Nursing 203 week 1 First 10 Chapters of Urden

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Week 1 for N480 West Coast University

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  • Algorhithm-decision making tree
    Protocols-patient must be qualified then protocol is followed exactly
    Practice guidelines-written by team of experts for a standard way to care for patient.
  • Nursing 203 week 1 First 10 Chapters of Urden

    1. 1. Nursing 203 Cheri Rievley Critical Care Nursing
    2. 2. Nursing 203 Syllabus Week 1.1 Critical Care Nursing •Describe Critical Care Nursing Roles What is it that CCU RN’s do, can you define? Patient Advocacy Advanced Assessment Intensive Intervention High Tech Monitoring Specialized Care Communication between all disciplines
    3. 3. • Nursing is based on evidence. • It needs to be consistent • It needs to have research backing to show the best possible results for the greatest number of patients. Critical Care Nursing Nursing 203
    4. 4. Nursing 203 Syllabus Week 1.2 Critical Care Nursing • Show the importance of holistic care for the chronically ill patient and family • Sheldon (2000) states: Patients need to feel that their circumstances and feelings are appreciated and understood by the health care team member without criticism or judgment. . . . If patients feel that the attention they receive is genuinely caring and tailored to meet their needs, it is far more likely that they will develop trust and confidence in the organization.” Shelton P.J.: Measuring and Improving Patient Satisfaction. New York: Aspen Publishers, 2000.
    5. 5. • Apply the six phases of the nursing process in critical care. (You will do this in clinical, be prepared) – Assessment – Diagnosis – Outcome Identification – Planning – Implementation – Evaluation Critical Care Nursing Nursing 203 Syllabus Week 1.3
    6. 6. • Compare and contrast interdisciplinary critical care management models and tools. – Case Management-overseeing care with MD • Algorithm • Protocols • Practice Guidelines – Outcome Management-manage outcomes with tools • Consistent standard of care • Patient functioning and well being (clinical outcomes) Critical Care Nursing Nursing 203 Syllabus Week 1.4 Locate an example on the internet so you can be familiar with these be able to define them
    7. 7. • Explain ethical principles as they relate to critical care patients. Critical Care Nursing Nursing 203 Syllabus Week 1.5 Mind It is easy to focus on all the technology and physical aspects of patient care in the Critical Care Unit. Give some examples of how you would focus on mind or spirit: Body Spirit
    8. 8. • Examine strategies to address moral distress in critical care nursing. – What is Moral Distress? (This can be very important to your own sense of right and wrong) – Moral distress occurs when: • 1. • 2. Critical Care Nursing Nursing 203 Syllabus Week 1.6
    9. 9. Nursing 203 Syllabus Week 1.7 Critical Care Nursing •Identify and discuss specific legal isssues in critical care nursing practice • Autonomy- • Beneficence- • Nonmalficence- • Veracity- • Fidelity- • Justice/allocation of resources • Can you Define these before I do?
    10. 10. • Autonomy – Freedom of choice or self-determination – Basic human right – Nurses can get “caught in the middle” in ethical situations • Assumes role of patient advocate – Providing more information – Clarifying points – Reinforcing information – Providing support in decision-making process Critical Care Nursing Nursing 203 Syllabus 1.7
    11. 11. Critical Care Nursing• Nursing 203 Syllabus Week 1. 8 Question A terminally ill patient has a “do not resuscitate” (DNR) order per patient request. The patient’s family is opposed to the order. What is the responsibility of the nurse? A. Resuscitate the patient until the issue is resolved B. Honor the patient’s request C. Have the family contact a lawyer D. Ask the physician to talk with the family
    12. 12. Answer B. Honor the patient’s request First and foremost the nurse has a duty to honor the patient’s request. The patient should not be resuscitated. The family can contact a lawyer if they wish but that is not the nurse’s responsibility. Asking the physician to talk with the family may or may not help with the situation.
