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1 Module 3 Fundamentals of Nursing. 2 Nursing as a Profession  Criteria of a profession Extended education Body of knowledge Provides a specific service.

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Presentation on theme: "1 Module 3 Fundamentals of Nursing. 2 Nursing as a Profession  Criteria of a profession Extended education Body of knowledge Provides a specific service."— Presentation transcript:

1 1 Module 3 Fundamentals of Nursing

2 2 Nursing as a Profession  Criteria of a profession Extended education Body of knowledge Provides a specific service Autonomy in decision-making and practice Code of ethics Professional organization and publication Disciplinary course of action

3 3 Definition of a Profession Discussion  How do you define the term profession?  What does the term professional mean to you? What behaviors would you expect?  How would you define nursing?

4 4 Definitions  Profession Type of occupation that meets certain criteria that raise it above the level of an occupation  Professional A person who belongs to and practices a profession  Nursing The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980)

5 5 Nursing Education Requirements  Associate degree  Diploma  Baccalaureate degree  Master’s degree  Doctoral Degree

6 6 Role of the Professional Nurse  Provider of care Assists the patient physically and psychologically  Communicator Communicates verbally and in writing to patients, significant others, health professionals and the community

7 7 Role of the Professional Nurse (continued)  Teacher Assists patients to learn and perform at a level necessary to restore, improve and maintain health status  Client Advocate Represents the patient’s needs/wishes to others; acts to protect the patients by assisting them to exercise their rights

8 8 Role of the Professional Nurse (continued)  Counselor Assists patients to recognize and cope with stressful problems, develop improved interpersonal relationships and promote personal growth  Change Agent Assists patients to make modifications in their own behavior

9 9 Role of the Professional Nurse (continued)  Leader Influences others to work together to accomplish specific goals  Manager of Care Manages the care of individuals, families and communities

10 10 Role of the Professional Nurse (continued)  Member of the Discipline of Nursing Models and values nursing, commits to professional growth, abides by the standards of practice and legal/ethical principles, conducts research, and strives to advance the profession of nursing.

11 11 Legal Basis for Nursing Practice  Nurse Practice Act Provides laws that control the practice of nursing in each state Mandates that, under the law, only licensed professionals can practice nursing All states now have mandatory nurse practice acts

12 12 Legal Basis for Nursing Practice (continued)  Standards of Practice Identify the minimal knowledge and conduct expected from a professional practitioner based on education and experience Nursing practice is guided by legal restrictions and responsibilities regulated by state nurse practice acts General standards have been developed by the American Nurses’ Association (ANA) Practice is also guided by professional obligations

13 13 Types of Law  Statutory – created by legislators at state and federal level  Regulatory – created by administrative groups (ex: Board of Registered Nursing)  Common – used to resolve disputes between 2 persons based on principles of justice, reason and common good

14 14 Types of Law (continued)  Criminal law Public law that deals with the safety and welfare of the public 2 types include misdemeanors or felonies

15 15 Types of Law (continued)  Civil Law Protects the rights of individuals in situations which generally involve harm to an individual or property Negligence is failure to use care that a reasonable person would use under similar circumstances Malpractice is professional negligence, misconduct, or unreasonable lack of skill resulting in injury or loss

16 16 Types of Law (continued)  Good Samaritan Act Protects health practitioners against malpractice claims for care provided in emergency situations Nurse is required to perform in a “reasonable and prudent manner” and within accepted standards

17 17 Legal Infractions Terms  Assault Unjustifiable threat or attempt to touch or injure  Battery Any intentional touching or injury without consent

18 18 Legal Issues Related to Nursing Practice  Review and discuss Legal Responsibilities of the Nurse on Study Guide 3  Review and discuss the Patient’s Bill of Rights

19 19 Legal Issues Related to Nursing Practice  Informed Consent Agreement to the performance of a procedure/treatment based on knowledge of facts, risks, alternatives

20 20 Informed Consent continued  Person giving consent must: Be of sound mind and physically competent and legally an adult Consent must be voluntary Consent must be thoroughly understood Must be witnessed by an authorized person such as the physician or a nurse

21 21 Informed Consent (continued)  The physician is responsible for obtaining the consent.  The nurse may witness the signing of the consent.

