Nursing A ConceptBased Approach to Learning VOLUME TWO
Nursing: A Concept-Based Approach to Learning VOLUME TWO EDITION VOLUME TWO || SECOND EDITION MODULE 51 Safety Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Concept of Safety • Protection from harm or injury • Nurses in key position Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Concept of Safety, continued • Institute of Medicine (IOM) report § 44, 000− 98, 000 deaths in hospital errors § Health. Grades estimate is 195, 000 • IOM definitions § Safety § Error § Adverse event • More than 50% errors preventable Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
National Patient Safety Initiatives • Foster collaboration • Need accurate data § Healthcare facilities • Patient Safety and § Government Quality agencies Improvement Act § Physicians and nurses § Healthcare clients Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition § Mandates reporting system § Protects individuals who report Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
National Patient Safety Goals • Developed by a panel of professionals with expertise related to client safety issues • Topics chosen for maximum impact and usefulness for minimum cost • 2015 National Patient Safety Goals Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Quality and Safety Education for Nurses • • • Patient-centered care Quality improvement Evidence-based practice Teamwork and collaboration Safety Informatics Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Concepts Related to Safety • • Clinical Decision Making Infection Perioperative Care Quality Improvement Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Injury Prevention in the Clinical Setting • Clinical setting complicated § Coordinated care across multiple shifts § Multiple clients § Clients often confused by treatment plans, terminology • Despite best intentions, adverse events and medical errors occur. § Numerous manifestations Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Falls • Orient clients • Assess ability to ambulate and transfer • Place tables near bed or chair for frequently used items • Encourage use of railings, grab bars Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition • Encourage nonskid footwear • Keep the environment tidy, and remove obstacles • Keep rooms well lit • Assess client's vision and eyewear use • Apply physical restraints when necessary • Be aware of client's medical regimen, side effects, and interactions Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Restraints • Protective devices used to limit physical activity or part of body • Physical restraints • Chemical restraints Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition • Purpose of restraints § To prevent injury to self or others § Can cause injury § Sentinel events • Demeaning, psychologically harmful • Limited autonomy • American Nurses Association (ANA) position: when no other viable option Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Restraints, continued • Legal implications § Know agency policies, state laws § Centers for Medicare & Medicaid Services (CMS) standards § Clients have right to be free from restraints • That are not medically necessary § Restraints cannot be used for staff convenience Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Restraints, continued • Selecting a restraint § Restricts client's movement as little as possible § Does not interfere with client's treatment § Readily changeable § Safe for particular client § Least obvious to others Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition • Types of physical of restraints § Safety strap body restraint § Belt restraint § Mitt or hand restraints § Limb restraints Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Healthcare-Associated Infections Catheter-related bloodstream infections Healthcare-associated pneumonia Surgical site infections Central line–associated bloodstream infections • Clostridium difficile–associated infection • • Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Wrong-Site Surgery • Inadequate client assessment, care planning • Communication failure • Inadequate medical record review • Multiple procedures on multiple parts in single operation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition • Failure to include client and family when identifying correct site • Failure to clearly mark correct site • Failure to recheck information before surgery Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Medication Errors • Follow the six rights of medication administration 1. 2. 3. 4. 5. 6. Right Right drug dose client route time documentation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 51. 1 Safety Considerations Across the Life Span Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Overview • Safety risks from before conception until death • Categories not universal to all ages • Every age group has own common injuries, illnesses Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prenatal and Infant Risk for Injury • Prenatal risk § Maternal exposures • Perinatal risk § § § Poor prenatal care Poor maternal nutrition Tobacco use Pollution exposure Pathogens Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prenatal and Infant Risk for Injury, continued • Neonatal risk § Congenital malformations, deformations, and chromosomal abnormalities § Disorders related to short gestation, preterm delivery, or low birth weight • Infant risk § Sudden infant death syndrome (SIDS) § Suffocation § Falls, insect bites, child abuse Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Children and Unintentional Injuries • Toddlers § Falls, burns, poisoning, drowning, shock § Automobile accidents • Preschoolers § Motor vehicle crashes § Choking, poisoning, burns § Drowning, harm from people/animals Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Children and Unintentional Injuries, continued • School-age children § Falls, accidents, playground injuries § Motor vehicle crashes § Fires, burns, suffocation • Adolescents § Vehicular accidents, recreational accidents § Firearms, substance abuse Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Children and Unintentional Injuries, continued • Nursing implications § Be aware of risk factors § Identify risks unique to client § Include client, family, caregivers, significant others in teaching § Reduce risk for injury § Increase likelihood of successful implementation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Adult Safety and Mortality • Young adults § Poisonings • Drugs, narcotics, medicines, or biologic agents § § Motor vehicle crashes Malignant cancers Suicide and homicide Overexertion Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Adult Safety and Mortality, continued • Middle adults § § § Malignant cancers Heart disease Poisoning Motor vehicle accidents Falls Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Adult Safety and Mortality, continued • Older adults § § § Heart disease Malignant cancers Alzheimer disease Diabetes Falls Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment • Indicators in nursing history, examination § Risk assessment tools § Evaluating environment • Consider client's culture, individual lifestyle choices • Acquire complete client history Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnosis • • Risk for Injury Risk for Trauma Risk for Delayed Development Deficient Knowledge Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Planning • Client will: § Verbalize awareness of common safety hazards for age group § Describe how to eliminate or minimize exposure to safety hazards § Seek medical assistance when injured § Report any drastic changes in health to a medical professional Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation • Assess and screen for safety concerns • Provide information on how to avoid, prevent, or treat these hazards • Children § Falls § Safety helmets, knee and elbow pads Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation • Adolescents § Tobacco, alcohol, illicit drugs • Older adults § Falls § Side effects of medications • All groups at risk for exposure to toxins § Chemicals, lead, substance abuse Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Evaluation • Recognize each individual's concerns, values § Some will actively avoid hazards § Some will ignore situation until active problem • Educate clients about wellness promotion, safety • Respect clients' decisions regarding lifestyle choices Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 51. 2 Workplace Safety Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Overview • Risks include bloodborne pathogens, needlesticks, latex allergies, musculoskeletal injuries, stress, violence • Injuries and illness • Safety critical to job satisfaction Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Regulation of Workplace Safety • Occupational Safety and Health Administration (OSHA) § Enforces safety guidelines § Consults regarding prevention methods • National Institute for Occupational Safety and Health (NIOSH) § Generates new knowledge in the field of occupational safety and health § Monitors National Occupational Research Agenda (NORA) Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Injuries and Etiology • Regardless of protocols, accidents still occur • Categories § Fatal § Nonfatal • Transportation accidents account for 41% of all workplace fatalities Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevalence • 3 million nonfatal workplace illnesses and injuries • In 2011, 4, 693 fatal work-related injuries • All occupations § Strains, sprains, and tears § Fractures § Exposure to hazardous and toxic substances Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevalence, continued • Nursing § § Back, shoulder injuries Falls, collisions Needlestick, sharps injuries Contact with contagious clients and bloodborne pathogens Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Injury Prevention in Nursing Practice • Take extra measure to ensure own safety • Protocols when working with needles, latex, infectious or potentially infectious agents Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Standard Precautions • Hand hygiene • Protective equipment • Needlestick injuries § Growing problem in healthcare industry § Very serious, result in numerous illnesses • HIV, hepatitis B and C § Used needles never recapped § Disposal containers puncture resistant, leakproof on all sides and bottom Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Latex Precautions • Allergy or sensitivity § Developing over time § Chances increase with use § Healthcare workers and clients • Hypoallergenic, powderless gloves • Wash hands after removing gloves Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Safe Client Handling • Use of mechanical devices to lift, move clients § Unless use proves to be unsafe, contraindicated for client • Decreases falls, skin injuries, musculoskeletal injuries Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Workplace Violence Protection • Any physical assault, threatening behavior, or verbal abuse occurring in the workplace • Scratching, hitting, biting • Psychiatric units, emergency departments most noted • Programs, training required in many areas • Prevention techniques • Encourage reporting of incidents Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
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