RNSG 1144 NURSING SKILLS CHP 2, 4, 9, 11, 12 & 14.

What does SPHM stand for?

safe patient handling and mobility

What is the main purpose for implementing SPHM?

To reduce risk factors in injuries in healthcare workers from moving patients.

What does SPHM involve?

involves the use of assertive devices to ensure patient and HC worker safety.

What is the #1 principle in SPHM?

Knowing if the patient is weight beating, also knowing oneselves limits on being able to help the patient or needing a colleagues help.

What kind of patients are most at risk from improper positioning and injury during transfer?

Those with:

poor nutrition

poor circulation

loss of sensation

alterations in bone formation

impaired muscle development

comprehensive SPHM program Includes:

use of safe pt handling and mobilization equipment.

use of pt risk assessment.

accurate pt hand off procedures

practices to improve pt mobility

staff training and education on equipment.

What is a good SPHM program effective for?

is effective at reducing patient handling injuries among nurses.

What are good strategies to provide good SPHM?

using lifting/transfer equipment

no lift policies

up to date training and education

Pt centered care in SPHM?

- if pt alert/oriented its his/her choice to increase mobility

- use simple language when providing info about complications of immobility and risks.

- consider the circumstances surrounding pt's loss of independent activity & mobility to ensure plan that is realistic and attainable.

- understand to what extent pt chooses family/caregiver to learn transfer/positioning techniques.

Evidence based practice in SPHM.

- SPHM programs helped improve safe pt handling/mobilizing practices.

- staff had more + attitudes toward increased use of pt handling equipment.

What does a comprehensive SPHM program include?

- proper equipment.

- pt mobility practices.

- pt assessments

- hospital infrastructure

- pt hand off procedures

- staff training

TRUE OR FALSE:

a multicomponent SPHM program has been found to be effective in reducing pt handling injuries among nurses?

True

What are the main safety guidelines?

- promote independence in pt when possible

- communicate clearly with HC team

- clear enviro. of clutter/obstacles

- monitor pt tolerance

- mentally review steps of transfer before u begin.

- stand on pt weak side

- When transferring/re-positioning, position bed to comfortable/safe height.

- determine amount and type of assistance required for transfer.

What are more safety guidlines?

- raise side rail of side opposite of where you are standing

- ensure personnel has traing on FDR'S before using

- educate pt and fam. about how equip works.

- arrange equip so it wont interfere w transfer

- make sure pt is in correct body alignment

What are FDR'S? And what are they good for?

-Friction reducing devices

-help reduce the risk of injury during positioning.

What are some types of FDR'S?

-air assisted transfer devices

-friction reducing slide sheets/tubes.

-transfer/ roller boards

What are two important things to remember when using FDR'S?

-anticipate problems when preparing to transf. pt

-follow principles of proper body mechanics.

What does delegation mean?

The process for a nurse to direct another person to perform nursing tasks and activities.

What must a nurse first do before moving a pt?

-assess pt and note their readiness, tolerance, strength and capabilities.

How does a nurse assist a AP in moving a pt for the first time after prolong bed rest, extensive surgery, critical illness or spinal cord trauma ?

-has to explain pt mobility restrictions to AP

- advise them to look for change in BP.

-look for sensory alterations ( ex:medicated, confused.)

- explaining what to observe and always report to the nurse. (ex: pt experiencing dizziness and ability/inability to assist.)

- designate specific times AP must reposition pt during shift.

- advise on # of other caregivers needed to help move pt.

What are some unexpected outcomes related to moving/transfering interventions?

- pt unable to comprehend or unwilling to follow directions for transfer.

-pt sustains injury during transfer.

What should you do if patient is unable to comprehend or unwilling to follow directions?

-reassess your instructions

-if pt tired/in pain allow for rest period before transferring.

- consider meds. for pain if indicated

- consider using hydraulic lift

what should you do if pt sustains injury during transfer?