    13. 13. • Beneficence – Concept of doing good, preventing harm – Requires that one promote the well-being of patients – Weigh benefits, choosing best principles to follow • Nonmaleficence – Dictates that one prevent harm and correct harmful situations – Primary duty for the nurse • What is the difference between these two? Critcal Care Nursing Nursing 203 Syllabus 1.7
    14. 14. • Veracity – Truth-telling – Underlies the nurse-patient relationship • Fidelity – Faithfulness and promise-keeping to patients – Forms bond between individuals – Extends to the families of patients • Incorporates: – Confidentiality – Privacy Critical Care Nursing Nursing 203 Syllabus Week 1.7
    15. 15. • Justice – Allocation of resources – Equal access to health care • Medical Futility – Defined as “any effort to achieve a result that is possible but that reasoning or experience suggest is highly improbable and that cannot be systematically reproduced.” Critical Care Nursing Nursing 203 Syllabus Week 1.7
    16. 16. • Ethical foundation for Nursing Practice – Framework for the profession – Based on 3 elements: • The professional code of ethics • The purpose of the profession • The standards of practice of the professional Critical Care Nursing Nursing 203 Syllabus Week 1.7
    17. 17. • Code of Ethics – Developed by the profession • Look up online – Delineation of its values and relationships with and among members of the profession and society Critical Care Nursing Nursing 203 Syllabus Week 1.7
    18. 18. Question What purpose does the ANA Code of Ethics serve? A. Provides a framework for addressing moral distress B. Provides a description of expected nursing roles and responsibilities C. Provides recommendations for managing care and treatments for specific diseases D. Provides guidance for analyzing ethical issues for the nursing profession
    19. 19. Answer D. Provides guidance for analyzing ethical issues for the nursing profession The American Nurses Association (ANA) Code of Ethics for Nurses provides the major source of ethical guidance for the nursing profession. The Code of Ethics for Nurses serves as the basis for nurses in analyzing ethical issues and decision making
    20. 20. • Code of Ethics for Nursing – Nursing is concerned with: • Protection of patient health • Promotion of patient health • Restoration of patient health • Prevention of patient illness • Alleviation of patient suffering • Can you identify one intervention from each for the CCU nurse? Critical Care Nursing Nursing 203 Syllabus Week 1.7
    21. 21. • Steps in Ethical Decision Making 1. Identify the health problem. 2. Define the ethical issue. 3. Gather additional information. 4. Delineate the decision maker. 5. Examine ethical and moral principles. 6. Explore alternative options. 7. Implement decisions. 8. Evaluate and modify actions. Critical Care Nursing Nursing 203 Syllabus Week 1.7
    22. 22. Nursing 203 Syllabus Week 1.7 Critical Care Nursing • Administrative Law and Licensing Statues • Health care agencies/boards • Governed by administrative law • These guys make the rules
    23. 23. Critical Care Nursing Nursing 203 Syllabus Week 1.7 Negligence and Malpractice Four elements of negligence and malpractice: 1. Duty and standard of care 2. Breach of duty 3. Causation 4. Injury or damages
    24. 24. Negligence The doing of something which a reasonably prudent person would not do, or the failure to do something which a reasonably prudent person would do, under circumstances similar to those shown by the evidence. It is the failure to use ordinary or reasonable care. “ordinary or reasonable” care That care which a person of ordinary prudence would use in order to avoid injury to themselves or others under circumstances similar to those shown by the evidence. You will note that the person whose conduct sets the standard is not the extraordinarily cautious individual, nor the exceptionally skillful one, but a person of reasonable and ordinary prudence. Black H. C. (1998). Black’s Law Dictionary. 9th ed. St. Paul, MN: West Publishing Company Critical Care Nursing Nursing 203 Syllabus Week 1.7
    25. 25. Question Which of the following situations is an example of malpractice? A. The patient gets out of bed against nursing advice and falls and breaks a hip. B. The nurse makes derogatory comments about the patient in the medical record. C. The nurse gives the wrong medication to a patient and the patient dies as a result. D. The nurse gives confidential information about the patient to the media
    26. 26. Answer C. The nurse gives the wrong medication to a patient and the patient dies as a result. The nurse giving the wrong medication to a patient and the patient dying as a result is an example of malpractice. It meets the 4 required elements of malpractice.
