week one the nurses role in adult Health nursing by IET claudo Masters in nursing education RN definition of and history so what is nursing nursing is both an art and science the art of it is therapeutic communication finesse your personal style to develop a trusting relationship with client family and Community the American Nursing Association also known as the Ana defines nursing as the diagnosis and treatment of human responses and advocacy in the care of individuals families groups communities and populations and recognition of the connection of all Humanity use of the nursing process and clinical judgment so what is the nursing process and clinical judgment you may have seen the letters a d p i e also known as adpie or a d p o a o p i e which is adop so we're going to talk about adpie a stands for assessment assessment of the patient family caregivers group or Community um d stands for diagnosis consider all the data that you collect and arrive at a nursing diagnosis that can be an actual problem that the patient has or one that the patient is at risk risk for P stands for plan of care you have to develop a plan like I said in class in order to develop a plan you have to have a goal plan care which includes prioritization of the problems with Goal settings for each one um I stands for intervention you want to perform the interventions that's based on your clinical judgment that will achieve your goal of care and then e stands for evaluation you're going to evaluate the patient to see if your intervention or plan worked you want to evaluate the patient the family the group or community's responses to the intervention so use of clinical judgment your interpretation or conclusion about a patient's needs concerns or health problems clinical judgment is dependent on what you know and how you reason it's the decision to take action or not de based on the patient's response so what are some of our nursing responsibilities well we have to integrate the Art and Science of caring we have to protect and promote and optimize Health and Human functioning also known as health promotion uh we have the responsibility to prevent illness and injury and that can be done through infection control and safety um we have to facilitate healing and we also have the responsibility to alleviate suffering through compassionate presence so what is all this mean to be a nursing student specifically here in nursing 100 well you're beginning to build your knowledge base related to Med sege to inform your decisions and judgments with this learned knowledge you'll be able to make thoughtful decisions that promote positive patient outcomes using your clinical judgment your first step step is to build your understanding about a variety of disorders their risk factors clinical presentation also known as manifestations or signs and symptoms diagnostic findings treatments and potential complications for nursing 100 that priority will always be assessment clinical manifestation nursing actions and considerations scope of practice so what is scope of practice the scope of practice is used to delineate actions that are legally permitted for a particular profession based on specific educational qualifications simply put it specifies the actions that the nurse can perform as a nursing student and nurse it is always important to consider can you perform the ordered task according to your scope of practice or are you putting your nursing license at risk just because your employer asks you to do a task that doesn't mean here or she it should be done for example um asking a unassisted Personnel uh to turn off the IV pump all right so let's talk about the nursing process again um it's an iterative process and begins a new with each step the first step is for you to build your understanding about a variety of disorders their risk factors clinical presentations diagnostic findings treatments and potential complications which are all nursing 100's Focus Associated not only with the condition but with your treatment for without that knowledge there is no ability to make appropriate safe clinical judgments we had um looked at the nursing process um but you'll be taking uh the boards which is which is called the Next Generation enlex it's the exam that you will take upon completion of your program um the en this NextGen enlex outlines six steps in the clinical reasoning model step one um recognizing cues where relevant and important information is ident identified from different sources so step one you want to look at um medical history or Vital Signs subjective and objective data Gathering all that information step two is to analyze these cues analyzing your data in the clinical setting this means organizing and linking the recognized cues to the patient's clinical presentation step three in uh involves prioritizing hypothesis where hypothesis are evaluated and ranked according to priority so this can include urgency likelihood risk difficulty and or time in this phase you cluster all of your findings together to arrive at a list of problems whether it's an actual problem or a potential at risk problem um that you believe that your patient is experiencing and determine the importance or urgency what do you think is of greatest concern prioritization is key step four is generating Solutions identified expected outcomes so you develop an hypothesis to help Define a set of interventions for the expected outcomes step five is to take action um so you take action where the solutions that addresses the highest priorities are implemented and then step six what do we do we see if our plan worked by evaluating you want to evaluate the outcome and compare the observed outcomes against what you expected the expected outcomes and here we go is the chart that compares the nursing process which we discussed assessment come up with a diagnosis plan Implement and evaluate Tanner's clinical judgment model and then what we just discussed the national clinical judgment measurement model [Applause] looking at maso's hierarchy of needs all right um and we discussed this in class when you're prioritizing in nursing you want to go with your ABC's Airway breathing and circulation then from there you want to look at your maso's