Ignatavicius: Medical-Surgical Nursing, 6th Edition

Chapter 1: Introduction to Medical-Surgical Nursing Key Points Print Chapter 1 provides an overview of the role of the medical-surgical nurse in health care. The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in patients from 18 to the end of life. Medical-surgical nursing requires a broad knowledge base to meet the needs of adult patients in a variety of settings across the continuum. Patients are recipients of care in mutually-trusting relationships with nurses and other members of the health care team. The Joint Commission requires that health care organizations create a culture of safety by implementing measures that encompass the National Patient Safety Goals. The Institute of Healthcare Improvement initiates interventions to save lives and prevent patient harm. In 2004, along with partner health care organizations, they launched the 100,000 Lives Campaignan effort to save patient lives over an 18-month targeted time frame. o Six interventions for quality improvement changes in care were implemented by partnering health care agencies. The next objective was to protect patients from five million incidents of medical harm over a 2-year period from December 2006 to December 2008. The Institute of Medicine published many reports suggesting ways to improve patient safety and quality care. o They identified five broad core competencies for todays practice reality to ensure patient safety and quality care. They are: Provide patient-centered care. Collaborate with the interdisciplinary health care team. Implement evidence-based practice. Use quality improvement in patient care. Use informatics in patient care. Rapid Response Teams are one initiative to save lives and decrease the risk for patient harm before a respiratory or cardiac arrest occurs. o Members of such a team are critical care experts who are on-site and available at any time to respond to calls for assistance. o Remember to always observe for slow and sudden changes in patient condition, especially changes in vital signs and mental status. The primary concern of medical-surgical nursing care is to meet the biologic, psychosocial, cultural, and spiritual needs of the adult patient in a mutually-trusting, respectful, and caring relationship. The primary roles of medical-surgical nurses include patient caregiver, educator, and advocate. In the caregiver role, nurses assess patients, analyze collected information to determine their needs, develop nursing diagnoses and collaborative problems, plan care and carry out the plan
Copyright 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

with the health care team, and evaluate the care given. Activities are often categorized as collaborative or independent. Collaborative actions are those that are mutually determined by the nurse and the physician or other health care team member, such as setting activity limitations or providing a special diet. Interdependent actions are those that are directed or prescribed by the health care provider but require nursing judgment. Independent nursing functions such as patient assessment are initiated and carried out without direction from the health care provider. Patient education is a major component of nursing care to improve health by facilitating patient learning regarding health promotion and disease. As an advocate, the medical-surgical nurse assists the patient and family through caring interventions. o Caring is a process, set of actions, and attitude that shows genuine physical and emotional concern. The three ethical principles to consider when making clinical decisions are selfdetermination, beneficence, and justice. Respect for people is one of three basic ethical principles that nurses and other health care professionals should use as a basis for clinical decision-making. Respect implies that patients are treated as autonomous individuals capable of making informed decisions about their care. Patient autonomy is referred to as self-determination or self-management. The second ethical principle is beneficence, which emphasizes the importance of preventing harm and assuring the patients well-being. Justice, the third principle, refers to equality; which means that all patients should be treated equally and fairly. The goal of the case management process is to provide quality and cost-effective services and resources to achieve positive patient outcomes. In collaboration with the nurse, the case manager coordinates inpatient and communitybased care before discharge from a hospital or other facility. Health care organizations must also establish procedures for hand-off communication between shifts and between departments. o A popular procedure used in many agencies today is called SBAR. o SBAR is a formal method of communication between two or more members of the health care team which includes these four steps: Situation: what is happening at the time Background: relevant background information Assessment: an analysis of the problem or patient need Recommendation: what is needed Nurses function as coordinators of care by communicating and collaborating with members of the health care team. Nurses use critical thinking and the nursing process to make timely and appropriate clinical decisions. Evidence-based practice is the deliberate use of current best evidence to make decisions

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about patient care. The best source of scientific evidence is research but nursing research is limited and often does not represent the highest or best level of evidence. One of the ways to evaluate care is to be part of the quality improvement process in your setting. As a medical-surgical nurse, you will be expected to identify indicators to monitor quality and effectiveness of nursing care, collect data to monitor the quality and effectiveness of nursing care, recommend ways to improve nursing care, and implement activities to improve the quality of nursing care. Informatics is a specialized computer science that is used to manage information and technology. o Nurses need to retrieve and use valuable information for patient care. o Informatics is used for patient documentation, Internet searches, and e-mail communication in health care.

REVIEW Which of the following is not one of the primary roles of medical-surgical nurses? A. Patient caregiver B. Patient educator C. Patient therapist D. Patient advocate

Copyright 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.