22 22 Consent of Minors  Consent of Minors Minors 14 years of age and older must consent to treatment along with their parent or guardian  Emancipated minor Is a person age 14 or older, who has been granted the status of adulthood by a court order or other formal arrangement They can consent for treatment themselves

23 23 Potential Liability for Nurses  See Study Guide 5 “Areas of Potential Liability for Nurses”  Choose several to discuss as a class

24 24 Restraints  Restraints A device used to immobilize a patient or extremity and restrain the level of activity

25 25 Restraints  2 justifications for using restraints To protect patients from injuring themselves To protect others from the patient

26 26 Alternatives to Using Restraints  Before restraining a patient, alternatives must be used and documentation must state that these were tried and failed  Try to determine the cause(s) of the patient’s behavior Eg: medication

27 27 Alternatives to Using Restraints (continued)  Physiological alternatives Reposition the patient Adjust medications to relieve pain Cover IV tubes to “hide” the tube  Psychological alternatives Provide appropriate visual/auditory stimuli Increase visits from friends and family

28 28 Alternatives to Using Restraints (continued)  Environmental alternatives Put items within easy reach Place patient near the nurses’ station Hire private duty nurse to stay with patient

29 29 Documentation of Restraint Use  Follow facility policies which protect you and them from legal actions  Document the patient evaluation process Why restraint was needed List behaviors Alternatives tried

30 30 Documentation of Restraints (continued)  Document the requirement for an order or protocol authorizing the restraints Physician’s order must be time limited Verbal orders must be signed within time specified in facility policy A PRN (as needed) order is never allowed

31 31 Documentation of Restraints (continued)  Document your on-going assessment and care of the patient Nutrition Hydration Elimination Special nursing services (ex: private duty nurse) Follow policy regarding frequency/documentation of on-going assessment

32 32 Applying Restraints  Follow the manufacturer’s instructions  Apply to provide for as much movement as possible  Be careful that vest restraints are not put on backwards  Adjust the restraint so it is not so tight to reduce circulation or cause pressure ulcers

33 33 Applying Restraints (continued)  Tie the restraint to the bed frame, not the bed rail  Use a knot that will not tighten when pulled (ex: clove hitch)  Pad bony prominences when needed

34 34 Monitoring the Patient in Restraints  Follow facility protocol  Assess every 30 minutes  Remove the restraint for 10 minutes at least every 2 hours; assess for skin and neurological impairment; perform range of motion  Document restraint assessment on appropriate restraint assessment tool provided by the facility

35 35 Types of Restraints  Mitt restraint  Belt restraint  Jacket restraint  Wrist or ankle restraint

36 36 Using Restraints in Behavioral Health  Strict time limits Adults: 4 hour limit Children age 9-17: 2 hour limit Children under age 8: 1 hour limit

37 37 Unusual Occurrence Incidents  Also known as incident reports  An incident is “any event that is not consistent with the routine operation of a healthcare unit or routine care of a patient” (Perry and Potter 2005)

38 38 Unusual Occurrence Incidents (continued)  Examples: Accidental needle stick Medication error Patient or visitor fall A physician’s order not being carried out by the nurse Equipment malfunction

39 39 Unusual Occurrence Incidents (continued)  The report is a confidential record between the observer of the incident and the agency Risk Manager that documents the facts of the incident  It is an objective account of the occurrence and does not include opinions, judgments or blame

40 40 Unusual Occurrence Incidents (continued)  Complete a report even if there is no injury  Never document in the nurses’ notes that an incident report was completed.

41 41 Unusual Occurrence Incidents  Class Discussion: Give some examples of incidents in which you would complete a report.

