Nursing Is an Art

Posted by Admin in Tuesday, November 24, 2009

Nursing is an art:
and if it is to be made an art,
It requires an exclusive devotion
as hard a preparation,
as any painter's or sculptor's work;
for what is the having to do with
dead canvas or dead marble,
compared with having to do
the temple of God's spirit?
It is one of the Fine Arts:
I had almost said,
the finest of Fine Arts.
- Florence Nightingale

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Admitting the adult patient

Posted by Admin

Admitting the adult patient
  • Speak slowly and clearly, greet the patient by his proper name, and introduce yourself and any staff present.
  • Compare the name and number on the patient's identification bracelet with that listed on the admission form. Verify the name and its spelling with the patient. Notify the admission office of any corrections.
  • Quickly review the admission form and the physician's orders. Note the reason for admission, any restrictions on activity or diet, and any orders for diagnostic tests requiring specimen collection.
  • Escort the patient to his room and, if he isn't in great distress, introduce him to his roommate. Then wash your hands, and help him change into a gown or pajamas; if the patient is sharing a room, provide privacy. Itemize all valuables, clothing, and prostheses on the nursing assessment form or in your notes if your facility doesn't use such a form. Encourage the patient to store valuables or money in the safe or, preferably, to send them home along with any medications he may have brought with him. Show the ambulatory patient where the bathroom and closets are located.
  • Take and record the patient's vital signs, and collect specimens if ordered. Measure his height and weight if possible. If he can't stand, use a chair or bed scale and ask him his height. Knowing the patient's height and weight is important for planning treatment and diet and for calculating medication and anesthetic dosages.
  • Show the patient how to use the equipment in his room. Be sure to include the call system, bed controls, TV controls, telephone, and lights.
  • Explain the routine at your health care facility. Mention when to expect meals, vital sign checks, and medications. Review visiting hours and any restrictions.
  • Take a complete patient history. Include all previous hospitalizations, illnesses, and surgeries; current drug therapy; and food or drug allergies. Ask the patient to tell you why he came to the facility. Record the answers (in the patient's own words) as the chief complaint. Follow up with a physical assessment, emphasizing complaints. Record any wounds, marks, bruises, or discoloration on the nursing assessment form.
  • After assessing the patient, inform him of any tests that have been ordered and when they're scheduled. Describe what he should expect.
  • Before leaving the patient's room, make sure he's comfortable and safe. Adjust his bed, and place the call button and other equipment (such as water pitcher and cup, emesis basin, and facial tissues) within easy reach. Raise the side rails.

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Admission - Fundamental Procedures

Posted by Admin in Monday, November 23, 2009

Admission
Admission to the nursing unit prepares the patient for his stay in the health care facility. Whether the admission is scheduled or follows emergency treatment, effective admission procedures should accomplish the following goals: verify the patient's identity and assess his clinical status, make him as comfortable as possible, introduce him to his roommates and the staff, orient him to the environment and routine, and provide supplies and special equipment needed for daily care.
Because admission procedures can color the patient's perception of the environment, they have a significant impact on subsequent treatment. Admission routines that are efficient and show appropriate concern for the patient can ease his anxiety and promote cooperation and receptivity to treatment. Conversely, admission routines that the patient perceives as careless or excessively impersonal can heighten anxiety, reduce cooperation, impair his response to treatment, and perhaps aggravate symptoms.
Equipment
Gown • personal property form • valuables envelope • admission form • nursing assessment form, if appropriate • thermometer • emesis basin • bedpan or urinal • bath basin • water pitcher, cup, and tray • urine specimen container, if needed.
An admission pack usually contains soap, comb, toothbrush, toothpaste, mouthwash, water pitcher, cup, tray, lotion, facial tissues, and thermometer. Because the patient's pack is included in his bill, he can take it home with him. An admission pack helps prevent cross-contamination and increases nursing efficiency.
Preparation of equipment
Obtain a gown and an admission pack.
Position the bed as the patient's condition requires. If the patient is ambulatory, place the bed in the low position; if he's arriving on a stretcher, place the bed in the high position. Fold down the top linens.
Prepare any emergency or special equipment, such as oxygen or suction, as needed.
Implementation
  • Adjust the room lights, temperature, and ventilation.
  • Make sure all equipment is in working order prior to the patient's admission.

