – results in misunderstanding, poor patient care, decrease patient satisfaction; not listening, being critical, rejecting what they are saying, dismissing client concerns “so many people have it worse than you” “don’t worry, it could be worse” -Active listening to the clients and their concerns and working through what we can do for them Therapeutic communication – silence, active listening, open ended questions “what would you do” requires more than a yes or no answer “and how did that make you feel?” giving the client an opportunity to give more information Restating, paraphrasing and summarize – repeat the question back to the client to ensure the client understands and identify any needs for clarification Reflection – used when clients are asking for advice or nurse opinion “what do you think you should?”

Instead of repeating the clients message back to them, the nurse attempts to reveal the clients feelings behind he message. Motivational interviewing – known by OARS: • Open ended questions: “tell me more” • Affirmations: statemtents that encourage clients o Ex. “you did very well with your food diary this week” • Reflective listening – restate what the client said encouraging clarification of feelings o Ex. “so youre worried you will get diabetes like your mother?” • Summarizing: paraphrasing what your client said o Ex. “so does your mother also have diabetes?” Communication barriers Language Cultural diversities Cognitive and developmental impairments – speaking in a language they will understand, speaking clearly in a slow pace, being aware of clients body language Safety Identify clients correctly - Name - DOB Utilize an open ended question: “Can you tell me your name and DOB?” - Barcode scanning: used at time of med admin; scanning ID bracelet Communication Reporting critical results such as lab results (blood work and potassium came back high) that are life threatening if not immediately improved Written documentation of the notification of results to the provider (who received the results and who communicated them) Use Medication Safely - Labeling all meds - Reconcile client medications: what they are taking, what they will continue to take, before discharge

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Use of alarms safely – intention is to warn providers of a serious event Ex. IV pumps Preventing Hospital-Acquired infections Central line – pathogens enter the bloodstream via central line; UTIs with catheters Surgical site – where the surgery occurred Ventilator associated pneumonia – while a client is on a ventilator Hand hygiene is the single most important step that healthcare workers can do to prevent the spread of infection Adverse events in surgery - A series of safety checks before beginning an invasive surgery Using two client identifiers - Marking of surgical site if possible - Time out in operation in procedure room to ensure correct client and procedure being performed Near miss – potiential error or event or circumstance that could have caused harm but was cauht and avoided  A client safety event is an unexpected event or circumstance that occurred with or without injury to the client, but that had the potential to cause harm to the client.  An adverse event is a situation or circumstance that caused unexpected harm to the client.  A sentinel event (never event) is a critical, unexpected adverse event that caused severe physical or psychological harm to a client, including death, dismemberment, permanent injury, and severe or temporary injury.

Creating a culture of safety – safe environment Transporting care at bedside – nurses spend 70% of time at bedside performing direct client care Strengthening management through leadership Implement rapid response – designated team that a nurse can notify if a client starts to deteriorate or have changes; interdisciplinary team Ex. Sudden change in vitals, change in mental status Hourly rounding – checking on the clients every hour and documenting Occurrence reporting Not intended to punish individuals but to learn from the incident Used to track those incidents Action plans must be created to prevent future occurrences Safety assessments 1) Preventing infections 2) Simplifying discharge instructions 3) Protocol to prevent venous thromboembolism (VTE) 4) Education regarding medications Electrical, chemical, radiation safety Electrical - Following safe practices when working with electrical appliances Chemical – Radiation safety – Hospital Acquired Injury (HAIs) Pressure injuries Reposition the client, turning the client Identifying High Risk Injury - Fall risk Screening tools - MORSE fall scale and braden scale Fall risk preventions - nonskid footwear and socks - bed at lowest position - locking bed wheels - basic orientation to the room; free of clutter, call light easily accessible

Fire Safety & Rescue RACE: Race Alarm Contain Extinguish PASS: Use of restraints Restraints should be used as a LAST resort Other interventions – deescalating the situation, remind and reorient client to not get out of bed and not pull on their tubing Physical restraints Mechanical Chemical Barrier Seclusion Seizure precautions Padding on side rails, suctions, oxygen ****Review precautions on particular disease processes**** Prevent of Work related injuries Work related musculoskeletal disorders (MSDs) Turn sheets, lifting devices, sit to stand lift device Types of Movements ****Need to Know**** Types of Movement  Flexion: bend; reduce the angle between the bones  Extension: straighten the limb  Abduction: move away from baseline  Adduction: bring closer to baseline  Pronation: turning to face backward

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 Supination: turning to face forward  Circumduction: circular motion  Rotation: side-to-side  Inversion: turn inward  Eversion: turn outward Proper body alignment Straight back, abdominal muscles tightened Creating a wide base by spreading feet shoulder width apart, PIVOT do not twist Object being handled needs to remain close to nurses body – raise bed Face to face with client while transferring Bend with the knees Integumentary system effects Prolonged pressure compresses of the skin around the bone Back of the head Shoulder blades Elbows Sacrum Heels Six stages of pressure injuries 1) Assessment of mobility Are they able to perform adls? What they can and cannot tolerate Assistive devices – gait belt, a cane, walker, crutches