42 42 Ethical Terms (continued)  Code of Ethics – a written list of professional values and standards of conduct which provide a framework for decision- making  There are several codes of ethics that may be adopted; in the U.S. the ANA Code of Ethics is generally accepted (see study guide)

43 43 Ethical Issues in Nursing Practice  Making ethical decisions is a common part of every day nursing care  Ethical decision-making is a skill that can be learned

44 44 Ethical Terms  Ethics – systematic study of what “ought” to be done, the justification of what is right or good  Ethical Dilemma – situation that required a choice between two equally favorable alternatives

45 45 Ethical Concepts That Apply to Nursing Practice  Define and discuss the following concepts from the study guide Morals Values Autonomy Beneficence

46 46 Ethical Decision-Making Process 1.Clearly identify the problem 2.Consider the causative factors, variables, precipitating events 3.Explore various options for action 4. Select the most appropriate plan for dealing with the ethical dilemma 5. Implement decided course of action 6. Evaluate results/consequences

47 47 Ethical Decision-Making Activity  Choose an ethical dilemma from the study guide (Common Ethical Issues Involving Nurses)  Discuss your chosen dilemma using the 4 steps for solving an ethical dilemma on the previous slide.

48 48 Confidentiality  Nurses are legally and ethically obligated to keep information about patients confidential.  The tort invasion of privacy protects the patient’s right to be free from intrusion into their private affairs.  The ANA Code of Ethics also provides for a patient’s privacy.

49 49 Confidentiality - HIPAA  The American Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 and was required to be instituted in April 2003  Requires that patient health information be available only to those with the right and need to have this information

50 50 Confidentiality  Nurses role in maintaining confidentiality Don’t discuss information where others might overhear Protect computer screen from being viewed by visitors Protect patient charts from being viewed Do not share your computer ID or password Access/transmission of patient information via internet requires strict scrutiny

51 51 The Joint Commission’s National Patient Safety Goals  Introduced in 2003; updated annually  Written by a group of experts who review all of the sentinel events (unexpected occurrences involving death or serious physical or psychological injury)  Experts define problem areas and advise The Joint Commission on how to remedy these problems

52 52 National Patient Safety Goals for Hospitals  In 2007, there are 8 goals that hospitals must follow  Goal # 1: Improve the accuracy of patient identification Use at least 2 patient identifiers Includes assigned ID number, social security number, name, date of birth as options Follow organizational policy

53 53 National Patient Safety Goals (continued)  Goal #2 Improve the effectiveness of caregiver communications Includes guidelines for verbal orders Hospitals must develop a list of abbreviations, symbols, and dose designations that are not to be used Must develop guidelines regarding abnormal test results and time for reporting Must create a standardized, consistent approach to “hand-off” communication

54 54  Goal # 3 Improve safety of using medications Standardize and limit the number of drug concentrations Identify and review look-alike/sound-alike drugs Create list of high-risk medications and have them labeled Patient identification must be on all medication containers National Patient Safety Goals (continued)

55 55  Goal # 7 Reduce the risk of healthcare- associated infections Proper handwashing Review infections leading to death or major permanent loss of function while a patient National Patient Safety Goals (continued)

56 56  Goal # 8 Accurately and completely reconcile medications across the continuum of care Compare current medications with those ordered when admitted Communicate complete list of meds to next provider of service National Patient Safety Goals (continued)

57 57  Goal # 9 Reduce the risk of patient harm resulting from falls Implement a fall reduction program Implement evaluation of the effectiveness of the program National Patient Safety Goals (continued)

58 58  Goal # 13 Encourage patients’ active involvement in their own care Encourage patients and their families to report concerns about safety Teach about preventing infection by washing hands Encourage self-care National Patient Safety Goals (continued)