-evaluate incident that led to injury

-complete incident report according to agency policy

What are some dangers of a wheelchair transfer?

-falls

-pressure injuries

-choking from seatbelts

-ejection

-collisions

-entrapped limbs

What are some critical safety components for pt who use wheelchairs?

- wheelchair prescription

-posture

-wheelchair training

-wheelchair maintenance

What types of patients benefit from therapeutic positioning?

- pt w/ impaired nervous/ musculoskeletal system function.

- pt w increased weakness

-pt restricted to bed rest.

What are some unexpected outcomes/interventions of moving/positioning patients in bed?

-joint contractures develop or worsen

- skin shows localized areas of erythema/breakdown.

What do you do if a pt joint contractures develop or worsen from moving and repositioning in bed?

-increase frequency of ROM exercises to affected areas.

- consider physical therapy consultation for diff. positioning

What to do if pt skin shows localized areas of erythema & breakdown from being in bed?

- increase frequency of repositioning.

- use a different FRD

- place turning schedule above pt bed.

What to do if patient avoids moving positions in bed?

-medicate with analgesia as ordered by HC provider. to ensure comfort before moving.

-allow pain meds to take effect before repositioning.

What is the purpose of physical activity while pt in hosp?

-elevates mood, attitude.

-promotes physical fitness

-boosts energy

-helps in stress management.

-promotes better sleep.

-improves self image.

-prevents hosp. acquired deconditioning

What are some regular physical activities pt's can do?

-moderate/ vigorous physical activity

-muscle strengthening activities

What are two types of activity that are beneficial?

-aerobic (endurance)

-muscle strengthening (resistance)

When caring for pt with reduced mobility what are some things to consider?

immobolization leads to:

-emotional, intellectual, sensory and sociocultural alterations.

Bed rest/ limited walking during hospital stay leads to?

Deconditioning

Deconditioning is one of the primary factors for loss of...

walking independence in hospitalized older adults.

People who are obese require adaptations with?

in approaches used to assist with walking, transfer and positioning.

What are some things to connsider for patient centered care when it comes to excercise and mobility?

-respect pt preferences for degree of engagement in care process.

-assess each pt expectations concerning exercise.

-determine his/her expectation of what is normal.

-always assess pt physical/emotional state before implementing activities or exercise therapies.

What is perceived self-efficacy?

Judgement of capability and applies to a persons willigness to engage in activity such as excercise.

What are some more things to consider in pt centered care when it cames to excercise and mobility?

-consider pt readiness to excercise.

- when helping w/ excercise and ambulate keeo in mind these place pt in positions that can be embarrassing.

-provide garment that protects pt privacy

-many cultures emphasize modesty meaning pt cannot participate in such activites.

What are some evidence based practice findings in regards to exercise/mobility in pt's?

-adults should move more and sit less throughout day.

-adult should do 150-300 min of moderate workout a week; or 75-150 of vigorous intense workout a week.

-adults should also do muscle-strengthen exercises that involve major muscle group 2+ days a week, leads to any additional benefits.

What are some SAFETY guidelines when assisting pt with any form of ambulation? (Ambulate: walk/move.)

-involve extra personnel (if necessary.)

-apply safe pt techniques

-use pt handling devices

-use flat/non-skid socks.

-become familiar w/ assistive devices and how to use them so you can educate pt. (ex: cane, walker, crutches, etc.)

-make sure pt is able and ready (ex: stable vitals, rested, and pain under control.)

-address pt fear of falling and how you intend to remove/limit risks of falling.

-consult w physical therapist

-advise pt of home health care plan and how to implement these exercises or assistive devices @ home.

What are some factors to take into consideration in order to promote exercise/activity in pt?

-use pt centered approach and help them set goals for activity that will benefit them most.

-be sure HC provider cleared pt for regular activity.

-teach pt what safe heart rate is which can be used to monitor bodies response to exercise.

What are some abnormal outcomes of exercise interventions in pt's?

