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Chapter 1 – Introduction to Nursing 8/29/
- Nurses with baccalaureate degree work with research.
- Florence Nightingale changed the roles of nursing for the better good, by challenging prejudice, elevated the status of all nurses.
- She established the first. Training school for nurses and wrote books about health care and nursing education.
- She identified the personal needs of client and role of nurse in meeting them.
- Established standards for hospital management
- Recognized two components: health and illness
- Believed nursing was separate and distinct from medicine
- Recognized that nutrition is important to health
- Instituted occupational and recreational therapy for sick
- Stressed the need for continued education
- Maintained accurate records, recognized as the beginnings of nursing research.
- Definition of Nursing originated from the Latin word nutrix (to nourish)
- Promotion of health, prevention of illness, collaborative care
- Patient/client is central focus of all definitions
- State Nurse Practice acts set laws and regulations for nursing practice.
- Each State has their own Nurse Practice acts
- Office of the professions is where our license to practice comes from
- Four blended competencies: Cognitive, Technical, Interpersonal, Ethical/Legal (CTIEL)
- Cognitive- thinking about the nature of thigs sufficiently to make decisions regarding care.
- Technical- enable nurses to manipulate equipment to produce a desired outcome.
- Interpersonal- Involve caring relationships.
- Ethical/Legal- Enable nurses to conduct themselves morally and professionally.
- Nursing Aims to promote health – state of optimal functioning or well-being.
- Factors affecting health: Genetic inheritance, Cognitive abilities, educational level, Race and ethnicity and culture, age and gender, developmental level, lifestyle and environment, socioeconomic status. Guidelines for Nursing Practice
- Standards of Nursing Practice - American Nursing Association (ANA) standards of practice protect and allow nurses to carry out our professional roles.
- Nurse Practice Acts and Licensure -regulate the practice of nursing practice including education and licensure.
- Nursing Process -guideline of nursing practice enabling nurses to implement their roles.
- Each state has their own established set of laws. The Nursing Process One of the major guidelines for nursing practice Helps nurses implement their roles Integrates art and science of nursing Allows nurses to use critical thinking and clinical reasoning Defines the areas of care that are within the domain of nursing
Types of Ethics:
- Bioethics - Encompasses several fields of “life sciences”
- Nursing ethics - Formal study of ethical issues that arise in the practice of nursing, Analysis used by nurses to make ethical judgments
- Feminist ethics - Critiques existing patterns of oppression and domination in society especially affecting women and the poor Two Categories of Action-Guiding Theories:
- Utilitarian: The rightness or wrongness of an action depends on the consequences of the action.
- Deontologic: An action is right or wrong independent of its consequences. Principle-Based Approach to Bioethics :
- Autonomy: Respect rights of clients to make health care decisions.
- Nonmaleficence: Avoid causing harm.
- Beneficence: Benefit the client.
- Justice: Give each his or her due and act fairly.
- Fidelity: Keep promises.
- Veracity, accountability, privacy, confidentiality Characteristics of the Care-Based Approach to Bioethics:
- Centrality of the caring relationship
- Promotion of dignity and respect for clients as people
- Attention to the particulars of individual clients
- Cultivation of responsiveness to others
- Redefinition of fundamental moral skills to include virtues
- Remember- each time we care for a client there is an ethical decision that is made.
- They are not the gallbladder in 302, they are someone.
- Nursing is our profession it is nonnegotiable ethical standard. ICN Guidelines to Achieve Purposes of Code of Ethics:
- Study the standards under each element of the code.
- Reflect on what each standard means to you.
- Discuss the code with coworkers and others.
- Use a specific example from experience to identify ethical dilemmas and standards of conduct in the code.
- Work in groups to clarify ethical decision making and reach consensus on standards or ethical conduct.
- Collaborate with other professionals to apply standards in practice, education, management, and research. Ethical Experience and Decision Making/Ethical Problems
- Ethical dilemma: Two (or more) clear moral principles apply but support mutually inconsistent courses of action. Ex. Doctor denies giving client morphine, but the nurse sees the client is in severe pain.