59 59  Goal # 15 Identify safety risks inherent in your patient population Hospital should review all of its own sentinel events and assess trouble spots in the care environment Complete assessment and follow-up on every patient admitted for behavioral/emotional problems. *According to The Joint Commission, suicide has been the most frequently reported sentinel event in staffed, round-the-clock facilities since The Joint Commission began its reporting policy in National Patient Safety Goals (continued)

60 60 Patient Falls  Falls are the leading cause of accidents among older adults  Electronic devices are available to detect patients attempting to get out of bed

61 61 Fall Risk Assessment  Identify clients at risk on admission and throughout hospital stay  Fall Risk Assessment Tools identify the risk level based on the following: Physical condition Mental status Medications Age History of previous fall Ambulatory devices used

62 62 Nursing Interventions to Prevent Falls  Identify clients at risk  Implement fall prevention precautions  Place items within easy reach of client  Assist with ambulation; use ambulatory aids  Teach client and family members of precautions used in the hospital Non-skid footwear Use of handrails

63 63 Body Mechanics  Safe and efficient body movements depend upon balance and the interrelationship of the center of gravity

64 64 Body Mechanics  Review Summary of Guidelines and Principles Related to Body Mechanics in the study guide

65 65 Body Mechanics When Moving Patients  Assess the situation; get help if needed  Ensure patient safety by engaging locks and brakes  Bring the patient close to your center of gravity  Face in the direction of movement to prevent spinal twisting

66 66 Body Mechanics When Moving Patients  Establish a broad base of support  Lower your center of gravity by bending your knees  Tighten gluteal, abdominal, leg and arm muscles

67 67 Applications of Cold and Heat  Cold applications Cause vasoconstriction Reduce blood supply Remove oxygen, metabolites, and waste Slow bacterial growth Decreases inflammation

68 68 Cold Applications (continued)  Dry cold: cold pack, ice bag, ice collar  Moist cold: compress or sponge bath

69 69 Applications of Cold and Heat  Heat applications Cause vasodilation Increase blood supply Brings oxygen, nutrients, antibodies and leukocytes Increases inflammation Helps rid body of waste (via polymorphonculear levkacytes)

70 70 Heat Applications (continued)  Dry heat: aqua pad, disposable heat pack, electric pad (K-Pad)  Moist heat: compress, soak, sitz bath

71 71 Nursing Care Cold and Heat Applications  Re-assess every 15 minutes after starting treatment  Evaluation: examine area to which cold or heat was applied and document client response on the medical record

72 72 Medical vs. Surgical Asepsis  Asepsis is the absence of pathogenic microorganisms  Medical asepsis - maintaining a patient and the environment as free from pathogens as possible  Surgical asepsis - eliminating all microorganisms, non-pathogenic and pathogenic

73 73 Surgical Asepsis Principles  Use a sterile field for sterile materials  Keep hands in front of you and above your waist  Edges of sterile containers are not sterile once opened  A dry field is necessary to maintain sterility of the field

74 74 Nosocomial Infections  An infection acquired while a patient  Caused by bacteria, viruses, fungi or parasites  Patients are at high risk Multiple illnesses Elderly Lowered resistance

75 75 Iatrogenic Infection  An iatrogenic infection is a type of nosocomial infection resulting from a diagnostic or therapeutic procedure  Example: a urinary tract infection (UTI) that develops after a catheter insertion

76 76 Chain of Infection  6 links in the chain of infection Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host

77 77 Nurses Role in Preventing Infection  Infection does not occur or spread when one of the links is broken  Discuss ways in which health care practitioners can break each link

78 78 Medical Asepsis Principles  Also known as clean technique  Includes Handwashing Standard precautions Isolation technique Cleaning/disinfecting of equipment

79 79 Infection Control  Standard precautions are the primary strategies for prevention of infection transmission Handwashing Gloves Mask, eye protection Gown

80 80 Change in a Patient’s Condition  The Nurse Practice Act requires that the nurse observe and appropriately report a change in a patient’s condition.  Reporting should include assessment data including vital signs, behaviors of the patient nursing interventions pertinent background information other related information (lab work, x-ray, etc.)

