Transcript Chapter 9*Providing Patient Care

Learning Objectives
1.
Describe nursing behaviors that demonstrate caring.
2. Outline the position of at least two nursing theories on
person, environment, health, and the profession of nursing.
3. Apply your understanding of nursing theory, nursing
process, and the concepts of transcultural nursing in your
practice of nursing.
4. Conduct research to find examples of how a specific
cultural or social diversity influences a patient’s response to
illness.
5. Create an environment that encourages visitors to spend
time with a patient.
6. Maintain an environment that eliminates or at least
minimizes the risk of illness or injury to patients.
Nurse-Patient Interactions
 Caring in Nursing:
 Protecting and looking after the well-being of another
 Requires creating interpersonal relationships
 Respecting and accepting others’ freedom to make
decisions
 Having knowledge and skills necessary to meet needs of
others
Obligations as a Student
 Get the best education you can
 Develop a self-awareness (skilled, empathetic,
sensitive, and caring human being)
 Develop confidence in and understanding of yourself
 Work on your caring skills –you may be the only
person in the health care system that provides both
physical and emotional care
Nursing Theory
 Attempts to describe or explain the nature of nursing
 Provides foundation for and guides the practice of
nursing
 Nursing theory also known as nursing model
Nursing Theory
Major Theorists
 Florence Nightingale 1859
 Environment affects health
 Putting the person in the best condition for nature
to act on him or her
 Nurse’s duty is to provide the right environment
 Health is being free from disease
 Physical, intellectual, and spiritual attributes
Nursing Theory
 Henderson 1955
 Health is basic to human functioning
 Ability to function independently depends on health
 14 components of basic nursing care individualized for each
patient
 Orem 1958
 Universal self-care requisites or needs
 Nurse helps patients meet self-care deficits
 Three categories of nursing intervention
Nursing Theory
 Roy 1964
 Adaptation model
 Stress produced by changing environment and need to
adapt
 Adaptability determines health
 Nurse’s goal is to help the person cope
Nursing Theory
 Neuman 1972
 Health care systems model
 To understand one thing about a person, you must
consider everything about the person
 Good health is maintained by using energy to balance
the effects of stress
 Nurse’s aim is to identify stressors and to intervene to
reduce or eliminate them
Nursing Theory
Relationship to Nursing Practice
 Provides the basis for continuing research on how nurses
can be more effective
 Guides practice
 Helps nursing recognize there is more to nursing than
performing treatments and procedures
Nursing Process
 Systematic, organized method of providing nursing care
 Five steps
 Assessment—objective and subjective data
 Nursing Diagnosis—NANDA-I list
 Planning—Setting priorities, written care plan
 Implementation—Putting the plan into action
 Evaluation—Constant process of evaluating success of the
plan and revising it
Transcultural Nursing
 Culture
 Shared values, beliefs, customs, rituals, attitudes, roles, and
behaviors passed from generation to generation
 Madeleine M. Leininger
 Respect other cultures, adapt nursing care to meet the
needs of people from cultures other than yours
 Goal is to preserve, accommodate, or repattern the cultures
of the patient
Transcultural Nursing cont’d
 Examples:
Preserve-Jewish patient who follows a kosher
diet must have that aspect preserved
Accommodation-male/female roles (may
need to hire a homemaker to carry out female
duties/roles)
Repattern-high cholesterol/fat diet, must
provide detailed information on the affects to the
cardiovascular system
Transcultural Nursing
Cultural Characteristics
 Deeply rooted
 Difficult or impossible to alter
 Customs and values reflect behavior correct within a
culture
Transcultural Nursing
Ethnic Characteristics
 Cultural subgroups
 Depend on:
 Education
 Geographic location
 Number of members in the group
Transcultural Nursing
Language
 Take time to communicate
 Obtain interpreter or family member
 Use nonverbal communication
Race
 Five major racial groups: American Indian or Alaska
Native, Asian, Black, African American, Native Hawaiian
or Other Pacific Islander, and White
 Race is only a physical distinction
Transcultural Nursing
Views on Aging
 Respect versus disrespect
 Sense of responsibility for care
Views on Childbearing
 Do’s and don'ts for pregnant women
 Birthing position (squatting, sitting, supine)
 Father’s role
 Care of the infant
Transcultural Nursing
Religion
 Religious beliefs may influence choice of treatment
 Many people do not belong to organized groups or
practice religion
 Organized belief systems
 Catholicism
 Protestantism
 Judaism
Transcultural Nursing
 Islam
 Buddhism
 Other Religions
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Mormons
Jehovah’s witnesses
Christian scientists
 Secular and nonreligious groups—atheist and agnostic
Transcultural Nursing
Views on Pain
 Result of one’s culture
 Personality and emotional state
 Ask the person if they are in pain
Views on Nutrition
 Preferences develop early, difficult to change
 Adequate nutrition is necessary for healing
Transcultural Nursing
Views on Death and Mourning
 Natural extension or great loss
 Dying with dignity
 Care of the body after death
 Mourning is a cultural expression of grief
Cultural Assessment Tools
 Printed forms to collect data
 Require good interviewing skills
 Informal conversation
 Formal interview
CS#1
Case Study #1
 As part of the curriculum in your nursing school, you are enjoying the obstetric
rotation in a small urban hospital. One of your classmates, Hildie, comes to you all
excited. She tells you that the client she is caring for has asked the doctor and the
staff to save her placenta. She plans to give the placenta to one of her friends, who
will prepare and bring it to her in time for her evening meal. Hildie was curious
and had asked her client many questions about her belief. Hildie’s client asked her
to join her for dinner.
