General Survey

Infection Control Practices - General Overview

• Essential to perform infection control measures before and after all client contact.

• Sterile instruments and devices must be used.

• Clean and disinfect environmental surfaces are crucial.

• Hand hygiene is paramount.

Core Components of Nursing Practice

• The core components of nursing involve:

  • Application of ethical principles.

  • Implementation of practices for client safety.

  • Integration of measures to ensure client privacy.

Ethical Principles in Nursing Practice

• Importance of Ethical Principles:

  • Ethical principles guide nurses in making choices regarding client care.

  • Key ethical principles include:

  • Nonmaleficence: "To do no harm"; the foremost principle in health care.

  • Beneficence: Actively promoting the good of the client; aims for a return to health and homeostasis.

  • Autonomy: Recognizing the client’s right to make decisions about their care; clients can refuse treatment when they have the mental capacity to do so.

  • Justice: Treating all clients equally, without regard to their ability to pay, social status, or background.

  • Confidentiality: Protecting client privacy; a legal and ethical obligation reinforced by laws such as HIPAA (Health Insurance Portability and Accountability Act) of 1996.

Safety in Nursing

• Priority of Safety:

  • Ensuring safety for clients, staff, and others during care.

• Infection Control Measures:

  • Use standard precautions with all clients, which include:

  • Hand hygiene:

  • Wash hands for $15-30$ seconds with friction on all surfaces.

  • Do before and after client contact, after invasive procedures, and after glove removal.

  • Alcohol-based rubs recommended when hands are not visibly soiled; rub hands for $20-30$ seconds.

  • Fingernails should be kept short; avoid artificial nails.

  • Personal Protective Equipment (PPE):

  • Includes goggles, masks (surgical and N95), gloves, and gowns.

  • Specific PPE is chosen based on the client's health status and type of care.

  • Gowns protect against transfer of infectious particles, either disposable or reusable.

  • N95 masks are required for airborne precautions.

Client Privacy

• Physical Privacy:

  • Critical for client comfort and security during assessments.

  • Environmental factors include adequate acoustics and privacy measures (e.g., pulling curtains).

  • Practice consciousness of the client's cultural and personal preferences during examinations.

• Personal Privacy:

  • Involves maintaining client confidentiality and proper identification.

  • Identification protocols involve confirming name and date of birth, ensuring respect for gender identity and preferred pronouns.

  • Documentation of names in medical records should reflect the client’s preferences.

Mandated Reporting

• Nurses are required to report suspected abuse cases, including:

  • Physical neglect or abuse.

  • Psychological or emotional abuse.

  • Sexual abuse.

  • Intimate partner and domestic violence, prevalent among various demographics.

  • Challenges in discussing topics like sexual health and abuse require nonjudgmental, open-ended questioning to ensure comfort and gather necessary information.

Communication Skills in Nursing

• Nurses must demonstrate holistic and inclusive communication when engaging with clients and families.

• Expectations for Effective Communication:

  • Maintain professionalism and prioritize the client’s needs.

  • Exhibit self-awareness to avoid biases that may affect interactions.

• Therapeutic Communication:

  • Must be proactive in introducing oneself and maintaining visibility of identification badges.

  • Engage in active listening, restating the client’s views for clarity.

  • Allow respectful space while considering cultural differences in communication like eye contact and personal space.

• Cultural Competence:

  • Understanding diverse cultural backgrounds to foster a therapeutic environment.

  • Adapt communication strategies according to clients' cultural norms.

Assessment Techniques and Tools

• Nursing assessments rely on four primary physical examination techniques and specific clinical tools:

  • Inspection:

  • A detailed visual observation for symmetry, color, size, and overall condition.

  • Requires adequate lighting and sometimes the use of a penlight to inspect the mouth or pupils.

  • Palpation:

  • Using hands to assess texture, temperature, moisture, and tenderness.

  • Fingertips: Used for fine tactile discrimination (e.g., pulses, skin texture).

  • Dorsum (back) of hand: Best for assessing temperature.

  • Palmar surface: Best for assessing vibrations.

  • Light Palpation: Depressing the skin $1-2$ cm to assess surface characteristics.

  • Deep Palpation: Depressing $4-5$ cm to assess deep organs or masses.

  • Percussion:

  • Tapping the skin with short, sharp strokes to vibrate underlying tissues.

  • Direct percussion: Tapping the body directly.

  • Indirect percussion: Using both hands (striking a finger placed on the body).

  • Sounds: Resonance (lungs), Tympany (stomach), Dullness (liver), and Flatness (bone).

  • Auscultation:

  • Listening to sounds produced by the body using a stethoscope.

  • Diaphragm: Used for high-pitched sounds (breath, bowel, and normal heart sounds).

  • Bell: Used for low-pitched sounds (extra heart sounds or murmurs).

  • Additional Clinical Tools:

  • Sphygmomanometer: Used with a stethoscope to measure blood pressure.

  • Pulse Oximeter: Measures oxygen saturation in the blood.

  • Otoscope and Ophthalmoscope: For visualizing the internal ear and eye structures.

  • Reflex Hammer: Used to test deep tendon reflexes.

Documentation Practices

• Documentation is a critical aspect of nursing practice to ensure effective communication and care continuity:

  • Maintain clear, legible, and precise notes following facility protocol.

  • Include relevant vital signs, medications, interventions, and client responses.

  • Adhere to nursing standards, including objective data collection and accuracy in recording subjective statements.

  • Utilize electronic health records, being mindful of confidentiality and security measures.

  • In cases of errors, follow correct protocols for amending records without misuse of correction methods.

Conclusion

• Ethical principles, safety practices, and client privacy are interconnected facets of nursing that ensure high-quality care.

• Nurses must be competent in their technical skills, communication abilities, and ethical considerations to support their clients effectively.