81 81 Change in Patient’s Condition (continued)  Changes might include: Sudden respiratory depression or difficulty Change in cardiac status Sudden unexpected pain Sudden confusion Critical change in vital signs Anything out of the “expected behavior” of a patient

82 82 Therapeutic Communication  Types of communication include Verbal Non verbal Active listening

83 83 Variables That Influence Communication  Perception  Values/beliefs  Culture  Gender  Age  Developmental level  Environmental factors

84 84 Characteristics of Therapeutic Relationships  Mutually determined goals  Goal-directed toward meeting patient’s needs  Provision of environment to maximize patient’s potential for growth  Patient learning new coping skills  Predictable phases of the relationship

85 85 Essential Conditions for Therapeutic Communication  Rapport  Trust  Respect  Empathy  Genuineness

86 86 Cultural Considerations for Therapeutic Communication  It is important to review the characteristics associated with a specific culture  These include Personal space Eye contact Use of touch Silence

87 87 Therapeutic Communication Techniques  Review the techniques listed in the study guide. Practice using several of these with a classmate.  Review Blocks to Therapeutic Communication in the study guide. Practice using these with a classmate.

88 88 Assessment and Interventions for Safe Fluid Therapy  Measuring intake and output (I & O) is an independent nursing function  Patients on intravenous (IV) therapy or who have a urinary catheter are automatically on I & O  I & O is used to determine the fluid and electrolyte status

89 89 Intake and Output  Intake includes All fluids taken my mouth All fluids taken by nasogastric and jejunostomy tubes All parenteral fluids (intravenous, blood)

90 90 Intake and Output  Output includes Urine Emesis (vomit) Diarrhea Gastric suction T-tube drainage Drainage from surgical wounds/other drainage tubes

91 91 Nursing Diagnoses for Fluid Volume  Fluid Volume Deficit Dehydration Hypovolemia  Fluid Volume Excess Hypervolemia

92 92 Nutrition  5 food groups Breads, cereals, rice, pasta Vegetables Fruits Milk, yogurt and cheese Meat, poultry, fish, dried beans and peas, eggs, nuts

93 93 Culture and Nutrition  Visit the web site listed in the patient study guide to view and discuss food pyramids from a variety of cultures

94 94 Common Therapeutic Diets  Discuss foods that are and are not allowed on the following diets Regular Soft Mechanical soft Clear liquid vs. full liquid No added salt (NAS) High fiber American Diabetes Association diets

95 95 Nutritional Assessment  Gather baseline data Include client’s weight  Identify specific nutritional deficits  Establish nutritional needs  Identify physical and psychosocial factors that may influence nutritional needs

96 96 Nursing Diagnoses for Nutrition  Body image disturbance  Altered nutrition: less than body requirements  Altered nutrition: more than body requirements  Self-care deficit: feeding

97 97 Nursing Interventions to Promote Nutritional Well-Being  Assist with food choices Refer to dietician if needed  Provide comfortable environment Free of odors, noise  Promote appealing food presentation Hot/cold food Offer to open containers  Assist with feeding as needed

98 98 Enteral Tube Feedings  Enteral feeding involves the delivery of formula via a tube into the stomach or jejunum  Includes Nasogastric tube (NG tube) Gastric tube (G-tube) Jejunal tube (J-tube)

99 99 Nursing Care with Enteral Tubes  Check for placement according to hospital policy An x-ray is the only positive method for placement  Assess bowel sounds  Assess skin around insertion site  Keep the head of the bed elevated for continuous feedings and during intermittent feedings to prevent aspiration

100 100 Nursing Care With Enteral Tubes (continued)  When delivering medications through a NG or G tube: Dissolve the tablet in water Flush the tube before and after delivering the medication  Blood glucose monitoring is often done during enteral feedings as the solutions can be high in glucose

101 101 Total Parenteral Nutrition (TPN)  A form of nutritional support in which nutrients are given intravenously  The patient must have a central venous access system in place

