NUR246 TOPIC 2 LECTURE
Topic Two Lecture: Caring for Diverse Patient Groups
The Nursing Process
The Nursing Care Process consists of four steps:
Assessment
Planning
Implementation
Review
Nursing Care Plans must document care from the assessment outcome to the review and must be developed and completed by a Registered Nurse (RN), as outlined in the Nursing and Midwifery Board of Australia's Registered Nurses Standards, specifically Standard 5: Develops a plan for nursing practice.
Care Plans
Various formats for care plans include:
Assessment, Goals, Interventions, Expected outcomes
Assessment, Diagnosis, Planning, Implementation, Evaluation
Narrative
Example of Care Plan: High risk of developing pressure injury due to impaired skin integrity and decreased mobility. Interventions include encouraging regular position changes and monitoring pressure areas, with an expected outcome that the patient will remain free of pressure injuries.
Health Promotion and Behavior Change
Theoretical and Conceptual Frameworks
The Five A’s Model
Assess the client's beliefs, behavior, and knowledge.
Advise about health risks and benefits through specific, relevant information.
Assist the client in identifying personal barriers and employing problem-solving techniques.
Agree on goals based on the client’s interests and their confidence in changing behavior.
Arrange referrals to other services and develop a specific follow-up plan.
Motivational Interviewing (MI)
Motivational interviewing is a strategy to encourage behavior change to improve health status, helping clients engage with recommended treatments and reduce lifestyle risk factors.
Intrinsic Motivation
Extrinsic Motivation
Four Fundamental Processes of MI
Engaging: Establishing a relationship with the client.
Focusing: Developing a directed conversation about behavior change.
Evoking: Identifying the individual's motivation for change.
Planning: Developing a commitment to change and establishing an action plan.
Evidence-Based Practice in Community Care
Current Statistics
Approximately four in ten adult patients receive care that is not based on current evidence or guidelines, including treatments that are ineffective, unnecessary, or potentially harmful.
Despite the availability of evidence-based guidelines, significant gaps remain in implementing evidence into routine clinical practice.
Standards for Best Evidence Care
The National Safety and Quality Health Service Standards outline the standards for providing best evidence care, as supported by research (Grimshaw et al., 2012; Runciman et al., 2012).
Quality Improvement in the Community
Quality improvement initiatives may include:
National digital health strategy – My Health Record
National Disability Insurance Scheme
Health Care Home Services for better outcomes for people with chronic and complex health conditions.
Risk Management in the Community
Risk Management is defined as the systematic application of policies, procedures, and practices aimed at minimizing potential adverse consequences when undertaking tasks.
Key Terms
Risk: The potential for gaining or losing something of value due to actions taken under uncertainty.
Incidents: Events or circumstances that resulted in or could have resulted in unintended harm to individuals, including complaints or damages.
Gayle’s Law
A video linked in class highlighted the tragic case of Gayle Woodford, focusing on the risks involved during community nursing activities and how her family advocates for improved safety for remote area nurses.
Pre-Visit Preparation
Prior to a home visit, nurses should:
Introduce themselves and the health service.
Explain the purpose of the home visit and that certain safety questions must be addressed.
Questions may include risks of violence or aggressive behavior, presence of pets, and substance use.
Ensure all risk assessments are accurately documented, especially concerning potentially dangerous situations.
Example Questions for Risk Assessment
“Have you been angry or annoyed with anyone recently?”
“Are there pets that need to be secured during the visit?”
“Is there anyone present during the visit that might harm the worker?”
Risk Control Strategies
Strategies may include:
Elimination: Can the risk be eliminated entirely?
Substitution: Can a less risky alternative be used?
Isolation: Can the hazards be isolated from the people?
Engineering: Use of mechanical or electrical devices to minimize risk.
Administrative: Procedures to ensure that safety measures are followed.
Personal Protective Equipment (PPE): Gloves or masks when performing certain tasks (e.g., blood draws).
On-the-Day of the Visit
Nurses should:
Check notes and plan the route adequately.
Ensure the vehicle is fueled and check weather conditions.
Park safely and keep equipment out of sight.
Remain alert for anything unusual during arrival.
During the Visit
Key actions include:
Wait to be invited into the home.
Show identification clearly.
Monitor the client’s mood and maintain infection control protocols (hand hygiene and cleaning of surfaces).
Risk Minimization Strategies
Identifying personal threats, handling animal interactions, and reporting incidents swiftly are critical. Strategies should be adapted per potential risk encountered.
At-Risk Clients
Groups at higher risk may include refugees, migrants, indigenous populations, and other minority and gender groups. Considerations include:
Discrimination and stereotyping.
Access to healthcare influenced by location and diversity of health care workers.
Socio-economic disparities that may create unhealthy environments or domestic violence.
Cultural Considerations
Characteristics of Culture
Culture encompasses behaviors, beliefs, values, traditions, and symbols acknowledged by a group, impacting healthcare experiences.
Acculturation
Acculturation is described as a lifelong process of integrating cultural or social elements throughout life.
Importance of Culture in Health Care
Key cultural aspects include:
Stereotyping: Oversimplified ideas about groups.
Ethnocentrism: Viewing one’s own culture as superior.
Transcultural Nursing: A nursing approach acknowledging diverse cultural needs and practices.
Cultural Competence / Cultural Safety
Defined as the ability to appreciate and work effectively with individuals from diverse cultures, aiming to provide safe, cross-cultural care that enhances satisfaction and reduces health inequities.
Cultural Factors Affecting Health and Healthcare
Considerations include:
Complementary/Alternative Healing: Importance of understanding cultural healing practices.
Communication Styles: Effective interactions require cultural sensitivity.
Specific Cultural Factors That Affect Healthcare
Time Orientation: Different cultures prioritise family/social obligations over punctuality.
Languages and Economic Factors: Barriers to accessing healthcare can arise from language differences and financial constraints.
Healthcare System Trust: Cultural distrust can prevent individuals from seeking care.
Strategies to Improve Cultural Competence
Awareness: Recognising personal cultural biases and values.
Knowledge: Learning essential aspects of individual cultures.
Skill Development: Performing thorough cultural assessments and avoiding assumptions based on cultural backgrounds.
Preparation for Tutorial and Lab Activities
Students are encouraged to refresh their knowledge on urinalysis interpretation and to create personal cheat sheets for this evaluation.
Avatar Simulation Preparation
An upcoming lab will involve meeting a patient named Alison Jeffers, requiring a psychosocial assessment that includes the PHQ-9 assessment. Students will work in groups to simulate this interaction and will receive feedback post-assessment.
Conclusion and Acknowledgment
Lecturer: Holly Clegg
Communication: All inquiries should be sent via LMS discussion.
Murdoch University thanks students for their engagement and participation.
References
Refer to the sources referenced in the transcripts for comprehensive details, including works by Brown, Edwards, Buckley, & Aitken (2020) documenting cultural competence in nursing education.