hierarchy of needs you have your physiological needs which we talked about in class oxygen Food Water Shelter um elimination rest sleep physical activity sexual activity you need these um physiological needs for survival second is Safety and Security that includes U uh both physical and emotional you want to be safe but feel safe love and belonging uh means to be loved and accepted self-esteem how a person perceives um themselves um himself um herself or themselves uh for example if your patient um newly diagnosed with cancer at a young age um is going to affect possibly their self-esteem or a patient that had um an iloom or some type of surgery may also affect their self-esteem so be cognizant of that and then self-actualization is reaching um helping the patients reach their fullest potential all right we discussed this in class about Mrs Brinkley so as the call light in room 345 bed two rings for the seemingly 12th time the shift the members of your nursing team look at each other and sigh in frustration Mrs Brinkley she's a retired librarian she um has a GI bleed but she also suffers from dementia the team is uh charting at the end of their shift and would like to finish before the shift ends right but someone needs to answer her call light so by license year who is responsible for answering Mrs Brinkley's call light in class we discussed this everyone is responsible the nurse is responsible uh primarily for Mrs Brinkley's outcome but everyone involved in this paragraph is is responsible for Mrs Brinkley's call light describe the proper chain of Delegation for patient care as in class we discussed RN to LPN LPN can delegate to the UAP the RN eventually is the uh responsible person for whoever he or she or they delegate to and their outcome so um what is delegation delegation is defined as the process process by which a nurse assigns or directs another member of The healthc Care staff to perform nursing activities delegation must be taught and practice to develop proficiency the delegating RN remains ultimately responsible for both the action and its outcome you have five Rights of Delegation these are important the right task right circumstances delegating to the right person right directions and communication right supervision and evaluation things that you need to know when delegating um how a patient ambulates when was the last time the patient received pain medications how was the patient Skin Integrity so I would study this chart and take a look at um what is within each of these um job description scope of practice this slide would be important all right Let's test your knowledge is the following statement true or false the scope of practice specifies interventions that are appropriate for patients who have specific medical and nursing diagnosis the answer is false as discussed earlier scope of practice is used to delineate actions that are legally permitted for a particular profession based on specific educational qualifications it does not specify specific um particular interventions that are appropriate for particular clinical situations in class we talked about different governing bodies we all have someone that we have to answer to as nurses we do so these are your governing bodies the American Nurses Association also know as the Ana they guide professional nursing practice with Publications in addition to the Ana scope and standards of practice and Ana code of ethics an example of violating the code of ethics and we discussed this in class would be a nurse taking the picture of a client without their permission and posting it on the internet we also have the state practice uh State nursing practice act if nurses do not follow the standards and scope of practice set forth by the nurse Practice Act they can have their license revoked by the Board of Nursing so in order to obtain a license you need a verification of graduation criminal background uh check in certain States a passing score on your enlex examination self-disclosure of any substance used in the past 5 years uh we talked about in class the nurse licenser compact which allows a nurse to practice across state lines with just one license uh this is great for travel nursing or if you want to practice in a different state you want to find um a compact state then we look into occupational safety Health uh and health administration also known as OSHA they are responsible for providing safe and healthy workplace for their employees The Joint Commission is an independent nonprofit organization their mission is to continuously improve the safety and quality of care provided to the public at present The Joint Commission accredits Approximately 80% of the nation's hospitals Department of Public Health also known as dph each state has their own dph dph has a legal obligation to enforce the laws and rules in a nurse Practice Act and is charged with the protection of the health and wellness well-being of the state's population and environment um patient protection and Affordable Care Act of 2010 also known as Healthcare reform or Obamacare increases the number of people with health insurance improves insurance policies and reimbursements based on quality of care finally we have centers for Medicare and Medicaid services manages Medicare which is a health insurance program for people over 65 years of age or people uh under 65 with certain disabilities and those with endstage kidney disease um the CMS also manages Medicaid which provides coverage for lowincome communities then we have cusin also known as quality and safety education for nurses they assist nursing programs in preparing nurses to provide safe high quality Care legal considerations as discussed in class um nursing profession is a litigious profession nurses are accountable for practicing nursing within the confines of law to Shield themselves from liability advocate for client rights provide care that is within the nurses scope for practice discern the responsibility of Nursing in relationship to the responsibilities of other members of the healthcare team and provide safe proficient care consistent with the standards of care uh federal laws affecting nursing practice we have Hippa which uh we all know as health insurance portability