102 102 TPN Complications  Complications can be reduced by meticulous care of the venous access device  Prevent infection  Prevent metabolic, electrolyte, fluid balance complications  Maintain parenteral system

103 103 Nursing Care of the Client on TPN  Change tubing every 24 hours using strict aseptic technique  Assess for signs of infection  Monitor blood glucose  Daily weight  Intake and output

104 104 Health Care of the Older Adult  Older adults are 65-years-old and older young old middle old old-old (fastest growing subgroup) elite old

105 105 Health Care of the Older Adult (continued)  50% of hospitalized clients on med-surg units are older than 65  8% of elderly have 1 or more chronic illnesses  50% have 2 or more chronic illnesses  5% live in institutional settings

106 106 Assessment Guidelines for Older Adults  Adjust to physiologic changes Be familiar with sensory changes, changes in each body system  Adapt assessment techniques to diminishing energy and ability Allow for frequent breaks if a lengthy assessment is needed

107 107 Assessment Guidelines (continued)  In addition to physical assessment, the older adult may need assessment of: Ability to perform ADL’s (Activities of Daily Living - functional assessment) Network of support (family and friends) Health beliefs in nutrition, exercise, etc. Sleep patterns Living arrangements Financial assessment Self-esteem View of life and acceptance of death

108 108 Reminiscence/Life Review  An adaptive function that allows them to recall the past and assign meaning to these experiences  Can be a nursing intervention to encourage self-esteem, increase communication skills, and increase social interaction

109 109 Pain and the Older Adult  May not report pain as feels it is a part of aging  85% of patients in nursing homes have pain  Pain response: have similar pain tolerance as young adults

110 110 Pain Assessment  Use methods as with adults (pain scale)  Don’t assume that if patient is busy or sleeping, they don’t have pain; need to ask them  If cognitive impairment is present, watch for non- verbal cues Agitation Aggression Wandering Change in vital signs Grimacing

111 111 Pain Management  Ask what they usually use for pain and is it working  If acute pain, can use narcotics but may need a decreased dose

112 112 Medications and the Older Adult  25% of all prescriptions are written for people older than 65  Physiologic changes caused by aging affect the activity and response of drugs Absorption, distribution, metabolism, excretion

113 113 Polypharmacy  Many older adults are using multiple medications, use multiple pharmacies, have multiple physicians  Multiple drugs may lead to adverse reactions

114 114 Polypharmacy  Most common adverse reaction in the elderly is confusion  Confusion in the absence of disease is not normal!!

115 115 Nursing Interventions for Polypharmacy  Assess medications they are taking  Encourage client to use one pharmacy for all medications  Encourage client to review with primary caregiver all medications they are taking

116 116 Medication Noncompliance in the Older Adult  May be non-compliant due to: Not understanding how to take medication Forgetful Don’t like the side effects Don’t have the money to purchase medications

117 117 Nutrition and the Older Adult  Risk of nutritional problems increases with age  Energy needs decrease but nutrient needs remain the same

118 118 Causes of Malnutrition in the Older Adult  Loss of teeth  Digestive system changes  Loss/decrease of appetite  Lactose intolerance  Fixed income  Lack of socialization during meals

119 119 Nursing Interventions to Improve Nutrition  Small, frequent meals  Assist with food choices  Identify causes of decreased appetite  Refer to dentist for teeth issues  Refer to social services for financial problems  Discuss ways to improve socialization during meal time

120 120 Goals for Older Adults  Follow therapeutic plan of care Ensure transportation to MD visits Ensure primary physician is aware of all medications currently taking  Maximize independence in self-care activities Educate about resources to assist them with care if needed

121 121 Goals (continued)  Maintenance of ability to communicate Educate about assistive devises such as hearing aids Assist with financial counseling to help pay for these aids if needed

122 122 Goals (continued)  Maintenance of positive self-image Assist the patient to participate in appropriate social activities to enhance the feeling of worth Encourage open expression of concerns such as feelings of hopelessness

123 123 Goals (continued)  Remain free of injury In the hospitalized patient  Perform fall risk assessment  Orient to surroundings and re-orient as needed  Provide assistance with ADL’s

124 124 Goals (continued)  Maintain bowel and bladder elimination patterns Discuss nutrition to promote elimination Discuss use of medications if prescribed Urinary incontinence (loss of bladder control) is a symptom, not a disease.