Proper positioning Aligning the body in neutral position Range of motion Passive or active Passive ROM – movement of joint by another person Active ROM – voluntary movement of joint by client without assistance Evidence Based Practice (EBP) How practices are developed, recommendations for treatment Positively impacts the client care, lower the costs, reduce the risks of medical errors Incentive spirometer - Handheld device to help patients improve the function of their lungs – lung tissue meet maximum volume Ex. Post surgical cases helps prevent pneumonia, patients that are unable to take deep breaths Is there improvement? Is this still working? Does this practice promote optimal client care Elements of EBP 1. Identify the problem – Asking a clinical question – why?? How?? Should always reflect the latest evidence The clearly the question, more specify, the more reliable the answer will be 2. Identify credible source of evidence – textbooks, ATI, references, scholarly articles, credible websites, 3. Evaluate the findings – reviewing literature, making notations on the findings of the literature; organizing and comparing 4. Implementing recommendations – using recommendations to practice changes i. Others may be resistant to change if something has been done a certain way for a long time, change is scary to some – resistance to change ii. The time investment can make this step challenging – time iii. Change often requires financial backing - money 5. Evaluating effectiveness – outcomes; sharing results P – population; group of people I – intervention; plan of action or treatment C – comparison; current practice or possible intervention O – outcome; result of outcome being evaluated T – time; how long it will take to achieve Spirit of Inquiry

Relaying on tradition and past experience is the opposite Always think about the why behind it Data Quantitative research – numerical data Ex. Researchers evaluating hand hygiene and counting the number of times hand hygiene is performed Qualitative – data collective in narrative nature; reasons, attitudes, motivations Obtained in interviews or dialog Ex. Client was newly diagnosed with diabetes and evaluating their attitudes or beliefs towards that diagnosis Mixed methods – quantitative and qualitative Nursing Process as a Tool for EBP Assessment – identification of problem Analysis – formulating research question Planning – designing research method Implementation – seeks to collect data Evaluation – ***in the slides at the bottom*** Clinical Guidelines EB recommendations to be used as guidelines of management of disease processes Recommendation regarding diagnosis, treatment, education Intended to provide objective information and guide health care professionals, care delivery systems, and health plans in decision making to promote optimal client outcomes. For example, a clinical practice guideline for the management of adult clients with diabetes would be a multipage document. It would provide recommendations regarding diagnosis, treatment, and self-care education for clients. Critical pathways – tools used within a health care organization and manage the delivery of client care Identifies who needs to be notified, what test need to be performed, what meds to administer Ex. Stroke patient; who needs to be informed? What test need to be ran? What meds need to be given? Enhance collaboration, reduce the cost of care, and improve client outcomes. They take form of algorithms, possibly with designated time frames, to assist in planning care.

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For example, a critical pathway for a client who has experienced a stroke may identify team members to notify, blood and diagnostic tests to perform, and medications to administer. Alternative pathways may be indicated dependent upon the client’s diagnostic results and condition. The algorithm may also specify where the client should be admitted in the facility and include discharge planning and rehabilitation treatments. Standards of Care Interventions implemented when caring for a client with a specific disorder Ex. Client is on a ventilator – frequency of oral care being performed Reflect the interventions that are typically implemented when caring for a client with a specific disorder. For example, studies have investigated interventions that could decrease the occurrence of pneumonia in clients who require long-term breathing assistance with a ventilator. The evidence shows that performing meticulous oral care for these clients can reduce the incidence of this complication. This information led to the recommendation to perform oral care at frequent intervals as a standard of care for all clients who are ventilator dependent. Reliable and Credible sources .gov – government, trustworthy .org – research organization to determine credibility .edu – trustworthy, educational Peer Reviewed Journals Articles reviewed by other professionals with similar licensure, education, experience Undergone rigorous review Non peer reviewed – not necessarily written by specialist Blogs, podcast, personal websites are not credible Critical appraisal – evaluation of each study Validity – did the researcher do a good job of study Reliability – Applicability – was research performed ……………… Modes of transmission Direct contact Indirect contact