and accountability act violations of HIPPA include sharing information on social media including accepting friend requests gossiping about patients a student accessing the medical record of a patient they cared for last week to see how they're doing mishandling a medical records reporting lab findings to the unit secretary to inform the patient's family and sharing EMR um electronic medical record passwords with anyone other than HR so um students always remember as nursing students when you uh go to your clinical site how easy you you can violate Hippa um none of the patient information should leave your uh clinical sites um we also have um Americans with Disabilities Act uh what is criminal law criminal law is an example of criminal law is a nurse who falsifies a record to cover up a serious mistake we also have state laws the Board of Nursing in each state has the authority to adopt rules and regulations that further regulate nursing practice and then we have the Good Samaritan law that protects healthcare workers from liability when they intervene at the scene of an emergency we also have the term called professional neg NE professional negligence is the failure of a person who has professional training to act in a reasonable and prudent manner the term reasonable and prudent describes a person who has the average judgment intelligent foresight and skill that a person with similar training and experience would have uh client's rights uh nurses are accountable for protecting the rights of clients examples include informed consent which we'll discuss um later refusal of treatment Advanced directives confidentiality and information security the client has the right to understand the aspects of care to be active in the decision-making process the client has the right to accept refuse or request modification of the plan of care and the client has the right to receive care from competent individuals who treat the client with respect and then we uh go on to Advanced directives types of advanced directives include living will a living will is a legal document that expresses the client's wishes regarding medical treatment in the event that client faces end of life issues most state laws include Provisions that protect healthcare providers who follow a living will from liability uh you also hear what's called durable power of attorney for Health Care also known as a POA this is a document in which clients designate a health care proxy to make Health Care decisions for them if they arable to do so uh the proxy can be any competent adult the client chooses does not need to be uh family and can change at any point um then we have uh provider's orders unless a provider writes a do not resuscitate DNR or allow natural death a and and prescription in the client's medical record the nurse initiates um life-saving measures CPR card cardiopulmonary resuscitation when the client has no pulse or respirations the provider has to consult with the client and the family prior to administering a DNR or a so students the first thing you want to do when you go and take care of your patients when during uh week six of your clinical is to see what their code status is are they a full code or there d uh DNR dni um so that you know whether or not you you are going to perform like saving measures on your patient um and then you have mandatory reporting um as uh nurses we are uh mandated reporters uh to report abuse and contagious diseases so let's talk about informed consent all right Who Um can obtain informed consent the provider okay um an informed consent should be obtained for every patient for any procedure okay uh the provider okay um the doctor the APRN the the provider um the uh has to describe the purpose of the procedure with a complete description the provider is responsible for giving clarification uh the provider um a description of the professionals who are involved um uh in in the patient procedure um that that's going to perform the patient's procedure and um participate um a description of the potential harm pain or discomfort the procedure may cause options for other treatments and the option to refuse um and the consequences of doing of refusing okay um the client the client then gives informed consent to give informed consent the client must be um not coerced give it voluntarily where no coercion is involved be competent and of legal age or be an emancipated minor the client must receive enough information to make a decision based on an understanding of what to expect so when the client is unable to provide consent another authorized person must give consent so what's our role what's within our scope of practice well the nurse Witnesses informed consent this means the nurse must ensure that the provider gave the client the necessary information ensure that the client understood the information and is competent to give informed consent have the client sign the informed consent document notify the provider if the client has more questions or appears not to understand any of the information document questions the client has um notification of the provider reinforcement of teaching and use of an interpreter okay types of of torts uh this slide is important so what is a tort a tort is a civil wrong that causes harm to a person or their property so the types of torts are intentional torts and these torts um they're intended to cause harm uh examples of intentional torts are assault which is uh the conduct of one person makes another person feel fearful and apprehensive an example of this is a nurse threatens to place an NG tube in a client who is refusing to eat what's an ND tube it's a nasogastric tube and basically it's a tube that goes from the client's nose down into their stomach second type of intentional tort is called battery which is intentional and wrongful physical contact with a person that involves an injury or offensive contact an example of this is a nurse uh who restrains the client and administers an injection against their wishes third type of intentional Tor is called false imprisonment a person is confined or restrained against their will example of this is if a nurse uses restraints on a competent client to prevent their leaving the healthcare