MedicalSurgical Nursing 3 rd edition Chapter 1 Caring

Objectives Compare the roles and functions of the licensed practical/nurse (LPN/LVN) with those of

Objectives (Cont. ) Relate how quality and safety education for nurses (QSEN) applies to

Objectives (Cont. ) Determine how the current health care system attempts to provide health

Roles of the LPN/LVN Uphold clinical standards. Provide safe patient care. Teach patients. Communicate

Leader and Delegator Uphold clinical standards. Delegation and assignment Ø Ø Delegation involves transferring

Five Rights of Delegation 1) 2) 3) 4) 5) Right task Right circumstances Right

Employment Opportunities for LPN/LVNs In hospitals: Ø Ø Outpatient surgery Intermediate care unit (step-down

Employment Opportunities for LPN/LVNs (Cont. ) Long-term care (nursing homes) Ambulatory care Rehabilitation services

Employment Opportunities for LPN/LVNs (Cont. ) Homes for developmentally disabled individuals Home health care

Audience Response Question 1 What should the nurse consider before delegating a specific task?

Ethical and Legal Practice Each state’s Nurse Practice Act defines the role and scope

Quality and Safety Education for Nurses (QSEN) Patient-centered care means the patient is a

Evidenced-based Practice (EBP) Uses the best current evidence from research findings to make decisions

Quality improvement process Copyright © 2017, Elsevier Inc. All rights reserved. 1

Quality Improvement Continuous Quality Improvement program in place that set standards for care These

Informatics Using information and technology to communicate, manage knowledge, prevent or mitigate error, and

Safety Patients are vulnerable to injury when ill or incapacitated in the hospital. The

Health Care Today Biomedicine Ø Complementary and alternative medicine Ø The goal of biomedicine

Healthy People 2020 Attain high-quality, longer lives free of preventable disease, disability, and the

Financing of Healthcare The Affordable Care Act Medicare and Medicaid Fee for service Provider

Financing of Healthcare (Cont. ) Group health insurance Managed care Ø Ø Health maintenance

Holistic Care Involves being aware of and attending to the following needs of patients:

Promoting a Therapeutic Nurse–Patient Relationship Use empathy. Establish trust. Therapeutic communication skills. Maintain patients’

Audience Response Question 2 Which statement(s) indicate(s) therapeutic nurse–patient relationship? (Select all that apply.

Meeting Cultural Needs Nurses should be openminded, nonjudgmental, and Ø Ø Ø Take differences

Meeting Spiritual Needs Patients’ beliefs and values can profoundly affect their response to these

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Objectives Compare the roles and functions of the licensed practical/nurse (LPN/LVN) with those of the registered nurse. Identify sites of employment for LPNs/LVNs in medical -surgical nursing. Correlate the nurse practice act and the standards of practice for the LPN/LVN that guide the practice of each nurse. Copyright © 2017, Elsevier Inc. All rights reserved. 2

Objectives (Cont. ) Relate how quality and safety education for nurses (QSEN) applies to LPN/LVN practice. Demonstrate the knowledge of how evidencebased practice is formulated. Explain the importance of National Patient Safety Goals and how they relate to patient safety. Predict how Healthy People 2020 can decrease health care costs. Copyright © 2017, Elsevier Inc. All rights reserved. 3

Objectives (Cont. ) Determine how the current health care system attempts to provide health care for all. Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare, including care excluded from reimbursement. Illustrate ways to provide holistic care. Copyright © 2017, Elsevier Inc. All rights reserved. 4

Roles of the LPN/LVN Uphold clinical standards. Provide safe patient care. Teach patients. Communicate effectively. Work as a collaborative member of the health care team. Advocate for the patient. Copyright © 2017, Elsevier Inc. All rights reserved. 5

Leader and Delegator Uphold clinical standards. Delegation and assignment Ø Ø Delegation involves transferring to qualified unlicensed assistive personnel (UAP) the authority to perform a selected nursing task or activity in a selected patient situation that is within the job description of the LPN/LVN. Assignment involves assigning nursing tasks or activities within the job description of the UAP to a particular individual. Copyright © 2017, Elsevier Inc. All rights reserved. 6

Employment Opportunities for LPN/LVNs In hospitals: Ø Ø Outpatient surgery Intermediate care unit (step-down unit) IV therapy team Emergency department Copyright © 2017, Elsevier Inc. All rights reserved. 8

Employment Opportunities for LPN/LVNs (Cont. ) Long-term care (nursing homes) Ambulatory care Rehabilitation services Hospice Group homes Assisted-living facilities Copyright © 2017, Elsevier Inc. All rights reserved. 9