Droplet – droplets from respiratory tract through the air and then to the mucosa of the host Airborne – small particulates move in the airspace to another host Vehicle – infectious agent transfer through a common source; catch a ride Vector Borne – transmission through animals; insects or rodents Diagnostic Tests If there is an infection and what that infection is Providers will select the appropriate test based on clients manifestation Urinalysis (UA) – ordered by provider to determine UTI; elevated WBC Urine culture and sensitivity test – what organisms are causing the sensitivity Chest X-ray – test for atelectasis, pneumonia, Cultures; throat, wound, blood – specimen is taken; swab, drainage from wound, blood drawn Blood tests – WBC count and Normal range: 5000-10000 Hand hygiene Alcohol based sanitizers – not effective on visible soiled hands; cover all areas of hands and wait until it completely dries. Medical asepsis – clean technique; used to define reduction of disease causing microorganism Surgical asepsis – techniques that ensures the sterility of items that will come in contact with the client through use of equipment such as sterile gloves in order to prevent pathogens Sterilization – cleaning instruments so all microorganisms are eradicated Sterile fields Flat surfaces, away from walls or potentially containing objects Close to the client; less room to contaminate the field Verify package is intact without signs of contamination Maintain 1in outer border – “wiggle room” for sterile field To open sterile package: Away from you Sides The bottom; closest to you Never reach over the open sterile field STERILE TO STERILE never place anything not sterile on the sterile field Keep all objects above the waist – in your line of vision Standard Precautions PPE Refer to all prevention practices applied to all clients

Contact precaution Minimum of gown and gloves Common with C.diff, large amounts of drainage from a wound Always remove PPE inside the clients room to minimize exposure Droplet precautions Mask when entering a room or coming into close contact with a client Airborne Precautions When a client has an infectious agent transmitted through the air N95 mask or respirator Negative pressure room - Active pulmonary tuberculosis Protective Isolations Used after first 100 days after transplant due to low immune system Interventions Health care associated infections – HAIs; a device creates a portal of entry to allow bacteria to enter and cause infection Sterile technique to prevent Infection control bundle – guidelines or protocols for how to care for a client to prevent or minimize infection Multi drug resistant infections – Nurses implement hand washing, utilizing contact precautions, education to family about finishing the antibiotics Gloves Blood, body fluids, non-intact skin, Gowns Infected material or blood that could penetrate or infect the nurse Masks, Goggles, Face shields Applying ppe before entering clients room DON: Gown Mask Goggles Gloves DOFF: removing it at the door Gloves Goggles

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Gown Mask Linens and Medical Waste Carry away from your body Risks Factors for the Development of Pressure Injuries and Wounds Mobility – skin breakdown Age – skin becomes thinner, elasticity is loss, blood supply is more sluggish Assessment is key with tissue integrity – assess for temperature, color, turgor, nutritional status Acute wounds – related to a trauma, surgical incision Chronic wounds – slow progression of the wound healing Assessment: is there drainage? The description of the drainage, is there any tunneling? Pressure injury Interventions: frequent turning, stable nutritional status, When documenting: location, stage, size, color of wound bed and surrounding tissue, drainage/color of drainage Treatment: surgical debridement, irrigation, biologic debridement, enzymatic agents Wound dressing types Clean vs sterile Dry vs wet For wound healing to occur a moist, not wet, must occur Sutures and staples: Document how many Wound Drains Pinrose drain: flat, uses gravity to drain fluids Portable wound suction – uses suction to remove drainage The nurses roll is to change the dressings as ordered, noting the same characteristics, monitoring the insertion site. Healing Primary – skin adhesives or sutures Secondary – wound is left open Delayed – combination of skin adhesives and left open Nursing Actions

Using tools to minimize risks Positioning client to minimize pressure Maintaining hygiene Hydration Educating and providing food options Factors influencing wound healing Diabetes Infections Drugs Tissue necrosis Hypoxia Extensive tensions Major complications of wounds are infections; redness or round, warm to touch, foul odor Systemic is when client is at risk of sepsis Eviscerations – immediate attention; internal organs protruding Quality Improvement Proactive and preventative Quality Assurance Pro reactive Plan/Do/Study/Act (PDSA) Method Plan – choose question or problem Do – action Study – review or analyze Act – implementing these steps Lean Approach – efficiency and decrease the amount of waste; cost efficient Analyzing a process and eliminating unnecessary steps or repeated actions 7 basic quality tools for process improvement 1. Causes and effect diagram (fishbone) 2. Check sheet or tally sheet 3. Control chart or graph 4. Histogram or bar graph 5. Pareto chart or bar graph 6. Scatter diagram

7. Stratification ***NDNQI*** Risk management – reduce the risk for errors by understanding the cause Goal - Protect, clients, staff, visitors from harm Data captured through QI process are incorporated into risk management plans to evaluate Incident reports – documentation of errors Important function of risk management because risk management is an identification and the reporting of incidents Only includes facts, avoids opinions and excuses, follows health care policies Root Cause Analysis The root of what happened What exactly happened? Why did it happen? What can be done to prevent it happening again? Cost effective care - Performing evaluations, client satisfaction, all leading to improved patient outcomes EBP Client Education Goals: health promotion restoration of health adaptation to permanent illness Domains of learning Cognitive: thinking Ex. Recalling how to do the dressing change Affective: feelings Ex. Attitude toward the wound Psychomotor: activities Ex. Demonstrations followed by return demonstration Basic principles of learning

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Relevance; to client and the nurse Self-directed; clients take part in their learning Life-experience Readiness; prepared Task-centered Motivation Health Literacy - able to obtain, read, and understand basic health info Feedback Teach back

NUR1118 Unit 2 Notes

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