facility quasi intentional torts quasi means partly not intended to cause harm intentional TS uh examples of this are breach of confidentiality breaking Hippa a nurse releases a client's medical diagnosis to a member of the press another example could be a nurse nurse informing their sibling who works in another unit that the nurse's client has herpes second type of Quasi intentional Tor is called defamation of character uh an example of this is a nurse telling a coworker uh coworker that they believe the client has been unfaithful to their partner uh the third type of tort is called unintentional tort where um the person unintentionally causes harm uh examples of this are negligence where the nurse fails to implement safety measures for a client at risk for Falls or a malpractice professional negligence a nurse administering a large dose of medication due to a calculation error and the client has a cardiac arrest and dies all right now we go to ethics so an ethical dilemma an ethical dilemma in nursing is a situation where a nurse must decide between competing values and knows that no matter what choice they make there are consequences ethical dilemmas May conflict with the nurse's personal values or with the code of ethics for nurses examples of ethical considerations you have prolife versus pro-choice end of life decision- making inadequate Staffing incompetence among nursing peers substance use disorder amongst nurses stem cell research gender reassignment and impaired providers prevalence of substance abuse and nursing um the prevalence the number is probably greater considering addiction amongst nurses is underreported due to stigma and fear of punitive action so why nurses and by nursing students right um stress right and everything is in our hands it can get tempted we have um you know all these drugs that are within our reach so um examples of high levels of stress are staff shortages significant expectations long rotating night shifts patient losses traumatic experiences and horizontal and vertical bullying so um basically if you see your peer or even your your peer as nurses or even your peers around you as nursing students um what stands out here in this slide if you see um one of your peers they're withdrawing from each other from from peers at the workplace and school if they're taking frequent or long breaks increase or unexplained absences or tardiness elaborate excuses for simple problems if there's a gradual decline in work and academic performance or if they're consistently signing out or wasting more narcotics than peers okay so this can be within um nursing school and also within your practice all right so here um we move from substance abuse and um to uh health education so as nurses we have the responsibility to educate okay so we promote Health by providing health education to our patients so what is health education health education according to the Ana is defined as teaching as a function of nursing um is included in all state nurse practice acts and in the scope and standards of clinical nursing practice um health education is an independent function of nursing practice and is a primary nursing responsibility it enables people to increase control over their health reduce rehospitalizations and health care costs and promotes self-care at home and in the community thereby improving Health RNs are charged with ensuring the public is obtaining accurate information for health education and health promotion um accurate information meaning using um evidence um based practice um so you can't use Google or Wikipedia or Tik Tok or Instagram it must be peer reviewed and evidence-based always consider the source remember that so who is in most need of health education those with chronic illness and disabilities are in most need of health education what is health promotion today there's an increased EMP is placed on health health promotion wellness and self-care Health how health is perceived depends on how it is defined what does it mean to you to be healthy a person's state of health is Ever Changing from Wellness to poor health to imminent death Wellness it is not equivalent to health um wellness and health are two different things it is more comprehensive and holistic in nature Mind Body Spirit environment a patient can be physically healthy but not have Wellness they can have depression or anxiety all right so health is the state of complete physical mental and social well-being and not merely the absence of disease and infirmity whereas Wellness implies a proactive process toward a goal of physical psychological and spiritual well-being in which people of any age and in various stages of healthcare are willing to work hard health promotion is an active process it's not something that can be prescribed or dictated it's up to each person to decide whether to make changes to promote a higher level of Wellness only the individual can make these choices have your patient be responsible for their care okay strategies include screenings genetic testing Lifetime Health monitoring environmental and mental health Pro uh programs risk reduction and health education uh so you hear the term evidence-based practice in nursing it's a lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories nursing is always changing so you always want to be up to date to evidence-based practice and finally models of nurses of Nursing Care um patient and family centered care the collaborative approach where you include the patient and family um it may include persons that are not legal related to the patient all right so along with health education is the learning environment how are we going to teach these patients are they ready to learn okay so the learning environment um how do patients learn timing is important why you want to avoid scheduling a teaching time when the patient is tired uncomfortable anxious in pain when visit visitors are present or when the patient's watching television you want to pay attention to whether the patient is squinting when reading um you want to see if the family would like to participate in in in uh provided care so the session should be scheduled for when the family members can be present um and allow ample time to learn discuss