Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Medical ethics wikipedia , lookup
Neonatal intensive care unit wikipedia , lookup
Special needs dentistry wikipedia , lookup
Long-term care wikipedia , lookup
Infection control wikipedia , lookup
Licensed practical nurse wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Safety Foundations of Nursing Christensen Kockrow Mosby Sharon L. Kinley Schwing BSN 2006 Leslie Lehmkuhl RN 2009 Safety • The need for a safe environment is always present. • A safe environment implies freedom from injury with focus on helping to prevent falls, electrical injuries, fires, burns, and poisoning. • Both protection and education are primary nursing responsibilities, with nurses directly and actively involved in ensuring a safe health care environment. SAFETY continued • The first priority in providing client care. • Constant attention to safety factors enables the nurse to maintain a safe environment for the client. • Safety is associated with health promotion and illness prevention. FACTORS AFFECTING SAFETY • • • • • Age Lifestyle/occupation Sensory/perceptual changes Mobility Emotional state Safe Environment • The need for a safe environment is always needed for every body. • Focus is placed on the: Immediate environment Local concerns National concern • This includes many issues within the environment. Safety Is for Every Age ACCIDENTS IN THE HEALTH CARE SETTING • Client behavior accidents–client’s behavior or actions. • Therapeutic procedure accidents–delivery of medical or nursing interventions. • Equipment accidents–malfunction, improper use of medical equipment. Precautions to Promote Safety • Orient patient to environment. • Place bedside table, and needed items within reach. • Assist patients who have had surgery, receiving narcotics, or are sedated. • Assist all patients during ambulation, or the first time out of bed. • Use bed alarms for the restless, confused patient. • Where non-slip shoes. IDENTIFY CLIENT • Checking the client’s ID band ensures that the correct person receives care. • Client identification is essential before rendering any care. Precautions to Promote Safety continued • Wipe, mop up spills to prevent injury. • Adequate lighting. • Emergency light, call bells in reach. • Answer bells in a timely manner. • Follow all “fall precaution” policies, adopted by your institution. Nurses Responsibilities • Overall safety of the patient. • Safe hospital environment. • Recognition and identification of potential hazards, and threats within the work setting. • Freedom from injury for patients, visitors and staff. • Providing and maintaining a safe environment within the work place. • See JACHO recommended patient safety goals. Left Handed • Unique challenges. • Hospital rooms are typically set up for right handed patients, and nurses ! • 12-30% of the population is a south paw. • Being left handed increases the risk of injury for a patient. Safety for the Left Handed Patient • Place all bathing articles at the patients left. • Left hand may be stronger by nature than the right. • Arrange meal trays, so that silverware, and drinks are at the left. • Ambulate the pt. by walking on the left side. • Adjust the patient room to accommodate the left handed patient. Falls • Common problem. • All patients are at risk for a fall. • Majority of patients fall during a transfer of some type. • Fall are the major , #1 concern for all patients in all institutions. • Very young, older adults, ill, and injured are all at risk for a fall. • Use of Anesthesia, sedatives, and or narcotics increase the risk of falls. Safety Reminder Devices • SRD/ defined as any number of devices used to immobilize a patient, or any part of the patients body part. • When would a SRD be used ? • What is the downside of SRDs ? • Doctors orders must be obtained. Patients must be closely watched. • Documentation includes: response. Why, How, How long, pts Elderly Safety Applying Safety Reminder Devices • Safety reminder device (SRD) is any device that immobilizes the patient or a part of the patient. – Soft restraint (Posey). • Used for patient safety and maintain treatment. • Prevent the disoriented patient from wondering and prevent or reduce risk of patients falling. • May be used with aggressive patient to protect other patients and staff. Extremity (ankle or wrist) Restraint (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Precautions When Using SRDs • Document the following: – Position of device – Circulation – Physical and mental status – Ongoing need for the device • SRDs should be removed at least every 2 hours and the skin assessed • Know the agency policy and procedures regarding SRD use Use of Gait Belts • Apply gait belt securely around patients waist. • Walk to the side of the patient. • Nurse should walk on the patients