125 125 Goals (continued)  Maintain adequate nutritional status When hospitalized  Intake and output  Daily weight  Dietary referral for preferences  Socialization  Assist with feeding  Liquid supplements as needed

126 126 Goals (continued)  Maintain adequate fluid and electrolyte status Place water within easy reach of the client Offer fluids every 1-2 hours Monitor electrolytes Intake and output Administer and monitor IV fluids if needed

127 127 End-of-Life Issues  Death and Dying Nurses must recognize influences on the dying process  Legal  Ethical  Religious  Spiritual  Biological Provide sensitive, skilled and supportive care

128 128 End-of-Life Issues (continued)  Both the patient who is dying and the family members grieve as they recognize the loss  Nursing Diagnosis of Anticipatory Grieving includes: Denial worthlessness Anger concentrate Feelings of guilt Inability to concentrate

129 129 End-of-Life Legal Issues  Medical Directive to Physician (Living Will) Addresses only the withholding or withdrawal of medical treatment that would artificially prolong life Becomes effective when the primary physician and one other doctor say in writing that an individual is in a terminal or irreversible condition and that death will occur if life-sustaining medical care is not given Some states allow for personal instructions to be added to this document

130 130 End-of-Life Legal Issues (continued)  Advanced Health Care Directive Used to be called Durable Power of Attorney An Advance Directive that allows an individual to appoint representatives to make health care decisions if they become incapacitated This document affects only health care and should not be confused with granting power of attorney for other matters Becomes effective when the person becomes terminally ill or incapacitated.

131 131 Nursing Responsibility for Advance Directives  Each state varies; nurses need to be aware of requirements for their state  Be prepared to answer questions from the patient about these directives  Ask if your patient has these and make sure copies are placed in their charts  Advance Directives must be honored

132 132 End-of-Life Issues (continued)  Artificial Nutrition and Hydration is another important ethical and legal issue  Feelings about withholding food and fluids are emotionally charged and often have religious connotations.  U.S. Supreme Court has upheld the right of patients to accept or reject the administration of artificial nutrition and hydration.

133 133 End-of-Life Issues (continued)  Hospice Care Focuses on support and care of the dying person and family Goal: to facilitate a peaceful and dignified death Based on holistic concepts  Improve quality of life rather than cure  Support patient and family

134 134 Hospice Care (continued)  Principles of hospice care can be carried out in a variety of settings  Home and hospital are the most common settings  Palliative care: differs from hospice in that the client is not necessarily believed to be dying

135 135 Nursing Care of the Dying Patient  Provide personal hygiene measures  Relieve pain Essential for patient to maintain some quality in their life  Assist with movement, nutrition, hydration, elimination

136 136 Nursing Care (continued)  Provide spiritual support Arrange access to individuals who can provide spiritual care Facilitate prayer, meditation and discussion with appropriate clergy or spiritual advisor

137 137 Nursing Care (continued)  Support patient’s family Use therapeutic communication to facilitate their feelings Display empathy and caring Educate family on what is happening and what the family can expect Encourage family members to participate in the physical care of the patient

138 138 Do Not Resuscitate  Also called DNR, No Code  Must be written  Must be reviewed regularly as per policy  May have specific requests Example: may okay vasopressors and fluids but no chest compressions or intubation

139 139 Photo Acknowledgement: Unless noted otherwise, all photos and clip art contained in this module were obtained from the 2003 Microsoft Office Clip Art Gallery.

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