    27. 27. • Legal Duties of Critical Care Nurses – Observe – Assess – Conduct ongoing observations and – assessments – Recognize significance of information – Report – Plan, implement, and evaluate care Critical Care Nursing Nursing 203 Syllabus Week 1.7
    28. 28. • Legal Duties of Critical Care Nurses –cont- – Respond to changes – Interpret and carry out orders – Take reasonable measures to ensure patient safety – Exercise professional judgment – Properly perform procedures – Follow hospital policies and procedures – Record and document Critical Care Nursing Nursing 203 Syllabus Week 1.7 What happens if you don’t do these? if
    29. 29. Six General Areas of Nursing Negligence • 1. Improper administration of treatments • 2. Improper administration of medications • 3. Inadequate or false written and verbal communication • 4. Insufficient supervision of patients • 5. Improper postoperative treatment and wound care • 6. Incorrect perioperative instrument or sponge count Critical Care Nursing Nursing 203 Syllabus week 1.7
    30. 30. Nursing 203 Syllabus week 1.7 Critical Care Nursing Nurse Practice Act • Right to practice and right to employment • Monitor practice, implement standards of care • Enforce rules and regulations • Issue sanctions and license revocation • Disciplinary action for unauthorized practice, negligence or malpractice, incompetence, chemical or other impairment, criminal acts, or violations of specific nurse practice act provisions These are your rights as an RN
    31. 31. Specific Patient Care Issues • Informed consent and authorization for treatment • Valid consent – Consent must be informed and timely • Diagnosis, condition, prognosis, material risks and benefits of treatment, explanation of procedure or treatment, providers of treatment, and probable outcome Critical Care Nursing Nursing 203 Syllabus Week 1.7
    32. 32. Specific Patient Care Issues (continued) • The right to accept or refuse medical treatment and the law of advance directives • The right to informed consent • The right to refuse treatment • Withholding and withdrawing treatment • Ethical, legal, and practical problems • Specific guidelines to guide decision makers Critical Care Nursing Nursing 203 Syllabus Week 1.7
    33. 33. Advanced Directives and the Patient Self-Determination Act (1990) • All adults must be provided written information on an individual’s rights under state law to make medical decisions, including the right to refuse treatment and the right to formulate advance directives • Living will • Durable power of attorney for health care • POLST Form Critical Care Nursing Nursing 203 Syllabus Week 1.7 What is the difference between these?
    34. 34. • Assess informational needs of families of critically ill patients. – What do they need to know? – How do they get information? – If you don’t know answers, where do you find them? Critical Care Nursing Nursing 203 Syllabus Week 1.8
    35. 35. • Apply teaching learning theory to the critical care setting. –Be prepared to teach something in class to show understanding of this concept. • When teaching an adult patient, tasks being taught should focus on current problem. – True – False Critical Care Nursing Nursing 203 Syllabus Week 1.9
    36. 36. • A. True • Adults bring a wealth of experience to the learning environment that must be recognized and promoted in educational techniques. Because their orientation to learning is life centered, the tasks being taught should focus on current problem resolution. Critical Care Nursing Nursing 203 Syllabus Week 1.9
    37. 37. Assessment Questions for the Critically Ill Patient and their Family • What brings you to the hospital? Can you tell me more? • What have you been told so far about your your family member’s) condition and plan of care? • What is the most important thing for you to know right now? • What would you like to know? What information can I give you right now? • Who are your main support people? • Has anything like this ever happened to you (your family) before? • Have you (your family) ever been in an intensive care unit or hospital before? • Do you have any special concerns that we need to address right now? Critical Care Nursing Nursing 203 Syllabus Week 1.9
    38. 38. Nursing 203 Syllabus week 1.9 Critical Care Nursing Your Logo Factors Affecting Patient Readiness to Learn • Physiological stressors • Psychological stressors • Sociocultural stressors • Financial stressors • Environmental stressors Define a barrier in each of these areas.