Employment Opportunities for LPN/LVNs (Cont. ) Homes for developmentally disabled individuals Home health care Private offices Military Dialysis centers Jails and prisons Copyright © 2017, Elsevier Inc. All rights reserved. 10

Audience Response Question 1 What should the nurse consider before delegating a specific task? (Select all that apply. ) 1. Know the scope of practice. 2. Be aware of the staff competency and experience. 3. Seek approval from the administration. 4. Determine stability of patient condition. Copyright © 2017, Elsevier Inc. All rights reserved. 11

Ethical and Legal Practice Each state’s Nurse Practice Act defines the role and scope of practice of LPNs/LVNs. Ethical practice means that the LPN/LVN abides by the Code for Nurses, adheres to the National Patient Safety Goals, and honors privacy via the Health Insurance Portability and Accountability Act (HIPAA). Copyright © 2017, Elsevier Inc. All rights reserved. 12

Quality and Safety Education for Nurses (QSEN) Patient-centered care means the patient is a full partner in decisions about his or her care. Compassionate and coordinated care should be planned and delivered with respect for the patient’s preferences, values, and needs. Care manager may be a designated nurse or social worker within the hospital. Copyright © 2017, Elsevier Inc. All rights reserved. 13

Evidenced-based Practice (EBP) Uses the best current evidence from research findings to make decisions about patient care Five steps in the process of developing evidence-based practice (Figure 1 -3) Copyright © 2017, Elsevier Inc. All rights reserved. 14

Quality Improvement Continuous Quality Improvement program in place that set standards for care These standards are based on standards for nursing practice set by the American Nurses Association, the American Hospital Association, and The Joint Commission. Copyright © 2017, Elsevier Inc. All rights reserved. 16

Informatics Using information and technology to communicate, manage knowledge, prevent or mitigate error, and support decision making comprises informatics (QSEN, 2011). The electronic medical record (EMR) or electronic health record (EHR) is at the heart of informatics. Copyright © 2017, Elsevier Inc. All rights reserved. 17

Safety Patients are vulnerable to injury when ill or incapacitated in the hospital. The National Council of State Boards of Nursing (NCSBN) has identified areas where nursing practice can improve safety. Copyright © 2017, Elsevier Inc. All rights reserved. 18

Health Care Today Biomedicine Ø Complementary and alternative medicine Ø The goal of biomedicine is to find the cause of disease and to eliminate or correct the problem. Patients need to be reminded that all herbals and supplements need to be included when they are asked for a list of drugs taken. Cost containment Copyright © 2017, Elsevier Inc. All rights reserved. 19

Healthy People 2020 Attain high-quality, longer lives free of preventable disease, disability, and the opportunities for progress. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2017, Elsevier Inc. All rights reserved. 20

Financing of Healthcare (Cont. ) Group health insurance Managed care Ø Ø Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Government-sponsored health insurance Ø Ø Medicare Medicaid Retrospective payment system Diagnosis-related groups (DRGs) Prospective payment system (PPS) Copyright © 2017, Elsevier Inc. All rights reserved. 22

Holistic Care Involves being aware of and attending to the following needs of patients: Ø Ø Ø Physiologic Psychological Social Cultural Spiritual Copyright © 2017, Elsevier Inc. All rights reserved. 23

Promoting a Therapeutic Nurse–Patient Relationship Use empathy. Establish trust. Therapeutic communication skills. Maintain patients’ self-esteem. Display competence. Ensure pain control. Display compassion. Use therapeutic touch. Copyright © 2017, Elsevier Inc. All rights reserved. 24

Audience Response Question 2 Which statement(s) indicate(s) therapeutic nurse–patient relationship? (Select all that apply. ) 1. “You poor thing; I had a similar surgery. ” 2. “You seem upset about your procedure. ” 3. “What do you mean when you say that? ” 4. “You will be fine. ” 5. “May I hold your hand? ” Copyright © 2017, Elsevier Inc. All rights reserved. 25

Meeting Cultural Needs Nurses should be openminded, nonjudgmental, and Ø Ø Ø Take differences at face value. Accept people as they are. Give high-quality care. Copyright © 2017, Elsevier Inc. All rights reserved. 26

Meeting Spiritual Needs Patients’ beliefs and values can profoundly affect their response to these crises, attitude toward treatment, and rate of recovery. Copyright © 2017, Elsevier Inc. All rights reserved. 27