n part 2 Flashcards
what are the examples of reluctance of nurses to associate nursing practice with comfort?
- stereotypes
- femininity
- weakness
define the term comfort
A state of physical and material well - being with freedom from pain and trouble and satisfaction of bodily needs; relief or support in mental distress or affliction; consolation, solace, soothing the state of being consoled or the feeling of consolation or mental relief.
original meanings:
- to strengthen, encourage
- physical refreshment or to sustenance
- a cause of relief from discomfort (cause)
- a state of ease and peaceful contentment (effect)
- relief from discomfort
How Kolcaba (1991) described comfort as existing in 3 forms?
relief, ease and transcendence
what happen when the patient is in comfort?
Use Kolcaba’s 3 forms of comfort .
if specific comfort needs of a patient are met, the individual experiences comfort in the ‘relief’ sense
if the patient is in a comfortable state of contentment, the person experiences comfort in the ‘ease’ sense.
Lastly, ‘transcendence’ is described as the state of comfort in which patients are able to rise above their challenge.
what are the context which comfort occurs?
– Physical: Pertaining to bodily sensations
– Psycho-spriritual: Pertaining to internal awareness of self, including esteem, concept, sexuality,
– and meaning in one’s life; one’s relationship to a higher order or being
– Environmental: Pertaining to the external surroundings, conditions, and influences
– Sociocultural: Pertaining to interpersonal, family, and social relationships.
describe comfort from a patient’s perspective
Subjective and individual
Comfort measures are not comfort measures unless
the patient perceives them as comforting
Comfort is a holisitic outcome that accounts for whole
person experiences Physical
Psycho-spiritual Environmental
Social
what is nursing in relation to comfort?
Nursing: the intentional assessment of comfort needs of
patients, families or communities; design of comfort
measures to address comfort needs, including re-
assessment of comfort level after implementation of
comfort measures, compared to a previous baseline (Kolcaba, 1997).
what are the alteration in comfort?
– Actual
- Those deviations from the comfort state that exist
due to illness, injury or treatment
– Potential
- Those deviations that a patient is at risk of developing in relation to their health status or treatment
what are the major 2 steps to begin assessing comfort?
– Requisite component of thinking – “What is going on here? “
– A range of tools specific to type of comfort/discomfort being assessed
– For example:
– Pain assessment tools
– Oral assessment tools – Pressure ulcer scales
– Quality of life tools
For
– Meeting basic physical, psychological and spiritual human needs
– Provision of empathic care and comprehension of the personal meaning the patient attaches to their individual experiences
– Must be underpinned by holistic assessment and effective communication.
what are the comfort care
– Physical comfort:
fluid and electrolyte balance, oxygenation, thermoregulation, analgesia, restoration of homeostasis
– Psycho-spiritual comfort: massage, therapeutic touch, visitors, encouragement, motivation
– Sociocultural comfort : culturally sensitive reassurance, support, positive body language, caring
– Environmental comfort: orderliness, quiet, comfortable furniture, free from odours, safety
what are the quality care for safety?
– The rights of patients set out to ensure that quality care is of a safe and high standard
– This includes:
– Providing a safe patient environment
• Temperature, food, physical hazards, infection control – Identifying and minimising risks and potential risks
• Falls, injury, accidents, equipment faults, procedures
– Nursinginterventionsforpromotingsafetymustbe individualised for development stage, lifestyle and environment
what are the some reason of immobility?
- Health status / acute illness.
- Prescribed restriction, such as bed rest.
- As a result of external devices, e.g. cast and /or traction.
- Voluntary restriction e.g. pain.
- Impairment of motor function which may be a result of disease processes, e.g. - Parkinson’s disease.
what are the 6 major systemic effects of immobility
- Metabolic changes
- patient may have decreased appetite due to immobility which affect weight loss and muscle wasting.
- gastrointestinal motility - respiratory changes
- increased respiratory effort
- atelectasis (collapse of the alveoli) and hypostatic pneumonia - cardiovascular changes
- increased cardiac workload
- orthostatic hypotension: drop in blood pressure when a patient rise
- deep vein thrombosis - urinary changes
- urinary stasis: in an immobile person, the kidneys and ureters are level, and urine remains in the renal pelvis longer before gravity moves It to there ureters and bladder
- urinary stasis cause growth of bacteria and may cause UTI
- integumentary changes
- pressure are sores/ulcers- an impairment of the skin as a result of decreased blood supply caused by a greater amount of pressure being applied to the skin than is found inside the small blood vessels supplying blood to the skin, - musculoskeletal changes
- decreased mobility and muscle atrophy- loss of muscle tissue
- impaired calcium metabolism
- joint contractures
what are the psychological effects of immobility
- anxiety
- depression
- helplessness
- feelings of hoplessness
- increased dependency
why bed making is important
- bed clothes need to be regularly for soiled linen, particularly when the patient is diaphoretic, has a draining wound or is incontinent
- to avoid transmission of infection
what are the components of conceptual framework of nursing care?
- contexts of care
- nursing philosophy, decline and practice
- the person and their family
- educational philosophy and context
what does it mean to think like a nurse?
- nurse have a way of being the people care for and they maintain a constant vigilance
- underpinned by a sound body of knowledge and well developed clinical reasoning skills
what is critical thinking
- reasoning: implies careful and deliberate thought
- thinking about your thinking-: while you thinking , to make it better and clear and accurate
what is clinical reasoning why it is important
it is a process of nurse, they
- collect cues
- process info
- make an understanding of patient problem and situation
- evaluate outcomes
- reflect on and learn from the process
it is important because clinical reasoning is central for clinical practice.