-pt has abnl. vitals.

-decrease in o2 sat.

-pt develops chest pain

-discomfort

if these things happen you should...

-end exercise

-notify provider

-continue to monitor vitals until pt stabilizes.

-prepare for possible electrocardiogram

-if in home setting caregiver call 911

What are some risks that can lead to reduction in joint ROM? (range of motion)

-injury to extremity

-neuromuscular disease

-after have been in prolonged bed rest

What are some ROM exercises?

-active

-passive

-active assisted

What is active ROM?

-pt needs no support/help and can move joint alone

What is passive ROM?

-Joint has full ROM but pt does not have enough strength to move it alone.

What are some reasons pt's would have to perform ROM exercises?

-pt w spinal cord injury

-pt w burns

-pt w orthopedic trauma

What is a venous thromboembolism? VTE

-A blood clot in a vein.

What are types of VTE'S?

DVT: deep vein thrombosis

-clot in a deep vein (leg, pelvis, pain.)

Pulmonary embolus:

-vein clot that breaks from vein wall travels to lungs and blocks some/all blood supply.

Define pt safety?

-prevention of errors/adverse effects to pt associated w health care.

What are some things necessary in order to provide good pt safety?

-effective communication

-teamwork

-critical thinking

-timely clinical decisions

What are the QSEN skills for safety?

-staff demonstrates effective use of tech and standard practice

-staff demonstrates effective use of strategies to reduce risk of harm to self/others.

-right strategies to reduce reliance on memory.

-communicates observations related to hazards/errors that can happen to pt, families, and health care team.

-participates in fixing mistakes and finding ways to fix it.

-uses national pt safety resources.

What is the goal of the joint commission's "speak up" campaign?

helping pt and their advocates become active in their care.

True or False:

it is essential for HC providers to

-share info on any pt injury

-learn from errors

-and participate in fixing those errors.

True.

Basically we must hold ourselves accountable to report any error, document or do whatever needs to be done to prevent us or pt's to get hurt.

True or False:

implementing EBP into nursing skills/procedures promotes safer care environment & improves pt outcome.

Basically, there is proof that certain processes work for efficient care so we must implement them in our routine in order for pt and ourselves to remain safe.

True

What is the definition of pt centered care in safety?

recognizing pt as source of control in providing compassionate/coordinated care based on their respect for preference, values, needs.

Basically.... the pt is ultimately the one in charge of what kind of or if he receives care. We are to be unbiased and respect their needs.

True or False:

pt and family should not be trated with respect. Family should not be active in pt care or contribute to their care. And we should not work alongside the family.

FALSE

What are some ways to improve response to pt needs?

-use proactive nursing rounds

T or F:

It is not the nurses responsibility to protect all patients regardless of cultural background.

False,

we must protect everyone. Most errors occur due to failures in communication.

What are some emotional roles a nurse must play for pt?

- support pt emotionally

-empower them to open about their values and preferences

-if restraints are needed advise the family why they are needed.

-work w/ family to accomodate to pt's culture perspectives regarding restraints, etc.

-be familiar w/ facilities policy on restraints.

-inform fam. and pt why they are fall risk.

What are some EBP that we should remember to implement in regards to fall preventions?

-promote pt to begin moving and coordinate w/ physical therapist.

-ensure appropriate training

What is the definition of pt safety?

prevention of errors and adverse effects to pt associated with health care.

What are some things required for effective communication?

communication, teamwork, critical thinking and timely decisions.

What does QSEN stand for?

quality and safety education for nurses.

TRUE OR FALSE:

integration of EBP into nursing skills/procedures promotes a safer care environment and improves pt outcome?

true

What campaign has the goal of helping pt and their advocates becoming active in their care?

The joint commissions speak up campaign.

What should we do to practice patient centered care along with pt family?

partner w pt family/caregivers in order to better

True or False:

Being hospitalized or living in an assisted living facility places pt at risk for injury in an unfamiliar and confusing environment.

true

True or false:

it is not a nurses responsibility to protect all patients regardless of their culture background.

false, it is our job to treat EVERYONE.