    39. 39. Critical Care Nursing Nursing 203 Syllabus week 1.9 Essential Critical Care Information for Patient/Family • Orientation to the various care providers and the services they deliver • Orientation to the unit environment • Orientation to the unit routines and plan of care • Visiting hours, frequency of monitoring and nurse assessments, venipunctures, daily weights, and special shift routines (extremely important) (continued)
    40. 40. Critical Care Nursing Nursing 203 Syllabus week 1.9 Essential Critical Care Information for Patient/Family • Explanations regarding reasons for equipment, monitors, and associated alarms • Explanations of all procedures and expected sensations/discomforts both in and off the unit • Medications given • Drug name, reason for receiving, and side effects to report to nurse/others • Immediate plan of care • Transition to next level of care • Reason for transfer, environment, staffing, and availability of care providers • Discharge plan • Medications, diet, activity, pathophysiology of disease, symptom management, special procedures and associated equipment, when to call health care provider, and available community resources.
    41. 41. Education Plan of Care – Expected outcomes – Objectives – Content to be taught – Interventions – Available education materials – Appropriate teaching strategies Critical Care Nursing Nursing 203 Syllabus Week 1.9 Choose a critical disease process and practice, practice, practice, someone’s life may depend on you
    42. 42. • Prior to educating a patient what do you need to know? – Ready to learn? – Language – Comprehension level • Remember age affects our ability to learn Critical Care Nursing Nursing 203
    43. 43. Nursing 203 Syllabus week 1.9 Critical Care Nursing Your Logo Question Which of the following educational methods would be best for teaching a patient how to check his or her blood sugar? Why? A. Lecture B. Discussion C. Demonstration and practice D. Closed-circuit television
    44. 44. Nursing 203 Syllabus week Critical Care Nursing Your own footer Your Logo Answer C. Demonstration and practice Demonstration involves acting out a procedure while giving appropriate explanations to provide the learner with a clear idea of how to perform a task. Patients can then practice the skill and can be given feedback about their performance. This method works best when teaching patients how to check their blood sugar.
    45. 45. Critical Care Nursing Nursing 203 Syllabus week 1.9 Strategies to Enhance Education Get the patient’s attention Information must be important to patient Stick to the basics Use simple everyday language Make the most of your time Teachable moments Reinforce learning
    46. 46. Critical Care Nursing Nursing 203 Syllabus week 1.9 The Older Adult • Cognitive changes  Process information more slowly • Physical changes  Presbyopia, cataracts, glaucoma, and macular degeneration affect the vision, more susceptible to over sedation, doesn’t bounce back like a younger patient, more easily toxic with any medication. • Psychological changes  Depression
    47. 47. Critical Care Nursing Nursing 203 Syllabus week 1.9 Question Which of the following strategies should be used to facilitate learning the older adult? A. Schedule sessions for later in the day. B. Keep sessions short. C. Withhold all pain medication 1 hour before the session. D. Written instructions should be printed in purple ink.
    48. 48. Critical Care Nursing Nursing 203 Syllabus week 1.9 Answer B. Keep sessions short. Learning can be facilitated by scheduling teaching sessions early in the day, keeping sessions short, and managing pain prior to learning. Colors in the blue end of the spectrum are difficult for the older adult to distinguish, thus blues, greens, and purples should not be used for written instructions.