- nurses are responsible for taking part of decision making in healthcare.
- the ability to respond to challenging situation requires sophisticated thinking abilities
- application of clinical reasoning brings positive outcome on patient
what are the 5 rights of clinical reasoning?
- the ability to collect right cue
- and take the right action
- for the right patient
- at the right time
- for the right reason
explain nursing process
- assessment
- subjective data
- objective data - diagnosis
- data analysis
- Problem identification
- label - planning
- priorities
- goals
- intervention - implementation
- nurse-initiated treatments
- doctor-initiated treatment
for all 4 steps, there is always evaluation for each step.
- evaluation
- data
- diagnosis
- aetiologies
- plans
- interventions
what are the description of 6 domains evident within all depiction of the clinical reasoning process
- gathering relevant information and data (what is going on here)
- making appropriate judgements and decision (
- setting priorities and establishing goals
- preparing for and taking action
4 evaluations imputes and outcomes (what is done) - learning from the process to inform future practice
what is the purpose for establishing goals and expected outcomes in nursing practice
to provide direction for nursing intervention
to give standard for determining effectiveness of intervention
what is the intervention and what they are performed for?
any treatment, based on clinical judgement and knowledge, which nurse perform to enhance the patient’s health
to:
monitor health status
reduce risks
resolve, prevent or manage the health problem
promote optimal sense of physical, psychological and ritual wellbeing
what are the types of intervention
- nurse- initiated
- doctor - initiated
- collaborative
what are the types of care plan in various settings?
- institutional care plan
- computerised care plan
- care plans for community
- based settings
- critical pathways
what is caring
can be defined in many ways
- a sense of caring
- fundamental to nursing practice
- doing for other people what they cannot do for themselves “care” for the health issues
what are the components of Nurse- patient relationship?
5 important components
- trust
- respect
- empathy
- professional intimacy
- power
what is documentation and why it is important ?
anything written or printed that is used to furnish evidence or information that is legal or official
- documentation and record keeping is a core competence of nurses
- it is internationally recognised that a nurse’s ability to accurately report a patient’s problem, complaints, clinical sign and responses to interventions is crucial for patient’s safety and well-being
what is the legal aspects of documentations?
Fact-finders need to be able to reconstruct reliably what happened
This is done on the basis of oral evidence, recollection of witnesses, expert evidence and most importantly evidence emerging from documentation
The quality of the records and the integrity of the processes employed to create the records is crucial.
what is the purpose of documentation?
- Ensuring continuity and quality of care through communication
- Providing legal evidence of the process and outcomes of care
- Supporting the evaluation of the quality, efficiency and effectiveness of patient care
- Providing evidence for financial and quality assurance purposes
- Education and research
- Assisting in establishing benchmarks for developing standards of nursing practice
what is patient records and what is the purpose of it?
Contain essential information pertaining to the patient
A valuable source of data that is used by all members of the MDT (MultiDisciplinary Team
Allows for exchange of information between team members
- Provide a record of patient’s healthcare experiences
- Compliance with professional standards
Promotes high standards of care - Provides evidence of care
- Allows for effective communication of client health information
- Provides an accurate account of pt problems/needs, assessment, care planned, evaluation
- Continuity of care
- Allows early detection of problems and changes in health status
- Promotes accountability
- Assistance of research and funding
what is EMRISE
Electronic medical record for in-professional simulation education
why hygiene is necessary?
- Physical hygiene is necessary for comfort, safety and wellbeing.
- Unwell patients often require assistance with personal hygiene.
- Several factors influence a patient’s hygiene practices.
what are the risk factors for skin impairment?
- immobility
- reduce sensation
- nutrition and hydration alteration
- secretions and excretions on the skin
what are the priority problems associated with hygiene?
- fatigue
- risk of infection
- powerlessness
- impaired skill integrity
address hygiene practice in order of nursing framework.
assessment - physical examination: skin feet and nails oral cavity hair eyes, ears and nose perineal area
planing
- involve the patient and family in planning and adapting approaches, also in hygiene instruction
- consider the timing of other care activities and choose the best time
- individual hygiene care to meet patient’s preferences
- apply standards of safety and promotion of patient dignity and comfort
implementation - patient's room environment - privacy - maintaining comfort - room temperature ventilation room deodorisers noise level light - room equipment: bed
evaluation of care
- evaluate care you provide
- documentation
what are the skills needed for the future?
- patient design- patient centre care
- lead the way in digital health
- be at home in the digital jungle
- focus on soft skills
- improving cognitive capabilities
what is digital health technology?
digital health technology encompasses a diverse range of solutions, including broadband connectivity, software, digital networking, big data, mobile connectivity, 3D painting etc
what are the 3 key focus areas for the nation digital health strategy
- Integrating and personalising services by increasing the uptake and use of My Health Records, and using eHealth solutions to better integrate health and social services.
- Empowering consumers by embracing and integrating the use of health information technologies in the health system.
- Creating an intelligent and responsive health system through the use of ‘big data’, predictive analytics and innovation
what are the digital therapeutics?
any intervention that is digitally delivered and has a therapeutic effect on a patient. They can be used to treat medical conditions in a similar way to drugs or surgery.
what is medical terminology?
Medical terminology includes all of the specialized vocabulary that medical professionals use to identify human anatomy (structures) and physiology (functions), as well as words that indicate location, direction, planes of the body, medical status, and instructions for administering medication.