weaker side. • Use of hand rail, support systems as needed. • Remove gait belt after ambulation. • Document procedure. Infants and Children • Infants and children require different type of safety within their environment. • These small patient require protection within their environments. • Accidents involving children are largely preventable. • Growth and development skills need to be taken into consideration, during the care of the young patient. Older Adult Considerations • Adults taken many different medications, and have an increase in fall risks. • Use of safety devices are encouraged. • Accidental poisoning/over doses are common in adults. • Changes in: Vision Perception Hearing Muscle strength Joint function Cardiovascular Peripheral vascular system Safety within the Hospital/Health Care Environment • Hospital environment is a source of potential hazards. • Use of various biologic, chemical, and physical hazards have been identified. • Use of laser, can cause skin and eye irritation. Fire risks are increased. • Exposure to blood, body fluids, needle, radiation and resp. diseases pose threats to all hospital personnel. • Needle sticks are still the prime source of blood borne pathogens. • “Do not Recap” and needle-less systems are now common practice Work Place Safety • Employee Right to Know Laws: • Regulation Relation to Hazardous Materials • Material Safety Data Sheets USE PROPER BODY MECHANICS • Center of gravity–located in center of body, in pelvic area. All movement should pivot around this central point. • Base of support–feet are base of support. The feet should be kept wide apart when lifting heavy items. Patient Teaching for Infection Control • The nurse will need to educate patient about the nature of infection and the techniques to use in planning or controlling its spread. – Infection control for home and hospice settings. – Prevention of infection. Hand washing Food preparation IV lines Waste containers Body fluid spills Hospital Environment • The hospital environment is a source of potential safety hazards to health care workers: Biological Chemical Physical hazards Blood and body fluids Radiation Contaminated needles Equipment Electrical Hazards • Much of the equipment used in health care are electrical. • Use of properly grounded plugs. • Use of only red plugs for life supportive equipment. • Do not use any equipment that is in poor condition. • Avoid use of electrical equipment , in or near water. REDUCE EXPOSURE TO RADIATION • Minimize time spent in contact with and distance from the radiation source. • Use appropriate radiation shields. • Monitor exposure with a film badge. • Label all potentially radioactive material. • Never touch dislodged implants or body fluids of a client receiving radiation. • Radiation: Radiation and radioactive materials are used to treat and diagnosis diseases. Environment related risks are present. Minimize time / Maximize distance Wear monitors / Never touch dislodged implant • Mercury Spill: Mercury is considered a hazardous chemical according to OSHA. Mercury spill cleanup procedures. Safety Promotion • Education is the key to safety in and out of the hospital ! What are some examples of safety education ? Cultural and Ethnic Considerations • Cultural heritage affects all dimensions of health, in and out of the hospital. • Ones culture may influence a persons every day life. • The medical personnel need to understand their own cultural beliefs, prior to taking care of patients. • Planning is as important as implementation when it comes to cultural and ethic differences, and patient care. Ensuring Fire Safety • Both homes and health care facilities are at risk for fire. • Fire in health care facility are most often related to smoking in bed. • Statistics report that approximately 8100 hospital and 4300 nursing home fires occur yearly. • Established fore safety programs are mandatory for health care facilities. • All employees should know hospital policies, escape routes, and location of all fire equipment. • RACE Ensuring Fire Safety Continued • Fires in the health care facility are often related to smoking in bed or faulty electrical equipment. • Established fire safety program is mandatory for all facilities. • Prevention by: Elimination of combustible materials Maintenance of fire protection devices, and equipment Special precautions for cooking and laundry equipment PREVENT FIRE • Make sure fire exits are clearly marked. • Identify the locations and demonstrate the operation of fire extinguishers. • Practice fire evacuation procedures. PREVENT FIRE (continued) • Post emergency phone numbers near all telephones. • Keep open spaces and hallways clear of obstacles. • Check electrical cords for exposed or damaged wires. • Teach clients about fire hazards. Disaster Planning • Disaster planning, or