 You tell Hildie that you think it is great that as her nurse, you showed enthusiasm
and not disdain or revulsion. However, you advise Hildie to first check with the
instructor. The instructor was surprised by the request and called the Coordinator
for Clinical Practice, Mrs. Hovey.
 The instructor does check with Mrs. Hovey. Mrs. Hovey applauds the learner for
her demonstration of client caring and lack of ethnocentrism. However, the learner
is not permitted to eat the woman’s placenta. (Learning Objective 3)
Questions for Case Study #1
1. Should the learner have accepted from the client
the invitation to eat the placental cuisine?
2. How does this situation fit within Leininger’s
definition of a culture?
3. How does this situation fit Leininger’s goal of
transcultural care?
4. How would you have reacted to this situation?
Social Diversity
The Child
 Children are generally afraid in health care settings
 Make them feel secure
 Offer quiet reassurance
 Establish good relationships with patients and other
family members
 The child who is abused has an induced fear of adults
Social Diversity
The Patient Who Is Elderly
 Have suffered some losses
 Treat them in a manner to reduce further loss
 Careful assessment for clues to medical causes of
symptoms
The Patient Who Is Having an Elective Abortion
 An emotionally charged event
 Exemption for assisting
Social Diversity
The Patient Who Is a Single Parent
 Biggest concern is being able to afford to care for their
children
 Be sensitive to concerns about their children
The Person Who Is Homosexual
 Partner is the significant person in his/her life
 Recognize and treat this relationship as you would for all
other patients and families
 Having AIDS does not mean the patient is homosexual
Social Diversity
The Patient Who Chooses Alternative Forms of Treatment
 Increasing number of people using nontraditional
approaches
 Stress the importance of sharing all information about
what they take or do with their physician
Social Diversity
The Patient Who Is Mentally Ill
 Mental illness is a disease and must be treated as such
 Nursing measures for dealing with intense emotions
 May require psychiatric evaluation
The Patient Who Is Withdrawn
 Never assume a patient who does not ask for anything
does not need anything
Social Diversity
The Patient Who Is Hostile
 Physical or vocal disruption
 Deal with the patient calmly
 Hostility can be cry for attention
 Don’t restrain without assistance
Social Diversity
The Patient Who Abuses Alcohol or Drugs
 Chemical interventions can become addictive
 Nurse must provide care regardless of what caused
person to need care
 Substance abuse is a disease and must be treated as such
Social Diversity
The Patient Who Is Dying
 Dying and death are facts
 Be secure with your own feelings
 Expected or accidental death
 Five stages of dying
 Denial, anger, bargaining, depression, and acceptance
 Maintain objectivity
Managing the Physical
Environment
Visitors
 Can have negative or positive effect on recovery
 Nurse must create positive relationships with visitors
 Always respect patients’ privacy
 Know facility policies regarding visitors
 Use authority with pleasantness
Managing the Physical
Environment
Safety
 Health care facility dangers
 Treatment errors
 Infections
 Injuries
Managing the Physical
Environment
 Prevention Measures
 Learn facility fire and safety regulations
 Know locations of exits and fire extinguishers
 Report any safety problems and follow through
 Checking identification bracelets before a treatment or
administering medications
 Use of bedrails
Managing the Physical
Environment
 Removal of used medical supplies
 Bed in low position
 Using locking devices
 Cleaning up spills
 Closing doors and drawers
 Proper use of restraints
Q#1
Question
 Is the following statement true or false?
The nursing process attempts to describe or explain
the nature of nursing.
Answer
 False
 Rationale: Nursing theory attempts to describe or
explain the nature of nursing. Nursing process is a
systematic, organized method of providing nursing
care.
Question
 The nursing process includes:
A. Assessment and medical diagnosis
B. Planning, culture, and assessment
C. Education and evaluation
D. Assessment and nursing diagnosis
Answer
 D. Assessment, nursing diagnosis
 Rationale: The five steps of the nursing process
include assessment, nursing diagnosis, planning,
implementing, and evaluation.
Question
 Is the following statement true or false?
When confronted with a patient who is threatening
violence, immediately restrain the person, and call for
help.
Answer
 False
 Rationale: Never restrain a person threatening
violence without assistance.
Question
 Three dangers in health care facilities include:
A. Treatment errors, infections, and injuries
B. Treatment errors, use of bedrails, and leaving doors
open
C. Incorrectly using restraints, the bed in high
position, and leaving medical supplies in the patient’s
room
D. Infections, injuries, and open drawers
Answer
 A. Treatment errors, infections, and injuries
 Rationale: Three dangers in health care facilities
include treatment errors, infections, and injuries.
Question
 Is the following statement true or false?
Nursing theory is not related to actual nursing practice
because it only provides a basis for research.
Answer
 False
 Rationale: Nursing theory provides the basis for
research on how nurses can be more effective, guides
practice, and helps nurses recognize there is more to
nursing than performing treatments and procedures.