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Fundamental Procedures - Introduction

Posted by Admin in Sunday, November 22, 2009

Patients come to hospitals and other health care facilities because they need skilled clinical observation and treatment. According to the American Hospital Association, about 37 million people undergo hospitalization each year, and for most, it's a trying experience. After all, hospitalization challenges the patient's sense of privacy and control of his life. He must relinquish at least part of his normal routine. He must rely on you and your coworkers to meet his fundamental needs. Depending on the complexity of his health problem, he and his family may also require teaching, counseling, coordination of services, development of community support systems, and help in coping with health-related changes in his life.
In many facilities, staff nurses, primary nurses, clinical nurse specialists, and nurse practitioners deliver these vital services. This chapter serves as a starting point to help you understand and perform many of these tasks confidently and effectively. It thoroughly covers all the fundamentals: admission, transfer, and discharge procedures; assessment (including a section on writing a nursing care plan); ensuring patient safety and mobility (including proper use of restraints and assistive devices); practicing correct body mechanics and patient transfer techniques; and using special orthopedic beds. The chapter also includes a comprehensive review of personal hygiene and comfort measures, nutrition, elimination, surgical care, spiritual care, and postmortem care.
Before turning to these nursing care specifics, however, review the broader aims of your care such as helping the patient cope with restricted mobility; giving him a comfortable, stimulating environment; making sure his stay is free from hazards; promoting an uneventful recovery; and helping him return to his normal life.
Dealing with restricted mobility
Whenever a patient's condition impairs or prevents mobility, your nursing goals include promoting his independence by motivating him; helping him set goals, to prevent injury and the complications of immobility; teaching him needed skills; and fostering a positive body image, especially if he faces long-term or permanent immobility.
Promoting a comfortable environment
By manipulating physical factors in the patient's environment—temperature, humidity, lighting—you can affect his comfort, condition and, at times, his response to treatment. For example, a room temperature of 68° to 72° F (20° to 22.2° C) and a relative humidity of 30% to 60%, although comfortable for most patients, may be too cold for elderly patients. Also, proper artificial or natural lighting helps duplicate the day-night cycle.
Providing sensory stimulation
Sensory stimulation (such as therapeutic touch) contributes to patient well-being. Although the amount and type of required stimulation varies with each patient, you can prevent sensory overload or deprivation by accurately assessing his needs. When evaluating stimuli in the patient's environment, remember that illness is a stressor that may intensify the patient's responses, especially to noise and odors.
Promoting safety
Besides weakening the patient, illness and any accompanying treatment may impair his judgment and contribute to accidents. Be alert to hazards in the patient's environment, and teach him and his family to recognize and correct them. When caring for a patient with restricted mobility, you must help him as he's moved, lifted, and transported. By using proper body mechanics and appropriate assistive devices, you can prevent injury, fatigue, and discomfort for the patient and yourself.
Preventing complications
For the bedridden patient, immobility poses special hazards such as pressure on bony prominences; venous, pulmonary, and urinary stasis; and disuse of muscles and joints. These can lead to such complications as pressure ulcers, thrombi, phlebitis, pneumonia, urinary calculi, and contractures. To prevent complications, be sure to use correct positioning, meticulous skin care, assistive devices, and regular turning and range-of-motion exercises.
Promoting rehabilitation
The first step toward rehabilitation typically is progressive ambulation, which should begin as soon as possible—if necessary, using such assistive devices as a cane, crutches, or a walker. Effective rehabilitation may also require you to teach positioning, transfer, and mobilization techniques to the patient and his family. Give him and his family the opportunity to demonstrate the skill or technique so that problems may be corrected. Demonstrating a technique—such as transferring from a bed to a wheelchair—during hospitalization helps the patient and his family to understand it. Allowing them to practice it under your supervision gives them the confidence to perform it at home. Encourage them to provide positive reinforcement to motivate the patient to work toward his goals.

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