um discharge teaching provide a highlighter um as we all I I talked about discharge sometimes when you discharge patients patients are in a rush to get out they'll probably just say yes to everything that you say so you want to assess and make sure that they're understanding what you're teaching them so what are some teaching techniques not a one- siiz fits-all approach um meet the patient and families where they're at lectures or explanation method should always be accompanied by a discussion something like a class other strategies include books pamphlets pictures computer assisted um audio group teachings demonstrations um you want to commun improve communication detect communication issues look for non-verbal cues do they speak English do they speak a second language is there a language barrier do they have a good rapport with you um using uh techniques such as ask tell ask close the loop ask permission tell explain ask for understanding close the loop teach back method so basically when you teach them make sure they teach what you taught them back to you if that makes sense that that's the teach back method reinforcement motivates learning feedback should be presented in the form of positive reimbursement and constructive suggestions for improvement when unsuccessful learner Readiness is based on culture attitude and personal values all right if we were in class this would be one of your interactive activities where you would um break into groups and discuss how these terms have an influence on Healthcare delivery immigration how does immigration have uh an influence in healthcare delivery US Census bureau's projections indicate that by 2060 one out of every five people will be from a different country so there will be differences in culture and language barriers um you all have a culturally uh competency test um that's due coming up culturally competent nursing care requires comprehensive knowledge of cultur specific information awareness and sensitivity it's important to exploring one's own cultural beliefs and how they might differ from the beliefs of the patient being cared for is the first step towards becoming culturally competent aging population the increase in lifespan has tripled one in seven people are over the age of 65 as we age our needs are usually chronic in nature and complex which necess necessitates uh changes in models of Nursing Care people are living longer changing patterns of disease um incre increasing chronic illnesses also uh means increasing health care costs advances in technology um we have access to faster less invasive less painful procedures artificial intelligence and machine learning Public Safety um The public's trust confidence in nursing um the cin project which we uh talked about earlier has established standards for Education educating nurses um there six competencies uh which is in box one5 in Honan in chapter one patient- centered care teamwork and collaboration evidence-based practice quality improvement safe safety and informatics all right so let's talk about regulatory bodies how do they have an influence in health care delivery um well we talked about the regulatory bodies earlier in the lecture um they are there to ensure that minimum standards are maintained what about professional societies and associations will they ensure basic standards and and promote and recognize Advanced knowledge and expertise hospitals and institutions they are constantly encouraging quality assurance and Improvement individual employees uh they maintain lure and also Health requirements economic social determinance of Health uh the social determinants of Health are the circumstances in which people are born grow up live work and age and the systems that are put in place to deal with [Applause] illness all right so let's test your knowledge a nurse observes an assisted Personnel remending a client for not using the urinal properly the assisted Personnel tells the client that diapers will be used next time the urinal is used improperly which of the following towards is the assisted Personnel committing the answer is a assault by threatening the client the AP is committing assault the ap's threats could make the client become fearful and apprehensive next question a nurse is caring for a competent adult who tells the nurse I am leaving the hospital this morning whether the doctor discharges me or not the nurse believes that this is not in the client's best interest and prepares to administer a PRN itive medication PRN means as needed the client has that the client has not requested along with the scheduled morning medication which of the following types of tort is the nurse about to commit the answer is B false imprisonment administering a medication is a as a chemical restraint to keep the client from leaving the facility against medical advice is false imprisonment because the client's neither requested nor consented to receive the sedative a nurse in the surgeon's office is providing preop teaching for a client who is scheduled for surgery the following week the client tells the nurse that I plan to prepare my Advanced directives before I come to the hospital which of the following statements made by the client should indicate to the nurse an understanding of advanced directives the answer is C I plan to write that I don't want them to keep me on a breathing machine the client has the right to decide and specify which medical procedures he wants when a life-threatening situation arises a nurse is caring for a client who is about to undergo an elective surgical procedure the nurse should take which of the following actions regarding informed consent select all that apply the answers are a make sure the surgeon obtained the client's consent and B witness the client's signature on the consent form a it is the nurse's responsibility to verify that the surgeon obtained the client's consent and that the client understands the information the surgeon gave them and B it's the nurse's responsibility to witness the client's signing of the consent form and to verify that they are consenting voluntarily and appear to be competent to do so the nurse also should verify that the client understands the information the surgeon has provided