- Ethical distress: Occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Ex. Working a shift short handed when you know this is unsafe Advocacy in Nursing Practice
- Primary commitment is to the Client.
Chapter 11 – The Health Care Delivery System IOM’s Six Outcomes for a New Health System for the 21st^ Century Safe Effective Efficient Patient-centered Timely Equitable Health Care: The Big-Pictures Issues Access to health care Quality and safety- medical errors!! Affordability Primary focus is health promotion. Hospitals today focus on acute care needs of the client. Read Table 11-2 Health Care network Characteristics of a Continuously Learning Health Care System Science and informatics: real-time access to knowledge; digital capture of the care experience Patient–clinician partnerships: engaged, empowered patients Incentives: aligned for value; full transparency Continuous learning culture: leadership-instilled culture of learning; supportive system competencies
IOM’s 4-Tiered Strategy to Prevent Medical Errors Establishing a national focus to create leadership, research, tools, and protocols to enhance our knowledge about safety Identifying and learning from errors by developing a nationwide public mandatory reporting system Raising performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care Implementing safety systems in health care organizations to ensure safe practices Health Care Settings Hospitals-focus on acute care needs. NOT CHRONIC Primary care centers- MD’s and APN’s provide primary health care services in offices and clinics. Ambulatory care centers and clinics Home health care-provides safe coordinated care at home. Hospital at home- safe and effective hospital level care in the home Extended care- provide medical and nonmedical care for people with chronic illnesses. Ranges from days to years. Specialized care centers and settings- provide care or a specific population or group. Located in easily accessible locations within a community. Health care services for the seriously ill and dying- Respite, Hospice, Palliative Health care agencies
Chapter 24: Asepsis and Infection Control 8/30/ Components of the Infection Cycle: Infectious agent: bacteria, viruses, fungi Reservoir: natural habitat of the organism Portal of exit: point of escape for the organism Means of transmission: direct contact, indirect contact, airborne route Portal of entry: point at which organisms enter a new host Susceptible host: must overcome resistance mounted by host’s defenses Infectious Agents:
- Bacteria: Most significant and most prevalent in hospital settings
- Virus: Smallest of all microorganisms
- Fungi: Plant-like organisms present in air, soil, and water.
- Parasites: malaria, intestinal worms Classification of Bacteria Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) Gram positive or gram negative based on reaction to Gram stain o Gram + have thick walls that stain violet- resist color removal o Gram – cell walls loss their color with alcohol –don’t stain Aerobic or anaerobic based on need for oxygen
Factors Affecting an Organism’s Potential to Produce Disease Number of organisms Virulence Competence of person’s immune system Length and intimacy of contact between person and microorganism Possible Reservoirs for Microorganisms
- Other people (cold viruses)
- Animals (rabies)
- Soil (Anthrax)
- Food, water, milk (E. coli)
- Inanimate objects (Influenza) Common Portals of Exit: Respiratory Gastrointestinal Genitourinary tracts Breaks in skin Blood and tissue Factors Affecting Host Susceptibility Intact skin and mucous membranes Normal pH levels Body’s white blood cells Age, sex, race, hereditary factors Immunization, natural or acquired
Cardinal Signs of Acute Infection Redness (vascular, dilation of vessels) Heat (vascular, dilation of vessels) Swelling (increased blood flow and histamine) Pain Loss of function Laboratory Data Indicating Infection Elevated white blood cell count—normal is 5,000 to 10,000/mm^3 Increase in specific types of white blood cells (Box 24-1 pg. 602) Elevated erythrocyte sedimentation rate Presence of pathogen in urine, blood, sputum, or draining cultures Elevated WBCs indicates an infection There are different types of WBCs and by looking at which ones are elevated we can tell what is going on in the body.
