PRIMARY FOCUS OF MED SURGE NURSING CARE IS

MEET THE 1) BILOGIC 2) PSYCHOSOCIAL 3) CULTURAL 4) SPIRITUAL NEEDS OF THE ADULT PT IN A MUTUALLY 1) TRUSTING 2) RESPECTFUL 3) CARING RELATIONSHIP (THESE BASIC NEEDS ARE REFERRED TO AS CONCEPTS)

MED SURGE NURSES MUST USE

1) EXPERT CLINICAL JUDGEMENT TO INSURE 1) PT. SAFETY AS THE PRIORITY IN PRATICE

NIGHTINGALE 1946

Putting the patient in the best condition for nature to act

Henderson, 1966

Assisting the client in the performance of activities contributing to wellness or recovery with the optimal goal being independence

Medical Dictionary, 2010

The provision, at various levels of preparation, of services essential to or helpful in the promotion, maintenance, and restoration of health and wellbeing or in prevention of illness

ANA, 2003

Diagnosis and treatment of human responses to actual and potential health problems

NURSING FOCUS

Self-care Physiologic processes Comfort Emotional Understanding of health & illness Decision making Perceptual orientation Transitions across the lifespan Relationships

Delivery of Nursing Care

 Team Nursing Groups LTC (Long term care) Primary Nursing Acute Care Settings Managed Care Community Settings

Meeting Client Needs

Maslows Hierarchy

Self-actualization Esteem & self-respect Belongingness & affection Safety & security Physiologic needs

Health

 State of complete physical, mental, and social well-being not merely the absence of disease and infirmity (WHO, 2006).

Wellness

 Capacity to perform Ability to adjust Perception of well-

being Harmonious feeling (Hood & Leddy, 2007)

Influences on Nursing Practice

Population : Aging population & increase in chronic conditions. Culture: More diverse; includes ethnicity & economic shifts. Disease: Increase in communicable disease such as TB, AIDS, STDs (Smelter et al., 2010).

Influences on Nursing Practice

Technology: Advances in IS, diagnostics, & genetics. Payor Sources: Managed Care (HMO, PPO), Medicare, Medicaid. Best Practices: CMS & JCAHO influence treatment and reimbursement.

Nursing Roles

Nurse Practitioner Leadership Research Education Care Delivery

Critical Thinking

Thinking Like a Nurse: Abstract Concept Metacognition Outcome-oriented Developed over time

Benners Theory: Novice to Expert (Benner, 1984):

 Novice Advanced beginner Competent Proficient Expert

Tanners Clinical Judgment Model (Tanner, 2006):

Noticing Interpreting Responding Reflecting

Ethics in Nursing

Autonomy Beneficence Fidelity Justice Nonmaleficence Respect Sanctity of life Veracity

Ethical Issues

Confidentiality Restraints Trust Refusal of care End-of-life Advance directives

Nursing Process

Assessment

Evaluation

Diagnosis

Implementation

Planning

The Plan of Care

Nursing Diagnosis NANDA PES format Goal Statement Clients perspective SMART criteria NOC (www.nursing.uiowa.edu/noc) Interventions EPB NIC (www.nursing.uiowa.edu/cnc) Collaborative

SMART Criteria:

 Specific Measurable Attainable Relevant Time Specific

Health Education & Promotion

The public has a right to know about important health information Nurses have a duty to educate and collaborate with others to encourage optimal compliance with health regime Outcomes rely heavily on the clients readiness to learn and apply knowledge

Patient Teaching Techniques

One-on-One Group Learning Style Teaching Aids Barriers Reinforcement (Smeltzer et al, 2010)

Learning Styles

VisualAuralRead/writeKinesthetic-

Health Promotion Components

Self-responsibility Nutritional Awareness Stress Management Physical Fitness

Health Promotion
Transtheoretical Model of Change

Precontemplative Contemplative Decision making Action Maintenance Termination

Assessment

 History Physical Head-to-toe Systems

Inspect

Palpate

Percuss

Auscultate

Nutritional