What does STEADI stand for ?

stopping elderly accidents death and injuries.

true or false:

accurate pt identification before any procedure is crucial to pt safety.

true

What are 3 ways to verify pt identity?

NAME

DOB

MRN #

How can you implement safety while caring for a pt using communication?

communicate clearly to other health care providers the plan of care, the procedures that need to be done

What does a safe patient room environment look like?

-room well illuminated at all times

-call button within reach

-side rails up for support

-bed alarm

-bedside commode placed alongside bed if needed.

-nonskid footwear available.

What are Intrinsic falls?

Pt related

What are extrinsic falls?

hospital environment and process related.

What is communication?

interaction between 2 or more people.

What is effective communication?

positively influences how nursing care is delivered and how satisfied pt are with that care.

What is something set into place in order to reduce falls?

universal fall precautions

What does AHRQ stand for?

Agency for Healthcare Research and Quality

What are some AHRQ reccomendations?

-fall prevention must be balanced with other priorities for pt.

-fall preventions one of many activities needed to protect pt from harm.

-fall prevention is interdisciplinary

-fall prevention needs to be individualized.

What to do if pt or their family are unable to identify fall risks or fall prevention strategies?

-reinforce risks and review safety measures w pt, family or caregiver.

-consider intsructional options

What do you do if pt is found on the floor after falling?

-call for assistance

-assess pt for injury, stay until help arrives

notify pcp & caregiver

-complete agency and sentinel event report.

-conduct post fall huddle w team after the fall

-involve staff and pt and discuss if appropriate interventions where involved in order to find out why fall happened and how to prevent it.

True or False:

A restraint free environment is the goal of care for all patients.

true

What is a restraint?

chemical or physical restriction of individuals freedom of movement, including physical activity or normal access to his or her body .

Restraints are not used to...

-part of a medical diagnosis or treatment procedure.

-not indicated to treat individuals medical condition.

-does not promote individuals independent functioning.

What are some things the nurse must delegate to the AP in order to create a provide a safe environment when using restraints?

-use specific diversional or activity measures for making the environment safe.

-apply appropriate monitoring or alarms.

-reporting pt behavior/actions to nurse.

What are some unexpected outcomes when using restraints?

-pt displays behaviors that increase risk of injury to self/others.

-pt sustains injury or is agitated and places others at risk.

-pt wanders away from health care agency.

What should you do if the pt displays behavior that increases risk of injury to themself or others?

-review the episode and find some alternatives that would eliminate them acting that way.

-discuss alternatives with providers and family.

What should you do if pt gets injured or agitated and places others at risk for injury?

-notify provider

-complete incident report

-identify some alternatives.

-apply physical restraint only as last source.

What should you do if patient wanders away from health care agency while on restraints?

-follow agency policy

-notify those who need to be notified

-determine who will look for pt

-where they will look for pt

-who will notify authorities

-who will notify family

-who will coordinate search efforts.

What are the form of restraints?

physical, chemical and seclusion.

What are physical restraints used for?

-prevent pt from injuring themself/others

-protect integrity of medical devices

When may restraints be used?

-May be used to ensure immediate physical safety

when should restraints be removed?

-at earliest possible time in order to maintain pt integrity

True or False:

assessing ot behavior, orientation to environment, need for restraints and appropriate use of restraints cannot be delegated to the AP.

true, AP cannot assess only help apply restraints.

How does a nurse instruct AP in applying restraints?

-appropriate restraint to use and correct placement

-when to change patients position, provide ROM exercises

-hydrate, toileting, skin care, and time to socialize

-when to report signs/symptoms of pt not tolerating restraint and what to do.

What are some unexpected outcomes when it comes to applying restraints?

-pt experiences impaired skin integrity

-pt becomes more confused/agitated

-pt has nuerovascular injury