emergency preparedness, enables rescuers to respond. • A disaster situation is and uncontrollable , unexpected, psychologically shocking. • Disaster situations are unique, and directly affects health care facilities. • What thing are considered disasters? • What affects response to disasters? Accidental Poisoning/Interventions • When a poisoning occurs. • Assess for changes in mental status. • Notify the poison control center. • Do not induce vomiting unless directed. • Wash hands • Document • Follow-up • Reduce risk of accidental overdose. Accidental Poisoning • Childhood poisoning is one the major causes of death in children under 5 years of age. • Specific antidotes and treatments are available for all types of poisons. • Potential for accidental poisoning: Cleaning solutions and disinfectants Drugs Substances in unmarked containers OTHER IMPLEMENTATIONS • Prevent poisoning. • Prevent choking. • Prevent suffocation. • Prevent drowning. • Reduce noise pollution. Hygiene and Care of the Patients Environment HYGIENE • The study of health and ways of preserving health. • Provides comfort and relaxation, improves self-image, and promotes cleanliness and healthy skin. • Part of safety in that proper hygiene protects the client against disease. • When providing the patient’s hygiene needs, the nurse has a opportunity to observe the patient. • All body systems can be assessed during the days care. • Patients are often place in a dependant role. • Nurse will help the patient remain as independent as possible, teaching health promotion and hygiene. • Hygiene, the science of health. Includes care of the whole body. • Conscientious personal hygienic practices are essential for the nurse. Nurses are role models . • Promotion of medical asepsis, clean technique. • Hygiene inhibits the growth and spread of pathogenic microorganisms. Factors that Influence a Patient’s Personal Hygiene • Social practice. • Body Image. • Socioeconomic status. • Knowledge. • Personal preference. • Physical condition • Cultural variables. Cultural and Ethnic considerations Personal Hygiene • Touching or lack of touch has cultural significance and symbolism. • Chinese-Americans, and Vietnamese Americans may view tasks associated with closeness and touch as being offensive. • Nurses must be aware of each patients reaction to touch. • Individual preferences usually do not affect health care, and must be added onto the care plan. CULTURAL CONSIDERATIONS cont. • Bathing hygiene is different within many cultures. Some cultures believe that hot water may be added to cold, however cold may never be added to hot. • Some cultures do not permit women to submerge their bodies in water during menstruation–fear that she may drown. • North Americans typically bathe daily and use deodorant products. • Many Europeans do not bathe daily or use deodorant products. Components of Patient’s Hygiene • Care of the skin • Oral hygiene • Hair care • Perineal care • Eye, ear, and nose care PROVIDE FOR CLIENTS’ BATHING NEEDS • Cleansing baths–routine for personal hygiene: – Shower – Tub Bath: Self help/Complete bed /Partial bath – Therapeutic Bathes PROVIDE FOR CLIENTS’ BATHING NEEDS (continued) • Therapeutic baths–require a physician’s order stating type of bath, body surface to be treated, type of medicated solutions to be used: – Hot, warm, or tepid – Soak or sitz – Oatmeal, cornstarch, sodium bicarbonate OTHER HYGIENE IMPLEMENTATIONS • Provide clean bed linen. • Provide perineal care. • Offer back rubs. • Provide foot and toenail care. • Provide oral care. • Provide hair care. • Provide eye, ear, and nose care. Sitz Bath Personal Hygiene for Nurses • Daily bath or shower. • Strong, odorless and effective deodorant everyday. • Clean undergarments. • Clean uniform daily. • Shampoo hair as necessary to maintain cleanliness. • Keep hair off collar. • Wear hose or socks. • Wear white comfortable shoes. • Short , clean fingernails. • Minimal to moderate make-up. • Small earrings. • Very light cologne, perfume, aftershave. • Standard departmental uniform. • Facial hair, clean and short, neatly trimmed. • Breath mints. Patient’s Room Environment • Patients with sever illnesses may be restricted to prolonged bed rest. • Patients with limitations such as traction, casts, or monitoring equipment. • Rooms should be comfortable and safe, increases the sense of well-being. • The patients illness can not be controlled, however something can be controlled. • Emptying and rinsing bedpans, and bedside commodes keep the room order free, and encourages a restful environment. • A patients energy must be directed toward recovery, keeping environment stimuli to a minimal will encourage this. A typical hospital room. