2. PRIMARY HEALTH CONCERNS OF
NURSING
A. Second level of Maslow’s hierarchy of human
needs.
B. Factors affecting safety.
C. Assessment for individual risk factors at home
and in health care facilities.
D. Plan/implementation
3. A. Second level of Maslow’s hierarchy of human
needs.
1.Besides prevention of injury, includes;
- protection from physical &
psychological harm,
- freedom from pain, and
- provision of a stable, dependable,
orderly, & predictable environment.
2. Nursing has the primary responsibility
ensuring the safety of patient in
health care facilities
Influencing the safety of persons in
home, work, and community
environments.
4. B. Factors affecting safety.
1. AGE/ DEVELOPMENT
a. Children – accidents constitute leading cause of death in all age groups
except infancy
1. Infants – accidents occur primarily in second half of first year
a. mouthing any object that they handle.
b. unsupervised/unrestrained rolling over, crawling, walking
can result in falls & enhance accessibility to small objects,
electric cord, poisonous substances.
2. Toddlers – high incidence of accidents
a. increasing curiosity; exploring using all senses (esp. taste
& touch); learning by trial/error.
b. Increasing gross & fine motor activity, climbing, running.
grasping.
c. totally uncomprehending and fearless of consequences;
increasing negativism as part of autonomy.
5. 3. Preschoolers – continued risk
a. increasing imitative behavior
b. refining fine and gross motor ability
4. School-agers – although better muscular control,
increased cognitive capacity, and more readiness to respond
to rules, there continues to be increased risk of accidents
related to identification with “super heroes,” increased
involvement and competitiveness in sports, and sensitivity to
peer pressure.
5 Adolescents – high incidence, especially motor
vehicles, associated with physical awkwardness related to
growth changes and conflict over
dependence/independence; peer orientation and approval
seeking; increasing goal orientation and risk-taking behavior;
and inner perception of omnipotence and immortality.
6. • b. Adults – disregard for safety regulations
• c. Elderly – diminished muscular strength/coordination, sensory
acuity, and impaired balance create special problems.
• 2. Awareness of environment, self and others
• A. impact on the individuals ability to perceive and react to
surroundings/circumstances.
• B. factors that may reduce perceptual awareness and ability to
perform ADL
• 1. level of consciousness, neurological function, sensory perception
• C. illness-associated signs and symptoms, treatments, anxiety, and
degree of weakness/impaired mobility.
7. • D. hospitalization
• E. lack of sleep
• F. meds
• 3. Ability to communicate – physical impairment, language
barrier, illiteracy.
• 4. Environment
• A. work place – hazardous machinery, chemicals, high stress
• B. residence – high crime areas, poorly maintained living conditions
• C. Unfamiliar surroundings in which specific safety information is
essential. - hospital
8. • D. physical and biological dimensions
• 1. space – defined personal areas sufficient for the purpose (play,
chores, hobby), w/ privacy as appropriate.
• 2. Lighting – natural/artificial appropriate to function – to provide for
day-night cycle.
• 3. temp. & humidity – the very young esp. neonate and old are
particularly vulnerable to extreme variations
• 4. ventilations –
• a.Smoking – not allowed in any confined areas where susceptible
individuals may be affected
• b.Room/central conditioners –should have high quality filters that are
changed frequently.
• 5. Sound – chronic exposure to loud noises can lead to permanent
hearing loss, work performance, sleep problems & psych stress.
9. • 6. Physical Layout – neatness & cleanliness
• E. Community resources
• 1. food & water supply
• 2. waste disposal
• 3. air quality
• 4. traffic management
• F. Assessment for individual risk factors at home and in
health care facilities
• 1. Hx of accidents
• 2. concern for/ perception of hazards
10. C. Assessment for individual risk factors at
home & in healthcare facilities
1. History of accidents – there is increased risk for other
mishap.
2. Concern for/perception of hazards
3. Evidence of unsafe behaviors – smoking in bed, non-
use of seatbelts, storage of toxic substances within
reach of children.
4. Physical/psychological impediments to safe function-
level of alertness, mental status, sensory acuity, mobility
limitations.
11. NSG MGT OF THE CHILD @ DIFF. DEV. STAGES
ACTION RATIONALE
Birth to 6 mo
Keep sharp & hot objects out of child’s
reach
Do not leave unattended; can roll off
flat surfaces
Administer unpleasant meds slowly via
nipple/syringe.
Has strong grasp reflex
Rolls over by about 3mos.
Aspirations can really occur
6 mo – 1 y
Restrain child adequately
Enlist aid of parent in doing difficult
procedures, if possible
Can resist with entire body, has active
cortical control
Knows parent as a source of comfort 7
security
12. 1 – 3y
Administer medications from a cup
Expect turbulent temperament;
tantrums common
- Prefers less dependent behavior
- Control envi; be consistent in
expectations
3 – 6y
Take special care to explain all actions
in advance
- Illness and procedures are seen as
punishment, body mutilation is feared.
6 – 13y
Provide time for child to handle and
play with equipment if possible
- Interested in learning
Adolescent
Noncompliance is the norm; attempt to
impose as few orders as possible
- Independence is important to their
emotional growth
13. D. Plan/ Implementation
• Requires attention to general principles of safety as well
as identification of specific hazards/risks and subsequent
measures to prevent injury; includes appropriate
anticipatory and responsive patient education, and
prevention of injury by active/passive identification of
hazards such as:
1) Orient new client to the immediate environment – call-
bell/signal, bed controls, location of bathroom, operation
of overhead and bed lights, schedule of unit activities
2) Maintain the bed in the lowest position except when
care is being provided, side rails in raised position when
client is in bed.
14. • 3) Provide adequate help when ambulating client,
especially for the first time.
• 4) Ensure client area is free of clutter-mop up or call
housekeeping to remove spills.
• 5) Never leave patient in total darkness – use night light
when room lights are off.
• 6) Always secure call-bell/signal within the patient’s reach.
• 7) Encourage the client to wear shoes when ambulating.
• 8) Use brakes when moving the client in/out of
wheelchair, commode, bed
15. • 9) Label & report malfunction of any equipment
immediately
• 10) Restrain client only as necessary; padded to prevent
undue pressure/constriction; checked every 1-2h;
removed every 2h while client is awake; never tied to side
rail; physician order necessary.
• 11) In case of accident, institute follow-up procedures –
document subjective and objective data concerning the
incidence of accidents/injury as well as reported/observed
use/non-use of identified safety measures; incident report;
fall assessment.