- Neutrophils - Normal = 60–70%- Increased in acute infections that produce pus; increased risk for acute bacterial infection if decreased; may also be increased in response to stress (Usually the one that is elevated)
- Lymphocytes- Normal = 20–40%-Increased in chronic bacterial and viral infections
- Monocytes- Normal = 2–8%- Increased in severe infections: function as a scavenger or phagocyte
- Eosinophil- Normal = 1–4%- May be increased in allergic reaction and parasitic infection
- Basophil- Normal = 0.5–1% Usually unaffected by infections
- Elevated erythrocyte sedimentation rate—red blood cells settle more rapidly to the bottom of a tube of whole blood when inflammation is present
- Presence of pathogen in cultures of urine, blood, sputum, or other (wound) drainage Five Moments for Hand Hygiene (WHO)
- Moment 1 – Before touching a patient
- Moment 2 – Before a clean or aseptic procedure
- Moment 3 – After a body fluid exposure risk
- Moment 4 – After touching a patient
- Moment 5 – After touching patient surroundings Endogenous – affects themselves than transferred to another area Exogenous – affected from the environment or someone else Iatrogenic – infected through medical treatment Bacterial Flora: Transient: attached loosely on skin, removed with relative ease Resident: found in creases in skin, requires friction with brush to remove Wash hands with soap and water if visible soiled (scrub for at least 20 seconds) Alcohol based cleanser (scrub for at least 15 seconds) o Before and after patient contact o After glove removal o Before donning gloves for a non-sterile procedure o After contact with objects in a patient’s room o When moving from a contaminated body site to a clean body site
Performing environmental contamination of rooms Educating health care providers (and patients/families as appropriate) on clinical presentation, transmission, and epidemiology of CDI Using antimicrobials at an appropriate dose and only when indicated Measures to Reduce Incidence of Nosocomial Infections
- Constant surveillance by infection control committees and nurse epidemiologists
- Written infection prevention practices for all agency personnel
- Hand Hygiene recommendations
- Infection Control Precaution techniques
- Keeping patients in best possible physical condition Factors Determining Use of Sterilization and Disinfection Methods Nature of organisms present Number of organisms present (↑ number ↑ time) Type of equipment (some methods can damage equipment) Intended use of equipment (medical or asepsis) Available means for sterilization and disinfection Time (appropriate amount to disinfect) Personal Protective Equipment and Supplies
- Gloves
- Gowns
- Masks
- Protective Eyewear
Standard Precautions Used in the care of all hospitalized patients regardless of their diagnosis or possible infection status Apply to blood, all body fluids, secretions, and excretions except sweat (whether blood is present or visible), nonintact skin, and mucous membranes New additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures Transmission-Based Precautions Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes. Don personal protective equipment (PPE) when entering the room of a patient on contact or droplet precautions. These categories recognize that a disease may have multiple routes of transmission: airborne, droplet, contact). Airborne Precautions- TB, Varicella, Measles (private room, negative pressure room, N95 mask, gown, gloves) Droplet Precautions- Rubella, Mumps, Influenza (mask, gown, gloves, private room) Contact Precautions- MRSA, C.dif (gown, gloves) Neutropenic Precautions- (private room, mask to protect patient)
Patient Teaching for Medical Asepsis at Home Wash hands before preparing or eating food. Prepare foods at high enough temperatures. Use care with cutting boards and utensils. Keep food refrigerated. Wash raw fruits and vegetables. Use pasteurized milk and fruit juices. Wash hands after using bathroom. Use individual care items. Evaluating Patient Goals Use techniques of medical asepsis. Identify health habits and lifestyle patterns promoting health. State signs and symptoms of an infection. Identify unsafe situations in the home environment.
Which of the following is the most significant and commonly found infection-causing agent in health care institutions? A. Bacteria B. Fungi C. Viruses D. Mold
Which infection or disease may be spread by touching a contaminated inanimate article? A. Rabies B. Giardia C. E. coli D. Influenza During which stage of infection is the patient most contagious? A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period Soaps and detergents (nonantimicrobial agents) are considered adequate for routine mechanical cleansing of the hands and removal of most transient microorganisms. A. True B. False Standard precautions should be used when caring for a noninfectious, postoperative patient who is vomiting blood. A. True B. False
