Pct ch 1

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 1Working in an Advanced Care Setting

Chapter 1Working in an Advanced Care Setting


Examples of Acute Care FacilitiesExamples 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


Areas of Acute Care FacilitiesAreas of Acute Care Facilities

• Medical-surgical unit

• Labor and delivery unit

• Rehabilitation unit

• Psychiatric unit

• Dialysis unit

• Operating room


QuestionQuestion

Which one of the facilities does not offer acute care?

A. Hospital

B. Skilled nursing unit

C. Rehabilitation facility

D. Hospice


AnswerAnswer

D. Hospice

Hospice care offers end-of-life care only.


Examples of PatientsExamples of Patients

• acutely ill pt. - severe illness or unstable.

Ex: CVA (stroke);

MI (heart attack)

• Pt. has 1 or more chronic conditions: tx. complicated.

• Ex.: Pt. w diabetes & CHF

Pt. w HIV & pneumonia


Approaches to Holistic and Humanistic Care Approaches to Holistic and Humanistic Care

• empathy & compassion

• respect for pt.

• Consider whole person- emotional, social, spiritual, & physical needs

• unique individual



Treat Each Person as an IndividualTreat Each Person as an Individual

• Knock

• call by preferred name

• listen

• get to know the patient; find out about likes & dislikes

• Ask permission before touching

• privacy

• confidentiality


Stop and think:Stop and think:

• You are a nursing assistant who has worked for several years in a LTCF (nsg. home). You have always felt that providing care in a humanistic manner was one of the most important aspects of your job. Now you have accepted a job in a hospital in a busy med-surg. unit. Many of your responsibilities are the same as they were at the LTCF. However, the pace at your new job seems more rushed. You wonder if you will still be able to provide humanistic care. Why is humanistic care so important in an advanced care setting? What are some things you can do to assure you provide humanistic care?


Factors Contributing to the Changes in Health Care Delivery Factors Contributing to the Changes in Health Care Delivery

• ↑ cost of health care

• Insurance (private &federally funded) limits on payments

• Nursing shortage

• Health care facilities’ attempt to control cost & meet pt’s needs


QuestionQuestion

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


AnswerAnswer

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.


Cross-trainingCross-training

Cross-training is teaching employees how to do skills that are not usually within their scope of practice.


Crossover SkillsCrossover Skills

• Collecting blood

• EKG

• cardiac monitors

• Transporting pt’s


Nursing Assistants May Have Many Different Titles Nursing Assistants May Have Many Different Titles

• Nursing assistants ( NA, STNA)

• UAPs (unlicensed assistive personnel)

• Health care assistants (HCAs)

• Patient care assistants (PCAs)

• Patient care technicians (PCTs)


QuestionQuestion

What do the initials UAP represent?

A. Unassisted aide practitioner

B. Unlicensed assistive personnel

C. Untitled aide personnel

D. Unlicensed assisted practitioner


AnswerAnswer

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.


Advanced Care SkillsAdvanced Care Skills

• Inserting & removing urinary catheter

• Changing a sterile dressing

• Caring for a tracheostomy

• Suctioning


Importance of Job DescriptionImportance of Job Description

• List the skills & tasks you are responsible for

• The skills might differ

• 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


Increased Responsibilities of Advanced SkillsIncreased Responsibilities of Advanced Skills

• Act professionally

• Thoroughly trained & comfortable with advanced care skills

• Ask for assistance if needed

• 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, & express an interest in the care being given


Stop and thinkStop and think

• Why might nurses be opposed to nursing assistants doing advanced care skills? How can you gain the nurses confidence in your skills and abilities?


Continuing EducationContinuing Education

• Continuing education is necessary to keep up to date

• Ask ????

• Read nursing journals

• Take advantage of in-service

• Stay motivated to keep learning & growing as a professional


QuestionQuestion

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


AnswerAnswer

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.


Quality ControlQuality Control

• U. S. government regulations protect community health care by ensuring that:

– Health care workers are properly trained & competent

– Health care facilities meet standards of cleanliness & quality

– Health care is available to everyone

– Independent organizations exist to help ensure that facilities provide quality health care


The Joint CommissionThe Joint Commission

• Established - 1951

• Sets national standards for all types of health care organizations & officially recognizes (accredits) organizations that meet these standards

• Standards establish expectations of how the organization carries out certain activities (patient safety & quality of patient care)


The Joint Commission (cont.)The Joint Commission (cont.)

Standards regarding:

• safe medication administration,

• infection control,

• use of restraints,

• use of abbreviations

• staffing levels

• staff education,

• response to emergencies


The Joint Commission’s Gold Seal of Approval is

displayed by accredited health care organizations & is recognized nationwide as

a symbol


THE FIVE RIGHTSTHE FIVE RIGHTS

of delegation


Five Rights of DelegationFive Rights of Delegation


Stop and think:Stop and think:

• You work in an advanced care setting. A new RN assigned to the unit where you work has just delegated a task to you that you have not been trained to do. What should you do?


Delegating a Task Delegating a Task

Before delegating a task, the nurse considers four major factors:

• State laws & standards of practice

• Ability of the NA

• Facility policy regulating what duties a nurse may delegate to a NA

• Assessment of patient’s condition


QuestionQuestion

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


AnswerAnswer

D. All of the above

The nursing assistant should consider all three things before accepting a task.


Discussion:Discussion:

• The RN just asked you to remove an indwelling catheter from Mr. Roberts in room 240.

• A. What should the RN consider before delegating this task to you?

• B. What are your responsibilities when this task is delegated?


Communication in Advanced CareCommunication in Advanced Care

• communicate effectively - critical skill for health care

• NA is the nursing team’s “eyes and ears”

• Communication is extremely important b/c pt. are acutely ill. They require close, frequent monitoring & reporting of observations

• Responsible for recording observations & care provided


Factors Affecting a Patient’s Ability to Communicate Factors Affecting a Patient’s Ability to Communicate

• not be fully conscious

• not be able to speak (stroke, head injury, or other medical condition)

• may have a breathing tube or an oxygen mask

• may be in severe pain


Alternate Ways of CommunicatingAlternate 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



QuestionQuestion

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


AnswerAnswer

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.


Discussion:Discussion:

• You are assigned to give Jose Haller in room 320 a partial bath. She was admitted yesterday with COPD and pneumonia. She is on continuous oxygen via nasal canula and extremely SOB.

• A. What problems with communication might you expect Jose to have?

• B. How will you communicate the care provided and the observations you made to others members of the team?


Computerized ChartingComputerized Charting

Documents

Pct ch 1