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Room Equipment • Bedside stand. • Over bed table. • Chairs, lounge and straight back. • Lights. • Call bell. • Beds. • Water repellent mattresses. • Bed controls. Bathing • The extent of the patient's bath and methods used for bathing depend on t e patient's capabilities, and degree of hygiene required. • Sitz bath • Cool water tub bath • Warm water tub bath • Hot water tub bath • Other baths • Back care/Bath rub Bed bath. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Bed bath. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Nursing Process for Hygiene • Determine if the patient can tolerate hygienic procedures • Nursing diagnoses: – Oral mucous membrane, impaired – Mobility, impaired physical – Skin integrity, impaired – Self-care deficit – bathing/hygiene, dressing/grooming Care of the Skin • Normal skin has the following characteristics: Intact without abrasions. Warm and Moist. Localized changes in texture across surface. Good turgor, generally smooth and soft. Skin color variations from body part to body part. • Prevention is the ultimate goal, when not possible, interventions can result in: Healing Decrease discomfort Decrease length on hospitalization. Stages of Pressure Ulcers • I – Nonblanchable erythema of the intact skin. • II – Partial-thickness skin loss involves epidermis and or dermis. • III – Full-thickness skin loss involves damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia. • IV – Full-thickness skin loss occurs with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. Diagram of shearing force exerted against sacral area. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Stage I pressure ulcer. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Stage II pressure ulcer. Stage III pressure ulcer . Stage IV pressure ulcer . Stage IV Pressure Ulcer Oral Hygiene • Oral hygiene • Dentures • Oral care must be provided on a regular basis. • Beneficial outcomes of oral hygiene may not be seen for several days. • Repeated cleansing is often needed to remove tenacious dried, including the tongue. Conditions that Place Patients at Risk for Oral Disorders • Lack of knowledge about oral hygiene. • Inability of perform oral care. • Alteration in the integrity of teeth and mucosa resulting from disease or treatments. • Lack of aggressive care. Patients who are particularly at risk: Paralysis Diabetes Being seriously ill NPO Status Upper extremity activity limitations Radiation therapy Unconsciousness Chemotherapy drugs Disorientation Oral surgery Hair Care • Proper hair care is important to the patient’s self image. • Bed ridden patients hair may soon become tangled. • Patients are aware of their appearance. • Good hair care must be completed daily. • Shampoo, and cleansing might have to be completed for the bed ridden patients in bed. • Shaving the patient. • Hand, foot and Nail Care. • Perineal Care. • Perineal care, Indwelling catheter. • Eye, Ear, and Nose Care. Contact lens Hearing aids Hearing aid. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.) Assisting the Patient with Elimination • The nurse should offer the bedpan or urinal frequently. • This procedure is personal and the patient should be afforded as much privacy as his or her condition allows. • It is not unusual for the patient to procrastinate using the bedpan because it is uncomfortable and embarrassing. • Poor cleaning after elimination leads to skin break down. Care of the Incontinent Patient • Incontinence characterized by urine of fecal slow at unpredictable times. • Incontinence is a very common problem, especially among older adults. • Incontinence is due to pressure in the bladder, or sphincter is weak. • Incontinence may be a small leak. • Products to guard against incontinence must be kept discreet for the alert patient. Care of the Comatose Client • Eye Care: Wipe gentle every four hours. Keep moist / Liquid tears. Shields or tape gently closed. • Oral Care: Never used fingers or tongue blade Assess gag reflex. Small amount of liquids / have suction on. Prevent aspiration. Patient Teaching: Hygiene • Initiated at the beginning of hospitalization and though out. • Independence should be taught and encouraged. • Explain steps. • Teach elderly how to evaluated water temperatures. • Teach proper cleaning. • Hand washing. • Use of sunscreen • Prevention or healing of chapped, dry lips. • Teach care and cleaning of dentures. Home Health Considerations Hygienic Care • Bathing • Skin Care • Oral Care • Hair care • Shaving • Nail and Feet • Bed making Nursing Process • Assessment • Nursing Diagnosis • Expected Outcome/Planning • Implementation • Evaluation Nursing Process • Using the nursing process, nurses can reduce the risk of injury to patients • Diagnoses: – Risk for falls – Impaired physical mobility • Interventions: – Health promotions – Developmental considerations – Environmental protection Questions ?