    49. 49. • Documentation – What was taught? – To whom? – Verbalized, return demo, how did they show they understood? – Nurses teach every shift but if it is not documented it is not done! – Give examples of simple teaching that might be forgotten Critical Care Nursing Nursing 203 Syllabus Week 1.9
    50. 50. Critical Care Nursing Nursing 203 Syllabus week 1.9 Illiterate Patients • Use simple language • Provide frequent examples • Use teach-back or return demonstration • Pictures, diagrams, and audio/videotapes can be helpful
    51. 51. • Interpreters and Interpreter Phones – Look at the patient not the interpreter – Speak to the patient, don’t use “tell him” – Know what you want to say in advance – Ask for a return demonstration so you know learning has taken place. Critical Care Nursing Nursing 203 Syllabus Week 1.
    52. 52. • Preparation for Transfer – Fear of the unknown – Explanations to relieve anxiety • Transfer destination • Reason for transfer • Nurse who will assume care of the patient • Expected changes in care • Expected self-care • Visiting hours and notification of family Critical Care Nursing Nursing 203 Syllabus Week 1.9
    53. 53. • Psychosocial Alterations – Anxiety and Pain – Powerlessness – Hopelessness – Spiritual Distress Critical Care Nursing Nursing 203 Syllabus Week 1.10 Understand how these apply to the patient in CCU define measures to alleviate
    54. 54. • Examine measures that are useful in reducing stress. – Coping mechanisms • Suppression Use of Family Support • Denial Sharing Concerns • Trust • Hope • Spiritual beliefs and Practices Critical Care Nursing Nursing 203 Syllabus Week 1.10
    55. 55. • Assess the impact of illness on the patient’s family and on family functioning. – How are they functioning • Helpful • Hostile • Overly concerned • Think of ways you would interact with each type of family Critical Care Nursing Nursing 203 Syllabus Week 1.11
    56. 56. • Examine safety issues in the critical care environment. – Cords/Plugs emergency versus regular power supply – Fall Risk – Restraints – Endotrachial Intubation Critical Care Nursing Nursing 203 Syllabus Week 1.12
    57. 57. • Assess changes in sleep pattern resulting from sleep apnea and critical care environment and interventions. – Sleep stages • NREM vs REM what’s the difference? • Url link to youtube for REM example – http://www.youtube.com/watch?v=SRwmDSkwpxk • Sleep cycles • Changes with aging Critical Care Nursing Nursing 203 Syllabus Week 1.13
    58. 58. • Abnormal Sleep – Sleep Apnea Syndrome – Obstructive Sleep Apnea • Medications and altered sleep (see chart in Urden pp40-41) • Medical management-What? • Nursing management-What? Critical Care Nursing Nursing 203 Syllabus Week 1.13
    59. 59. • Nutrition – Types of diets in the Critical Care Unit • Cardiac – Low Na, Low fat • Renal – Low protein • Enteric feeding – NGT placement is checked by xray the first time then by air insertion/aspiration • TPN – High glucose, great medium for infection, isolated line – High glucose can cause increased CO2 levels on vent pt Critical Care Nursing Nursing 203
    60. 60. • PAIN – Very subjective – Use a pain scale for better consistency between nurses and patient – Remember geriatric patients are more sensitive to pain medications – If giving ANY medication to pediatric patient must check with a second nurse Critical Care Nursing Nursing 203
    61. 61. • Sedation Medications – Short and Long acting – It is always preferable to use a sedation scale for consistency in medication – Any patient on a continuous sedation drip should be on a protocol and have a sedation vacation every 24 hours to allow them to wake up, and attempt to breath on their own – Anytime a pt is on a neuromuscular blocking agent they MUST be on sedation as well. Critical Care Nursing Nursing 203
    62. 62. Nursing 203 Syllabus week Critical Care Nursing Your Logo Define: Death with Dignity Watch this presentation on death with dignity: http://www.youtube.com/watch?v=OU284t4axQ0
    63. 63. • Death with Dignity – Should allow the patient to be kept comfortable – Should be explained fully to the family, we still care for the patient, turn, keep them comfortable, we just don’t intervene if their heart or breathing stop. – Palliative Care Nurses are very important to help the family during a difficult time. Critical Care Nursing Nursing 203
    64. 64. Week One is Done! See you next week. Your Logo

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