Transcript LWW PPT Slide Template Master

Chapter 1
Working in an Advanced Care Setting
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Examples of Acute Care Facilities
• Hospital—high level of nursing care
• Subacute care unit (skilled nursing unit)
• Rehabilitation facility
• Acute care unit in a long-term care facility
• Person’s home
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Areas of Acute Care Facilities
• Medical-surgical unit
• Labor and delivery unit
• Rehabilitation unit
• Psychiatric unit
• Dialysis unit
• Operating room
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Question
Which one of the facilities does not offer acute care?
A. Hospital
B. Skilled nursing unit
C. Rehabilitation facility
D. Hospice
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Answer
D. Hospice
Hospice care offers end-of-life care only.
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Examples of Patients
• An acutely ill person who has a severe illness or is
unstable. Examples: Person with a CVA (stroke); person
with an MI (heart attack)
• A person who has one or more chronic conditions, whose
treatment is complicated. Examples: Person with
diabetes and congestive heart failure; person with HIV
and pneumonia
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Approaches to Holistic and Humanistic Care
• Act with empathy and compassion
• Have respect for the person
• Consider the whole person, and her emotional, social,
spiritual, and physical needs
• Treat each person as a unique individual
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Treat Each Person as an Individual
• Knock on the patient’s door before entering
• Always call the patient by preferred name
• Be a good listener
• Take the time to get to know the patient; find out about likes
and dislikes
• Ask permission before touching the patient or belongings
• Maintain the patient’s privacy during care
• Treat all information regarding the patient as confidential
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Factors Contributing to the Changes in
Health Care Delivery
• Increasing cost of health care
• Insurance (private and federally funded) limits on
payments for services
• Nursing shortage
• Health care facilities’ attempts to control costs but still
meet patient’s needs
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Question
Which of the following is a factor that has contributed to
changes in health care?
A. Cost of health care is decreasing
B. Shortage of nurses
C. No limit on insurance payments on health services
D. No need to limit costs for hospitals
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Answer
B. Shortage of nurses
In the United States today, there is a nursing shortage. As
a result, hospitals and other types of advanced care
settings are relying more on nursing assistants to round
out the nursing team.
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Cross-training
Cross-training is teaching employees how to do skills that
are not usually within their scope of practice.
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Crossover Skills
• Collecting a blood sample
• Performing an EKG
• Observing cardiac monitors
• Transporting patients
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Nursing Assistants May Have Many
Different Titles
• Nursing assistants
• UAPs (unlicensed assistive personnel)
• Health care assistants (HCAs)
• Patient care assistants (PCAs)
• Patient care technicians (PCTs)
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Question
What do the initials UAP represent?
A. Unassisted aide practitioner
B. Unlicensed assistive personnel
C. Untitled aide personnel
D. Unlicensed assisted practitioner
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Answer
B. Unlicensed assistive personnel
UAPs are health care workers who are not required to
obtain a license to practice their profession, such as
nursing assistants who work under the direction of a
licensed professional, such as a nurse.
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Advanced Care Skills
• Inserting and removing a urinary catheter
• Changing a sterile dressing
• Caring for a tracheostomy
• Suctioning
• Discontinuing intravenous fluids
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Importance of Job Description
• List the skills and tasks you are responsible for knowing
how to do
• The skills you are expected to do might differ from one
unit to another in the same facility
• You may be expected to learn more advanced skills
• If you ever have a question regarding performing a skill,
check your job description or ask your supervisor
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Increased Responsibilities of Advanced
Skills
• Always act professionally
• Make sure you are thoroughly trained and comfortable in
the advanced care skills listed in your job description
• Ask for assistance when you need it
• Promptly report to the nurse any observations that may
indicate a change in a person’s condition
• Be available to assist the nurse with skills that you may
not be responsible for, and express an interest in the care
being given
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Continuing Education
• Continuing education is necessary to keep up to date
• Ask questions
• Read nursing journals
• Take advantage of in-service education at your facility
• Stay motivated to keep learning and growing as a
professional
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Question
Tell whether the following statement is true or false.
One way to keep up to date on skills is to attend in-service
education at your facility.
A. True
B. False
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Answer
A. True
It is important to keep up to date on developments in your
field, and the best and most economical way is to take
advantage of in-services at the workplace.
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Quality Control
• U. S. government regulations protect community health
care by ensuring that:
– Health care workers are properly trained and
competent
– Health care facilities meet standards of cleanliness
and quality
– Health care is available to everyone
– Independent organizations exist to help ensure that
facilities provide quality health care
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The Joint Commission
• Established in 1951
• Sets national standards for all types of health care
organizations and officially recognizes (accredits)
organizations that meet these standards
• Standards establish expectations of how the organization
carries out certain activities (patient safety and quality of
patient care)
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The Joint Commission (cont.)
• Standards regarding safe medication administration,
infection control, the use of restraints, the use of
abbreviations in documentation, staffing levels and staff
education, and responding to emergencies
• The Joint Commission’s Gold Seal of Approval is displayed
by accredited health care organizations and is recognized
nationwide as a symbol of quality
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Five Rights of Delegation
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Delegating a Task
Before delegating a task, the nurse considers four major
factors:
• State laws and standards of practice for nurses in
your state
• Ability of the nursing assistant
• Facility policy regulating what duties a nurse may
delegate to a nursing assistant
• Assessment of patient’s condition
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Question
When a task is delegated by the nurse, the nursing
assistant is responsible for:
A. Recognizing which tasks are within her scope of practice
B. Knowing her range of abilities
C. Knowing what is in the nursing assistant’s job
description
D. All of the above
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Answer
D. All of the above
The nursing assistant should consider all three things
before accepting a task.
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Communication in Advanced Care
• To communicate effectively is a critical skill for every
health care worker
• Nursing assistant is the nursing team’s “eyes and ears”
• Communication is extremely important in the advanced
care setting because patients are acutely ill and require
close, frequent monitoring and reporting of observations
• Nursing assistants who work in advanced care settings
are often responsible for recording their observations and
the care they provide in medical records on paper or
computerized charting
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Factors Affecting a Patient’s Ability to
Communicate
• The person may not be fully conscious
• The person may not be able to speak as the result of a
stroke, head injury, or other medical condition
• The person may have a breathing tube down his throat
or an oxygen mask over his mouth, making it impossible
to speak
• The person may be in severe pain
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Alternate Ways of Communicating
• Write down needs
• Point to a picture on a picture board
• Observe body language
• Use senses to meet needs, such as touch to feel body
temperature, and supply blankets or lighter clothes as
needed
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Question
When a patient is unable to communicate, the nursing
assistant should:
A. Ignore the patient
B. Only communicate with the patient’s family
C. Not observe body language
D. Use alternate ways to communicate, such as picture
boards
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Answer
D. Use alternate ways to communicate
There are different devices that can assist patients to
communicate, such as a notepad and pencil or a picture
board and pointer.
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Computerized Charting
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